Date of Award

Spring 2012

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research

Committee Director

Karten A. Karlowicz

Committee Member

Phyllis D. Morgan

Committee Member

Agatha Parks-Savage

Committee Member

Kimberly Adams Tufts


Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) does not discriminate among different races, ethnicities or genders; however, African Americans carry a larger burden related to the HIV epidemic than others (CDC, 2010c; Cunningham, Sanchez, Heller & Sohler, 2007; Mugavero, et al., 2009). Persons living with HIV/AIDS (PLWHA) who do not adhere to their medical regimen, including failure to maintain contact with their health care provider for health care monitoring, tend to have poorer health outcomes from the disease as compared to HIV/AIDS patients who adhere to their medical regimen (Cunningham et al., 2006; Lima et al., 2009). African Americans represent 14% of the population in the United States, but they account for almost half (44%) of people living with HIV and nearly half (45%) of persons newly infected each year (CDC, 2010d; 2011b).

The purpose of this study was to examine non-adherence to medical follow-up among African American subjects with HIV/AIDS using an adapted version of the Andersen Behavioral Model of Health Services Utilization by Ulett et al. (2009). This study explored perceived barriers to adherence to the medical regimen and appropriate follow-up care and determined the predisposing, enabling, and environmental factors that influenced adherence to outpatient medical follow-up care.

This study used a descriptive correlational research design with a mixed methods approach. A retrospective electronic medical records review was completed in 2010 (N = 125). Subjects (N = 20) who attended a "walk-in" clinic for HIV/AIDS completed a survey and the Engagement with Health Care Provider Tool.

After reviewing the electronic medical record (EMR), the researcher concluded there were statistically significant findings for predisposing factors. Predisposing factors were related to the number of scheduled visits and Highly Active Antiretroviral Therapy (HAART) medications initiated. On the open-ended questionnaire, subjects identified barriers to care/obstacles/difficulties to keeping scheduled appointments. Psychosocial, personal, and scheduling conflicts were identified, along with experienced stigma. The Behavioral Model of Health Services Utilization did explain non-adherence to outpatient medical follow-up for PLWHA.





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