A comparative analysis of representations for executive function in the context of HIV medication adherence and methamphetamine use
Item
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Title
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A comparative analysis of representations for executive function in the context of HIV medication adherence and methamphetamine use
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Identifier
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d_2009_2013:420a6424eac5:11325
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identifier
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11749
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Creator
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Kowalczyk, William J.,
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Contributor
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Sarit A. Golub
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Date
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2012
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Language
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English
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Publisher
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City University of New York.
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Subject
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Clinical psychology | Neurosciences | Public health | Executive Function | Factor Analysis | HIV | Medication Adherence | Methamphetamine
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Abstract
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The current research seeks to clarify the relationship between executive function and the behaviors of medication adherence and methamphetamine use in HIV+ men who have sex with men. Executive function is impaired by HIV, and those impairments are associated with difficulties in adherence. Difficulties in adherence lead to greater disease burden and more impairment. Methamphetamine contributes to the problem by exacerbating executive function directly, and by impacting executive function indirectly through disease progression related to poorer adherence, less effective treatment, and by directly increasing the replication rate of HIV.;Executive function is the process by which distinct cognitive functions are coordinated in order to direct behavior towards a goal. The construct of executive function and many of the neuropsychological tests used to measure it are multifaceted in nature, making it difficult to delineate specific components of executive function. This inability to accurately differentiate components creates a barrier to targeted intervention development for impacting executive function problems that may lead to nonadherence and methamphetamine use.;The present study operationalized executive function in three ways: a) by using individual neuropsychological test variables; b) by averaging individual variables to create a executive domain NPZ score, the standard for the current literature; and c) by using factor scores created through exploratory factor analysis of the individual neuropsychological test variables. These three methods were compared in their association with demographic variables, methamphetamine-use characteristics, disease progression, and adherence variables.;The factor analysis yielded a six-factor solution: Executive Inhibition, Decision Making/Reinforcement Processing, Wisconsin Card Sorting Test Performance, Motor Impulsivity, Slowness of Processing, and Sustained Attention.;All three methods for operationalizing executive function predicted adherence behavior while controlling for methamphetamine dependence severity. However, the comparison of the three representations of executive function demonstrated the strengths and weaknesses of each approach. Analyzing the relationship between executive function and HIV-related health behaviors using neuropsychological test variables individually retained specificity, but lacked statistical predictive power. The executive domain NPZ score was a powerful predictor, demonstrating a relationship between executive function and adherence even when controlling for demographic factors. However, this method lacked specificity and was sensitive to misinterpretation. The factor scores were not as powerful, but greatly added to the interpretability of function associated with HIV-related health behavior.;These three methods for operationalizing executive function all retain some value for predicting HIV-related health behaviors. The factor scores provide an intermediate level of power between individual scores and an executive domain NPZ score. Most importantly, the convergent and divergent evidence provided by the factor loadings increases the confidence that the factor scores are measuring specific delineated functions than. Clarifying the relationship between specific functions and health behavior is the first step in paving the way to targeting executive function difficulties for intervention development in HIV+ persons.
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Type
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dissertation
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Source
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2009_2013.csv
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degree
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Ph.D.
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Program
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Psychology
