Papers by heidemarie kremer
Aids Patient Care and Stds, May 1, 2006
Knowledge is limited regarding decision-making about antiretroviral treatment (ART) from the pati... more Knowledge is limited regarding decision-making about antiretroviral treatment (ART) from the patient's perspective. This substudy of a longitudinal study of psychobiologic aspects of long-term survival, conducted in 2003, compares the rationales of HIV-positive individuals (n = 79) deciding to take or not to take ART. Inclusion criteria were HIV/AIDS symptoms, or CD4 nadir less than 350, or viral load greater than 55,000. Those not meeting any criteria for receiving ART (2/2003 U.S. DHHS treatment guidelines) were excluded. Diagnosis was on average 11 years ago; 36% were female, 42% African American, 28% Latino, 24% white, and 6% other. Qualitative content analysis of semistructured interviews identified 10 criteria for the decision to take or not to take ART: CD4/ viral load counts (87%), quality of life (85%), knowledge/beliefs about resistance (66%), mind-body beliefs (65%), adverse effects of ART (59%), easy-to-take regimen (58%), spirituality/worldview (58%), drug resistance (41%), experience of HIV/AIDS symptoms (39%), and preference for complementary/alternative medicine (17%). Participants choosing not to take ART (27%) preferred complementary/alternative medicine (r = 0.43, p < 0.001)1, perceived a better quality of life without ART (r = 0.32, p < 0.004), and weighted avoidance of adverse effects of ART more heavily (r = 0.24, p < 0.030) than participants taking ART (73%). Demographic characteristics related to taking ART were having a partner (r = 0.31, p < 0.008) and having health insurance (r = 0.26, p < 0.040). Decisions to take or not to take ART depend not only on patient medical characteristics, but also on individual beliefs about ART, complementary/alternative medicine, spirituality, and mind-body connection. HIV-positive individuals declining treatment place more weight on alternative medicine, avoiding adverse effects and perceiving a better quality of life through not taking ART.
Aids Patient Care and Stds, Feb 1, 2009
We examined spiritual=mind-body beliefs related to treatment decision-making and adherence in 79 ... more We examined spiritual=mind-body beliefs related to treatment decision-making and adherence in 79 HIVpositive people (35% female, 41% African American, 22% Latino, 24% White) who had been offered antiretroviral treatment by their physicians. Interviews (performed in 2003) identified spiritual=mind-body beliefs; the Adult AIDS Clinical Trials Group (ACTG) questionnaire assessed adherence and symptoms=side effects. Decision-making was influenced by health-related spiritual beliefs (e.g., calling on God=Higher Power for help=protection, God=Higher Power controls health) and mind-body beliefs (e.g., mind controls body, body tells when medication is needed). Participants believing God=Higher Power controls health were 4.75 times more likely to refuse, and participants with mind-body beliefs related to decision-making were 5.31 times more likely to defer antiretrovirals than those without those beliefs. Participants believing spirituality helps coping with side effects reported significantly better adherence and fewer symptoms=side effects. Fewer symptoms=side effects were significantly associated with the beliefs mind controls body, calling on God=Higher Power for help= protection, and spirituality helps adherence. Spiritual=mind-body beliefs as barriers or motivators to taking or adhering to treatment are important, since they may affect survival and quality of life of HIV-positive people.
Religions, Aug 25, 2011
How can the diagnosis of HIV/AIDS result in a positive spiritual transformation (ST)? The purpose... more How can the diagnosis of HIV/AIDS result in a positive spiritual transformation (ST)? The purpose of this sub-study is to identify special features of the experiences of individuals in whom HIV/AIDS diagnosis triggered a positive ST. We found ST triggered by HIV/AIDS to develop gradually, with a key adaptation phase after diagnosis in which the patient develops an individualized spirituality. Most participants (92%) expressed having an individual connection to a higher presence/entity. Most (92%) also described themselves as feeling more spiritual than religious (p < 0.001). Religious professionals did not play a key role in fostering ST. Despite experiencing stigma by virtue of certain religious views, participants accepted themselves, which supported the process that we called -the triad of care taking‖. This triad started with self-destructive behavior (92%), such as substance use and risky sex, then transformed to developing self-care after diagnosis (adaptation) and gradually expanded in some (62%) to compassionate care for others during ST. Spirituality did not trigger the adaption phase immediately after diagnosis, but contributed to long-lasting lifestyle changes. Overcoming self-reported depression, (92% before diagnosis and in 8% after ST) was a common feature. After the adaption phase, none of the participants blamed themselves, others or God for their HIV+ status. The prevailing view, rather, was that -God made them aware‖. Our results suggest that it may be important to find ways to support people with HIV in feeling connected to a higher presence/entity, since this leads not only to a deeper connection with a higher presence/entity, but also to a deeper connection with oneself and to more responsible and caring behavior.
