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An adjustment to HIV scale
PTiEN 1 EdUCATiON ANd COUME/iN(,
ELSEVIER
Patient
Education
and Counseling
24 (1994) 353-354
Research note
An adjustment to HIV scale Michael W. Ross Center for Health Promotion Research and Development, University of Texas School of Public Health, PO Box 20186. Housron, TX 77225, USA
The response of a person to illness may form an important component of the course of that illness, as has been noted in the case of some cancers and in terms of the impact of mental states on immune function [l-4]. However, the attitudes of people with HIV disease have seldom been measured, although coping strategies in people with AIDS have been described and may be associated with attitudes toward HIV in those infected. There does exist, however, a well-established scale to measure attitudes toward cancer in those with the disease, the 38-item Mental Adjustment to Cancer (MAC) scale [5,6]. We modified the MAC by replacing the word ‘cancer’ with the word ‘HIV/AIDS’ and in the item ‘I really don’t believe I have cancer’ with ‘I really don’t believe my blood test result’, and administered the scale to 107 Australian men with HIV infection, of whom 36 had an AIDS-defining condition, who were patients at an ambulatory care facility and in a research study. The data were factor analysed using a method identical to that used in the development of the MAC scale to determine the latent dimensions of attitudes toward HIV/AIDS in this sample. The full details of the methods and the results of the factor analysis are reported elsewhere [7] along with the scale items. The factor analysis of the original MACS with people with cancer yielded four factors: Help073%3991/94/$07.00 0 1994 Elsevier Science Ireland SSDI 0738-3991(94)00644-2
lessness-Hopelessness, Fighting Spirit, DenialAvoidance, and Fatalism. Analysis of the revised modification into a Mental Adjustment to HIV scale (MAH) revealed live factors: HelplessnessHopelessness, Fighting Spirit, and Denial-Avoidance as in the original MAC scale, plus a Fatalism scale which also measured preoccupation, and a new scale, which measured Belief in Influencing the Course of the Disease. Together, these live factors accounted for almost half (49.7%) of the variance. While these data must be interpreted with the caveats that this is a small and unrepresentative sample, these data suggest that while there are similarities between mental attitude to cancer and mental attitude to HIV in the latent dimensions of the questionnaire items, there are also some differences. Chief among these is the belief in the people with HIV disease in being able to personally influence the course of the illness, and the combination of preoccupation with fatalism. The fact that these five subscales of the MAH scale had Cronbach’s alpha reliabilities between 0.80 and 0.55, and were coherent factors which were readily interpretable, suggests that minor modification of the MAC scale to measure HIV disease is both clinically and psychometrically feasible and may be useful for measurement of attitudes toward HIV disease in those infected. However, further research on its validity is needed.
Ltd. All rights reserved
354
M. W.
Ross /Patient
Educ. Couns. 24 (1994)
References [I]
Greer S, Morris T, Pettingale KW. Psychological responses to breast cancer: effect on outcome. Lancet 1979; ii: 785-787. [2] Moulton JM, Sweet DM, Temoshok L, Mandel JS. Attributions of blame and responsibility in relation to distress and health behaviour change in people with AIDS and AIDS-related complex. J Appl Sot Psycho1 1987; 17: 493-506. [3] Auerbach TE, Oleson TD, Solomon GF. A behavioural medicine intervention as an adjunctive treatment for HIVrelated illness. Psychology and Health 1992; 6: 325-334.
353-354
[4] Remien RH, Rabkin JG, Williams JBW, Katoff L. Coping strategies and health beliefs of AIDS longterm survivors. Psychology and Health 1992; 6: 335-345. [5] Watson M, Greer S, Young J, Inayat Q, Burgess C, Robertson B. Development of a questionnaire measure of adjustment to cancer: the MAC scale. Psych Med 1988; 18: 203-209. [6] Watson M, Greer S, Bliss JM. Mental Adjustment to Cancer (MAC) Scale Users’ Manual. Sutton: Institute of Cancer Research, 1989. [7] Ross MW, Hunter CE, Condon J, Collins P, Begley K. The Mental Adjustment to HIV Scale: measurement and dimensions of response to AIDS/HIV disease. AIDS Care 1994; 6: 407-411.
