Integrating the Health Belief Model into HIV Care: A Case Study of ART Adherence in Wassa Amenfi West

Abstract

Background: Antiretroviral therapy (ART) adherence is critical for viral suppression, reduced HIV transmission, and improved quality of life. In rural Ghana, socio-economic challenges and behavioural factors threaten optimal adherence. The Health Belief Model (HBM) provides a framework to understand and address these behavioural determinants.

Objective: To examine the association between HBM constructs—perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy—and ART adherence among people living with HIV (PLHIV) in Wassa Amenfi West Municipality, Ghana.

Methods: A cross-sectional study was conducted among 602 PLHIV aged ≥18 years who had been on ART for at least six months. Participants were selected through systematic random sampling from ART clinic registers. Data were collected using a structured questionnaire guided by HBM constructs, with adherence assessed via self-report and pharmacy refill verification. Chi-square tests and logistic regression were used to examine associations between HBM constructs and adherence, with significance set at p < 0.05.

Results: Optimal adherence was significantly associated with high perceived susceptibility (χ² = 16.82, p < 0.001), high perceived severity (χ² = 10.95, p = 0.001), high perceived benefits (χ² = 22.14, p < 0.001), low perceived barriers (χ² = 18.47, p < 0.001), presence of cues to action (χ² = 15.68, p < 0.001), and high self-efficacy (χ² = 17.92, p < 0.001). Participants with high benefit perception and strong self-efficacy had the highest adherence rates.

Conclusion: The findings highlight the utility of the HBM in predicting ART adherence and designing theory-driven interventions in rural Ghana. Addressing barriers, reinforcing benefits, enhancing self-efficacy, and providing consistent cues to action should be prioritised in adherence programs. Integrating HBM-informed strategies into both clinic-based counselling and community outreach can strengthen ART outcomes in resource-limited settings.

Keywords: Health Belief Model, ART adherence, HIV, behavioural theory, rural Ghana, self-efficacy, cues to action.