Aids Care-psychological and Socio-medical Aspects of Aids/hiv, Jul 1, 2006
This qualitative study examines whether HIV-positive people (N = 79) tell their physicians whethe... more This qualitative study examines whether HIV-positive people (N = 79) tell their physicians whether they take antiretroviral treatment (ART) as prescribed and why. Interviews, analyzed with qualitative content-analysis, asked about taking/not taking ART and, if taking, whether they shared their reasons for non-adherence with their physician. Patients are more likely to inform physicians why they take than why they do not take ART (p < 0.01). Only half of those not taking ART shared the reasons for their decision with their physician. The six motives were: anticipation that physicians will not support the decision, cannot discuss feelings, lack of trust in physician's opinion, unable to discuss spiritual/ moral issues, no need for physician to know, and not seen physician yet. Of those taking ART, 21% did not tell their physician why they missed doses. The five motives were: not viewed as important, physician not asking, not seen physician yet, rarely non-adherent, no indications in surrogate markers. A significant proportion of patients are not taking their medications as prescribed and are not telling their physicians. To facilitate the chance that patients communicate with their physicians, physicians need to ask and, while giving the patients medical information, create a non-judgmental, respectful atmosphere where patients feel comfortable sharing their personal view.
Religions, Oct 21, 2014
Our ten-year study examined the association between compassionate love (CL)-other-centered love, ... more Our ten-year study examined the association between compassionate love (CL)-other-centered love, as well as compassionate self-love, and spiritual coping (SC)the use of spirituality (connection to a Higher Presence or God) as a means to cope with trauma, and gender differences in 177 people living with HIV (PLWH). In a secondary data analysis of six-monthly interviews/essays, we coded five criteria of CL and rated the benefit of CL giving, receiving and self for the recipient. Synergistically, we rated longitudinal SC based on coding of 18 coping strategies. Overall, mean CL towards self was very high, followed by CL receiving and giving, while mean SC was moderately high. Women, in comparison to men, perceived higher benefit from SC and giving CL to others. Overall, CL towards self had the strongest association with SC, more pronounced in women than in men. Beyond gender, only CL for the self was a significant predictor of SC. Although there was a moderate association between SC and the perceived benefit from giving CL, after controlling for gender, this association was present in men only. Conversely, receiving CL from others yields a stronger association with SC in women than in men. Women perceived to benefit significantly more from SC and giving CL to others compared to men, whereas no gender differences were found on perceiving benefit from receiving CL from others or oneself. In conclusion, although women perceive more benefit from giving CL to others than men, this does not explain the higher benefit from SC among women. Ultimately, both men and women perceive to benefit more from SC the more they OPEN ACCESS Religions 2014, 5 1051 exhibit CL towards self and thus spiritual counseling should keep the importance of the balance between CL towards self and others in mind.
The Journal of Positive Psychology, Jul 30, 2017
Abstract A budding literature has shown the benefits of compassionate love on psychological well-... more Abstract A budding literature has shown the benefits of compassionate love on psychological well-being. Yet, much less is known on its relevance for health outcomes. The purpose of the present study is to examine the effects of compassionate love on survival among people living with HIV (PLWH). 177 PLWH at the mid-stage of illness participated in a longitudinal study of stress and coping. They completed questionnaires, interviews, and essays every 6 months. Three components (giving and receiving compassionate love, and compassionate love toward self) were rated using interview and essay transcripts. Giving compassionate love and compassionate love toward self predicted longer survival, even when controlling for substance use and social support. Only giving compassionate love remained a significant predictor when controlling for adherence. Being compassionate toward others as well as oneself may have survival benefits. Giving compassionate love appears to be more important than receiving.
