Effect of Extrinsic Motivation on Adversity Quotient in Patients With

HIV & AIDS

Yulia Dewi Puspitawati¹, Misutarno², Nursalam³

¹Post Graduate Program, Universitas Airlangga, Airlangga 4-6 Street, Surabaya, Indonesia

²Department Infection Disease Intermediary Treatment Unit, Dr. Soetomo Hospital, Surabaya

³Faculty of Nursing, Universitas Airlangga, Mulyorejo Surabaya,Indonesia

Keywords: Extrinsic motivation, Adversity Quotient, HIV & AIDS patients.

Abstract: Patients with HIV & AIDS may have various types of psychological response, so it is a very difficult

situation for them. Difficulty can be measured with Adversity Quotient. So nurses are expected to give

extrinsic motivation to bring back the quality of life for patients with HIV & AIDS. The objective of this

study was to identify the presence of the effect of extrinsic motivation on Adversity Quotient in patients

with HIV & AIDS in the Infectious Disease Intermediary Treatment Unit, Dr Soetomo Hospital, Surabaya.

This study used a quasi-experimental design. The population was taken from ambulatory patients. Samples

were taken using purposive sampling, in which the patients involved were those who only met the inclusion

criteria, with the total sample of 16 individuals. The independent variable in this study was extrinsic

motivation, which was presenting as social support, and the dependent variable was Adversity Quotient.

Data were collected using questionnaires and interviews, and were subsequently analyzed using the

Wilcoxon Signed Rank Test and Mann-Whitney Test with a significance value of 0.05. Results revealed that

the Adversity Quotient of the patient indicated the effect of extrinsic motivation on Adversity Quotient of

patients with HIV & AIDS (p = 0.017). The extrinsic motivation was found to have an effect on control

response (p = 0.027) and origin response (p = 0.028), while there was no influence on ownership response

(p = 0.334), reach (p = 0.129), and endurance (p = 0.161). The extrinsic motivation with intervention of

social support has a positive effect on the improvement of Adversity Quotient in patients with HIV & AIDS.

The level of Adversity Quotient in these patients may have an effect on the attitude in dealing with the

recovery of their disease. Further study should measure the effectiveness of Adversity Quotient training on

acceptance response in patients with HIV & AIDS.

1 INTRODUCTION

Generally, AIDS patients are in a situation that

makes them feel that death is coming in the near

future and this situation they anticipate specifically.

When an individual is declared as HIV-infected,

they will show changes in psychosocial character

(living in stress, depression, lack of social support

and behavioural changes) (Nasronudin, 2005).

Psychological responses to psychological

adaptations depend on three important factors,

including biological factors (symptoms of the course

of the disease), psychological factors (personality

and problem-solving skills and interpersonal

support) and sociocultural factors (social stigma

attached to HIV infection) (Muma, 1997).

Psychological systems emphasize the effects of

psychodynamic factors, motivation and personality

on the experience of illness and reactions to illness

(Tandiono, 2007). Transpersonal psychotherapy

(including motivation) is an option for those who

feel near-death, isolation, or other psychological

problems so that they will experience harmony

internally and externally (Maramis, 2005). High

motivation can influence behavior through increased

knowledge and skills (Colquite, 2000 in Niniek,

2004). Individuals who have Adversity Quotient

(AQ) are highly emotionally and physically flexible

enough to face adversity (Stoltz, 1997). Adversity

Quotient (AQ) has three forms of definition. First,

AQ is a new conceptual framework for

understanding and improving all facets of success.

Second, AQ is a measure of knowing one's response

Dewi Puspitawati, Y., Misutarno, . and Nursalam, .

Effect of Extrinsic Motivation on Adversity Quotient in Patients With HIV AIDS.

DOI: 10.5220/0007541502850291

In Proceedings of the 2nd International Conference Postgraduate School (ICPS 2018), pages 285-291

ISBN: 978-989-758-348-3

285

to adversity. During this time, these unconscious

patterns are actually already owned by each

individual. Finally, AQ is a set of tools that have a

scientific basis for improving individual responses to

deal with adversity (Stoltz, 1997). According to

Stoltz (1997), AQ consists of five dimensions:

COORE which includes control, origin, ownership,

reach and endurance. However, the effect of

extrinsic motivation on Adversity Quotient on HIV

and AIDS patients is unclear.

The prevalence of depression in patients with

HIV & AIDS has doubled compared with the normal

population. In treated patients, this figure is higher

(about 40%). A longitudinal study found that CD4 +

lymphocyte count decreased 38% more in HIV

patients with depression than in the group of HIV

patients without depression. The prevalence of

depression increased from 15-27% in 36 months

before the diagnosis of AIDS to 34% at 6 months

before the diagnosis of AIDS and 43% at 6 months

after the diagnosis (Tandiono, 2007).

