The Influence of Psychological Predictors and Cognitive Behavioral Stress Management Intervention on Antiretroviral Therapy (ART) Adherence Among HIV-Positive Female Haitian Alcohol Users

Purpose: Over half the HIV-infected persons in the Caribbean, the second most HIV-impacted region in the world, live in Haiti. Using secondary data from a parent study, this research assessed the effects of psychological and social factors on antiretroviral therapy (ART) adherence among Haitian, HIV-positive, female alcohol users. Theoretical Foundation and Research Questions: Using the Theory of Planned Behavior/Reasoned Action and the Information, Motivation, Behavior skills model as guiding theoretical frameworks, the study examined the effectiveness of an adapted cognitive behavioral stress management (CBSM-A) intervention in improving ART adherence. The effect of psychological factors (depression, anxiety, beliefs about medicine, and social support), social factors (stigma, relationship status, and educational attainment), and alcohol on adherence to ART was assessed. Methods: The sample consisted of 116 female ART patients who were randomly assigned to the CBSM-A intervention or the wait-list control group. Participants completed intervention sessions as well as pre- and post-test assessments. Analyses of variance, t-tests, and point biserial correlations were used to test hypotheses. Results: Surprisingly, ART adherence rates significantly decreased for both groups combined [F (1, 108) = 8.79, p = .004]; there was no significant difference between the intervention and control groups with regard to the magnitude of change between baseline and post assessment. On average, depression decreased significantly among participants in the CBSM-A group only [(t (62) = 5.54, p < .001)]. For both groups combined, alcohol use significantly decreased between baseline and post-assessment [(F (1, 78) = 34.70, p < .001)]; there was no significant difference between the intervention and control groups with regard to the magnitude of change between baseline and post-assessment. None of the variables were significantly correlated with ART adherence. Discussion: Adherence to ART did not improve in this sample, nor were any of the variables significantly associated with adherence. The findings suggest that additional supportive and psychological services may be needed in order to promote higher adherence to ART among HIV-positive females. More research may be needed on this sample; a focus on mental health issues, partner conflict, family and sexual history may allow for better targeting and more successful interventions.

Acceptable vs. marginal police officers' psychological ratings : a longitudinal comparison of job performance

Archival research was conducted on the inception of preemployment psychological testing, as part of the background screening process, to select police officers for a local police department. Various issues and incidents were analyzed to help explain why this police department progressed from an abbreviated version of a psychological battery, to a much more sophisticated and comprehensive set of instruments. While doubts about psychological exams do exist, research has shown that many are valid and reliable in predicting job performance of police candidates. During a three year period, a police department hired 162 candidates (133 males and 29 females) who received "acceptable" psychological ratings and 71 candidates (58 males and 13 females) who received "marginal" psychological ratings. A document analysis consisted of variables that have been identified as job performance indicators which police psychological testing tries to predict, and "screen in" or "screen out" appropriate applicants. The areas of focus comprised the 6-month police academy, the 4-month Field Training Officer (FTO) Program, the remaining probationary period, and yearly performance up to five years of employment. Specific job performance variables were the final academy grade average, supervisors' evaluation ratings, reprimands, commendations, awards, citizen complaints, time losses, sick time usage, reassignments, promotions, and separations. A causal-comparative research design was used to determine if there were significant statistical differences in these job performance variables between police officers with "acceptable" psychological ratings and police officers with "marginal" psychological ratings. The results of multivariate analyses of variance, t-tests, and chi-square procedures as applicable, showed no significant differences between the two groups on any of the job performance variables.