ELSEVIER
Patient
Education
and Counseling
24 (1994) 353-354
Research note
An adjustment to HIV scale Michael W. Ross Center for Health Promotion Research and Development, University of Texas School of Public Health, PO Box 20186. Housron, TX 77225, USA
The response of a person to illness may form an important component of the course of that illness, as has been noted in the case of some cancers and in terms of the impact of mental states on immune function [l-4]. However, the attitudes of people with HIV disease have seldom been measured, although coping strategies in people with AIDS have been described and may be associated with attitudes toward HIV in those infected. There does exist, however, a well-established scale to measure attitudes toward cancer in those with the disease, the 38-item Mental Adjustment to Cancer (MAC) scale [5,6]. We modified the MAC by replacing the word ‘cancer’ with the word ‘HIV/AIDS’ and in the item ‘I really don’t believe I have cancer’ with ‘I really don’t believe my blood test result’, and administered the scale to 107 Australian men with HIV infection, of whom 36 had an AIDS-defining condition, who were patients at an ambulatory care facility and in a research study. The data were factor analysed using a method identical to that used in the development of the MAC scale to determine the latent dimensions of attitudes toward HIV/AIDS in this sample. The full details of the methods and the results of the factor analysis are reported elsewhere [7] along with the scale items. The factor analysis of the original MACS with people with cancer yielded four factors: Help073%3991/94/$07.00 0 1994 Elsevier Science Ireland SSDI 0738-3991(94)00644-2
lessness-Hopelessness, Fighting Spirit, DenialAvoidance, and Fatalism. Analysis of the revised modification into a Mental Adjustment to HIV scale (MAH) revealed live factors: HelplessnessHopelessness, Fighting Spirit, and Denial-Avoidance as in the original MAC scale, plus a Fatalism scale which also measured preoccupation, and a new scale, which measured Belief in Influencing the Course of the Disease. Together, these live factors accounted for almost half (49.7%) of the variance. While these data must be interpreted with the caveats that this is a small and unrepresentative sample, these data suggest that while there are similarities between mental attitude to cancer and mental attitude to HIV in the latent dimensions of the questionnaire items, there are also some differences. Chief among these is the belief in the people with HIV disease in being able to personally influence the course of the illness, and the combination of preoccupation with fatalism. The fact that these five subscales of the MAH scale had Cronbach’s alpha reliabilities between 0.80 and 0.55, and were coherent factors which were readily interpretable, suggests that minor modification of the MAC scale to measure HIV disease is both clinically and psychometrically feasible and may be useful for measurement of attitudes toward HIV disease in those infected. However, further research on its validity is needed.
Ltd. All rights reserved
354
M. W.
Ross /Patient
Educ. Couns. 24 (1994)
References [I]
Greer S, Morris T, Pettingale KW. Psychological responses to breast cancer: effect on outcome. Lancet 1979; ii: 785-787. [2] Moulton JM, Sweet DM, Temoshok L, Mandel JS. Attributions of blame and responsibility in relation to distress and health behaviour change in people with AIDS and AIDS-related complex. J Appl Sot Psycho1 1987; 17: 493-506. [3] Auerbach TE, Oleson TD, Solomon GF. A behavioural medicine intervention as an adjunctive treatment for HIVrelated illness. Psychology and Health 1992; 6: 325-334.
353-354
[4] Remien RH, Rabkin JG, Williams JBW, Katoff L. Coping strategies and health beliefs of AIDS longterm survivors. Psychology and Health 1992; 6: 335-345. [5] Watson M, Greer S, Young J, Inayat Q, Burgess C, Robertson B. Development of a questionnaire measure of adjustment to cancer: the MAC scale. Psych Med 1988; 18: 203-209. [6] Watson M, Greer S, Bliss JM. Mental Adjustment to Cancer (MAC) Scale Users’ Manual. Sutton: Institute of Cancer Research, 1989. [7] Ross MW, Hunter CE, Condon J, Collins P, Begley K. The Mental Adjustment to HIV Scale: measurement and dimensions of response to AIDS/HIV disease. AIDS Care 1994; 6: 407-411.