Motivation has a major influence in the life of a

person, whether extrinsic motivation, for example,

parents, friends support etc, as well as intrinsic

motivation, i.e. motivation that comes from within

the individual themself. In a state of deterioration

only self-motivation in themselves can help to

recover because humans have control over their

health and well-being. The role of supporters and

those around is merely a guide that helps restore

natural and emotional balance (Santrock, 2002).

Social support affects health and protects a person

against the negative effects of severe stress

(Nursalam, 2007). HIV & AIDS patients are directed

to develop themselves with the transformation of

awareness in order to manage their emotions

independently so they can perform activities like

healthy people to improve their quality of life. Based

on the phenomenon that psychological and

motivational conditions in people with HIV & AIDS

cause different psychological responses, and also

because the effect of extrinsic motivation on

Adversity Quotient on HIV & AIDS patients has not

yet been studied, this study was conducted to

identify the effect of extrinsic motivation on

Adversity Quotient in people with HIV & AIDS.

Extrinsic motivation in the form of social support is

needed by HIV & AIDS patients to accelerate the

acceptance of the disease.

2 MATERIALS AND METHODS

This study used a quasi-experimental design by

involving a control group in addition to the

experimental group, which was carried out in the

Infectious Disease Intermediate Treatment Unit, Dr.

Soetomo Hospital, Surabaya, from June to July

2008. Samples were HIV/AIDS-infected patients

treated in the Unit. The samples were chosen by

purposive sampling method with inclusion criteria

including HIV & AIDS patients receiving ARV

treatment, confirmed as positively infected for 1-2

years, more than 20 years old, willing to participate

in research and able to communicate and able to read

and write.

Data collection in this study used questionnaires

and interviews for primary data, while for secondary

data collection was done by using the patients'

medical records. Data obtained were processed and

analyzed using Wilcoxon Signed Rank-Test test to

determine the difference of pre-test and post-test on

the dependent variable of Adversity Quotient of HIV

& AIDS patients before and after intervention. The

use of the MannWhitney statistical test analyzed the

difference between Adversity Quotient between

groups with extrinsic motivation (social support) and

no extrinsic motivation. Statistical tests were

performed using the SPSS program.

3 RESULTS AND DISCUSSION

3.1 Level of Adversity Quotient of HIV &

AIDS Patients

The variables measured in this study were Adversity

Quotient of patients according to Stoltz. Results

questionnaires are presented in the table as follows:

ICPS 2018 - 2nd International Conference Postgraduate School

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Table 1 : Level of Adversity Quotient of HIV & AIDS

patients in IDITU Clinic, Dr. Soetomo Hospital.

Adversity

Quotient

Intervention

Adversity

Quotient

Control

Adversity

Quotient

Intervention Control

Pre Post Pre Post Post Post

1 71 74 70 72 74 72

2 67 78 67 66 78 66

3 72 75 64 70 75 70

4 70 80 71 70 80 70

5 83 82 68 69 82 69

6 66 77 80 78 77 78

7 68 75 74 70 75 70

8 71 74 71 72 74 72

Mea

70,75

5.338

2.828

70,625

4.83846

70,87

3.440

2.82843

70,87

3.440

Uji Wilcoxon

p = 0,017

Uji Wilcoxon

p = 0,943

Uji MannWhitney

p = 0,003

The test results show the value (p) = 0.017. This

significance value is less than 0.05, indicating the

effect of extrinsic motivation on Adversity Quotient

in HIV & AIDS patients.

3.2 Response of Control Dimension

The first dimension of Adversity Quotient is control,

response of control dimension as table below.

Table 2 : Response of control dimension.

(Control)

Intervention

(Control)

Control

(Control)

Intervention Control

Pre Post Pre Post Post Post

1 14 14 14 14 14 14

2 15 17 16 15 17 15

3 16 17 12 14 17 14

4 13 15 15 16 15 16

5 18 18 13 13 18 13

6 13 16 17 16 16 16

7 12 18 12 15 18 15

8 15 16 16 17 16 17

Mea

14,5

1.927

16,3

1.40

789

14,3

1.92

261

15,0

1.30

931

16,375

1.4078

15,0

1.30

931

Uji Wilcoxon

p = 0,027

Uji Wilcoxon

p = 0,236

Uji

MannWhitney

p = 0,008

Test results show the value (p) = 0.027. This

significance value is less than 0.05, indicating the

presence of the effect of extrinsic motivation on

control responses in HIV & AIDS patients.

3.3 Response of Cause/ Origin

Dimension

The second dimension of Adversity Quotient is

cause dimention, response of cause/origin dimension

as table below.

