Validation of the Perceived Barriers to Antiretroviral Therapy Adherence (PEDIA) Scale Among Gay, Bisexual, and Other Men Who Have Sex With Men and Transgender and Nonbinary Persons: Cross-Sectional Study

TL;DR

This study validated a 10-item tool to measure barriers to HIV medication adherence among gay, bisexual, and transgender individuals in Brazil.

Contribution

The study developed and validated a shorter version (PEDIAr) of a scale to assess perceived barriers to ART adherence in key populations in Brazil.

Findings

PEDIAr showed good psychometric properties with a 2-factor structure (practical and psychological barriers).

The reduced scale had strong convergent and discriminant validity and adequate internal reliability.

PEDIAr scores correlated negatively with ART adherence measures, supporting its construct validity.

Abstract

Approximately 30% of people living with HIV in Brazil have suboptimal adherence to antiretroviral therapy (ART). Theoretical models of health behaviors and objective evidence support the role of perceived barriers in hindering health behaviors.

We aimed to evaluate the psychometric properties of the perceived barriers to ART adherence (PEDIA) scale among gay, bisexual, and other men who have sex with men (MSM) and transgender and nonbinary (TGNB) persons in Brazil.

Using a cross-sectional study design, we evaluated the factor structure, construct validity, convergent and discriminant factorial validity, and internal reliability of the PEDIA scale using 2 convenience samples of participants aged 18 years or older living in Brazil. Sample 2020 was recruited through an internet-based survey between February and March 2020 and Sample 2021 between May 2021 and January 2022. The study instrument included sociodemographic information, ART use, and the 3 measures of ART adherence. Using Sample 2020, we performed exploratory factor analysis (EFA) with parallel analysis to evaluate PEDIA’s factor structure. Based on the goodness of fit measures and theoretical relevance, we developed a reduced version of PEDIA (PEDIAr). Using Sample 2021, we performed a psychometric evaluation of PEDIAr, which included confirmatory factor analysis (CFA), examination of modification indexes and item-item and item-total correlations, and an assessment of its correlation with different measures of adherence to ART. Goodness of fit was evaluated based on multiple indices.

EFA conducted on Sample 2020 (n=1692) revealed a 2-factor structure with 3 factor loadings <0.4 (excluded). Using Sample 2021 (n=4893), modification indices from the CFA and item-item and item-total correlations along with item relevance analysis suggested the exclusion of 5 additional items. CFA fit indices for PEDIAr were adequate (root mean square error of approximation=0.07, comparative fit index=0.95, Tucker-Lewis Index=0.94, standardized root mean square residual=0.05). Construct validity was supported by factor loadings above 0.6 and negative correlations between PEDIAr scores and 3 measures of adherence to ART. McDonald omega was 0.795 and 0.859 for factors 1 and 2, respectively. The square root of the average variance extracted (AVE) was 0.704 and 0.711 for factors 1 and 2, respectively, and the difference between AVE and the square of the factor correlations with other items was small (0.001 and 0.009, respectively) and not statistically significant for both factors (P=.94 and P=.55, respectively).

PEDIAr, the 10-item reduced version of PEDIA, proved to be valid among gay, bisexual, and other MSM and TGNB persons in Brazil. This shorter instrument was able to capture 2 distinguished dimensions of the perceived barriers to adherence to ART (practical aspects and psychological aspects). By proactively identifying individuals struggling with adherence to ART, PEDIAr can facilitate timely interventions and improve personalized care.

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