Journal of General Internal Medicine, May 5, 2016
BACKGROUND: Studies of spirituality in initially healthy people have shown a survival advantage, ... more BACKGROUND: Studies of spirituality in initially healthy people have shown a survival advantage, yet there are fewer research studies in the medically ill, despite the widespread use of spirituality/religiousness to cope with serious physical illness. In addition, many studies have used limited measures such as religious service attendance. OBJECTIVE: We aimed to examine if, independent of medication adherence, the use of spirituality/religiousness to cope with HIV predicts survival over 17 years. DESIGN: This was a longitudinal study, started in 1997. Study materials were administered semi annually. PARTICIPANTS: A diverse sample of 177 HIV patients initially in the mid-stage of disease (150-500 CD4-cells/ mm 3 ; no prior AIDS-defining symptoms) participated in the study. MAIN MEASURES: Participants were administered a battery of psychosocial questionnaires and a blood draw. They completed interviews and essays to assess current stressors. Spiritual coping (overall/strategies) was rated by qualitative content analysis of interviews regarding stress and coping with HIV, and essays. KEY RESULTS: Controlling for medical variables (baseline CD4/viral load) and demographics, Cox regression analyses showed that overall positive spiritual coping significantly predicted greater survival over 17 years (mortality HR = 0.56, p = 0.039). Findings held even after controlling for health behaviors (medication adherence, substance use) and social support. Particular spiritual coping strategies that predicted longer survival included spiritual practices (HR = 0.26, p < 0.001), spiritual reframing (HR = 0.27, p = 0.006), overcoming spiritual guilt (HR = 0.24, p < 0.001), spiritual gratitude (HR = 0.40, p = 0.002), and spiritual empowerment (HR = 0.52, p = 0.024), indicating that people using these strategies were 2-4 times more likely to survive. CONCLUSIONS: To our knowledge this is the first study showing a prospective relationship of spiritual coping in people who are medically ill with survival over such a long period of time, and also specifically identifies several strategies of spirituality that may be beneficial.
Our ten-year study examined the association between compassionate love (CL)-other-centered love, ... more Our ten-year study examined the association between compassionate love (CL)-other-centered love, as well as compassionate self-love, and spiritual coping (SC)the use of spirituality (connection to a Higher Presence or God) as a means to cope with trauma, and gender differences in 177 people living with HIV (PLWH). In a secondary data analysis of six-monthly interviews/essays, we coded five criteria of CL and rated the benefit of CL giving, receiving and self for the recipient. Synergistically, we rated longitudinal SC based on coding of 18 coping strategies. Overall, mean CL towards self was very high, followed by CL receiving and giving, while mean SC was moderately high. Women, in comparison to men, perceived higher benefit from SC and giving CL to others. Overall, CL towards self had the strongest association with SC, more pronounced in women than in men. Beyond gender, only CL for the self was a significant predictor of SC. Although there was a moderate association between SC and the perceived benefit from giving CL, after controlling for gender, this association was present in men only. Conversely, receiving CL from others yields a stronger association with SC in women than in men. Women perceived to benefit significantly more from SC and giving CL to others compared to men, whereas no gender differences were found on perceiving benefit from receiving CL from others or oneself. In conclusion, although women perceive more benefit from giving CL to others than men, this does not explain the higher benefit from SC among women. Ultimately, both men and women perceive to benefit more from SC the more they
Introduction: The purpose of this study is to describe the decision about antiretroviral therapy ... more Introduction: The purpose of this study is to describe the decision about antiretroviral therapy (ART) from the perspective of people living with HIV/AIDS (PWHA) and to develop models to reduce decisional conflict and to optimize the quality of life in PWHA. Methods: 79 HIV+ people who had been offered ART by their physicians participated. In the qualitative part of this study, interviews on reasons and sources of information for decision-making and patient-physician relationship were evaluated with qualitative content analysis. In the quantitative part of this study, questionnaires examined preferred and perceived role in decision-making (Control Preferences Scale), decisional conflict (Decisional Conflict Scale), adherence and symptoms of HIV/ART (ACTG Adherence Questionnaire), quality of life (HIV/AIDS Targeted Quality of Life), depression (Beck Depression Inventory), perceived stress (Perceived Stress Scale), patient-physician relationship (Doctor-Patient Relationship) and belie...
Ironson, G., Kremer, H., & Ironson, D. (2006). Spirituality, spiritual experiences, and spiritual transformations in the face of HIV. In J. Koss-Chiono & P. Hefner (eds.), Spiritual transformation and healing: Anthropological, religious, neuroscientific and clinical perspectives. Walnut Creek, CA...
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Papers by heidemarie kremer