This application presents plans for a qualitative and quantitative study of health care of related trust and its impact on health-seeking behaviors and medical adherence among prisoners in Connecticut.
The Specific Aims are: 1) to use existing psychometric scales and qualitative methodologies in order to arrive at a better conceptual and operational delineation of health care-related trust; 2) to describe the factors that potentiate or mitigate trust among HIV positive and HIV negative inmates; and 3) to determine the effect of trust on health-seeking behavior and adherence to medical therapy among HIV positive inmates. In-depth interviews and focus group discussions will elicit the issues most relevant to trust in this population. A scale to measure health-related trust (including trust in the medical establishment and trust in health care provider) will be developed. Using existing psychometric scales, a strict operational definition of trust will be derived from findings of the qualitative study. Standardized surveys including psychometric scales for trust and related constructs will be administered to approximately 80 HIV positive inmates in treatment, 40 HIV positive inmates not in treatment, and 40 HIV negative inmates. This descriptive study will attempt to verify the significance of factors identified in the qualitative research as being influential in health care-related trust among prisoners. The level of trust will also be compared among the three cohorts. A review of computerized pharmacy records and medical charts will corroborate self- reported information on health-seeking behavior, and acceptance/adherence towards therapy for HIV positive inmates. A case- control analysis will examine the relationship between trust and health- seeking behavior, adherence to medical therapy, and willingness to participate in clinical trials. The correctional system offers not only access to a disenfranchised, often mistrustful population that has been consistently under- represented in clinical and behavioral studies, but also a unique setting where the decision to seek health care is considerably simplified due to factors including: 1) uniform access to health care; 2) absence of common barriers such as lack of transportation; and 3) an environment free of drug dependence. These features of the correctional system are expected to significantly facilitate the conduct of this study. These studies will be conducted within an established clinical service at the correctional facilities, in close collaboration with the Connecticut Department of Corrections, with support from a multidisciplinary group of collaborators with substantial experience in conducting ethnographic, psychometric, and epidemiological studies.