Table 3 : Response of cause/origin dimension

(Origin)

Interventio

(Origin)

Control

(Origin)

Intervention Control

Pre Pos

ePos

Pos

1 16 17 16 15 17 15

2 14 18 15 16 18 16

3 18 20 19 15 20 15

4 16 21 16 17 21 17

5 21 20 14 15 20 15

6 12 15 20 19 15 19

7 17 18 19 18 18 18

8 18 19 12 11 19 11

Mean

16,

2.7

18,5

1.92

725

16,3

2.77

424

15,7

2.43

487

18,5

1.9272

15,7

2.43

487

Uji

Wilcoxon

p = 0,028

Uji Wilcoxon

p = 0,366

Uji

MannWhitney

p = 0,028

The test results show the value (p) = 0.028. This

significance value is less than 0.05, indicating the

persence of the effect of extrinsic motivation on the

origin response in HIV & AIDS patients.

3.4 Response of Ownership Dimension

The third dimension of Adversity Quotient is

ownership dimention, response of ownership

dimension as table below.

Table 4 : Response of ownership dimension

(Ownership)

Intervention

(Ownership)

Control

(

Ownershi

Interven

tion

Control

Pre Post Pre Post Post Post

1 17 19 18 19 19 19

2 18 18 17 17 18 17

3 19 18 15 15 18 15

4 17 19 16 15 19 15

5 15 15 18 17 15 17

6 16 17 19 18 17 18

7 17 16 16 14 16 14

8 16 16 18 20 16 20

Mean

16,87

1.246

17,25

1.488

17,12

1.356

16,87

2.100

17,25

1.488

16,875

2.10017

i Wilcoxon U

i MannWhitne

Effect of Extrinsic Motivation on Adversity Quotient in Patients With HIV AIDS

287

= 0,334

= 0,589

= 0,721

Test results show the value (p) = 0.334. This

significance value is greater than 0.05, indicating no

effect of extrinsic motivation on ownership

responses in HIV & AIDS patients.

3.5 Response of Reach Dimension

The fourth dimension of Adversity Quotient is reach

dimention, response of reach dimension as table

below.

Table 5 : Response of reach dimension

(Reach)

Interventio

(Reach)

Control

(Reach)

Interve

ntion

ntr

Post Pre Post Post Po

1 9 9 6 7 9 7

2 11 12 5 5 12 5

3 7 9 6 6 9 6

4 8 10 9 8 10 8

5 11 10 7 8 10 8

6 10 11 7 7 11 7

7 7 7 6 4 7 4

8 9 9 9 9 9 9

9,0

1.6

9,62

1.50

594

6.8

1.4

577

6,75

1.66

905

9,625

1.5059

6,7

1.6

Uji

Wilcoxon

p = 0,129

Uji

Wilcoxon

p = 0,705

Uji

MannWhitne

p = 0,003

The test results show the value (p) = 0.129. This

significance value is greater than 0.05, meaning

there is no effect of extrinsic motivation on reach

response in HIV & AIDS patients.

Table 1 shows the effect of extrinsic motivation

on Adversity Quotient response in HIV & AIDS

patients with significance (p) = 0.017. Quantitative

results have been significant, but there were still

respondents who have not made maximum efforts in

overcoming difficult times since the diagnosis of

HIV. This was indicated by patients who did not

increase the value of Adversity Quotient. Stoltz

(2004) suggests that Adversity Quotient is a

snapshot of one's response habits to adversity, a

consistent measure of the subconscious pattern that

has been developed by individuals for many years.

Adversity Quotient is a conceptual framework

capable of predicting an individual's ability to

overcome life's difficulties. The struggle to reach the

goal and struggle to face the existing obstacles is

analogous to the journey up the mountain. Adversity

Quotient is a conceptual framework that can predict

which individuals are capable and unable of coping

with life's difficulties.

Adversity Quotient is used to help individuals

who have to bounce back from each setback and

strengthen resistance to their illness. The existence

of motivation, social support, and the opportunity to

express feelings are able to push the patient toward a

good level of health and provide much information

related to their illness. This is especially desirable,

especially for new patients, as reflected in the

enthusiasm of new patients on given activities as

well as demonstrated by a substantial increase in AQ

in patients who have just been diagnosed.

Nasronudin (2005) states that people with HIV &

AIDS have severe psychological adaptations due to

positive results on blood samples. This greatly

affects the patient's psychological psyche and affects

the patient's immunity level. According to the theory

of psychoneuroimmunology, as the foundation for

the formation of Adversity Quotient, there is a

significant effect of the patients' resistance on the

course of the disease (increasing HIV virus results in

CD4 decline).

Factors that are quite influential on the course

of the disease in boosting immunity depends on the

individual themself. The attitude of HIV & AIDS

sufferers in facing the health condition in the future

certainly will not be much different with the

assessment of his fighting power. As an assessment

of the ability or resilience in facing difficulties in the

face of illness, Adversity Quotient includes an

assessment of whether a person feels a useful

person, has many abilities and beliefs to live a

normal life even though they are infected with HIV,

has resilience in the face of problems, and has

control over an event that creates difficulties. This

will have a great influence on the patient's immunity

and immunity.

A person with a high level of Adversity Quotient

will tend to have a positive attitude towards

everything. In people with HIV & AIDS, this level

of Adversity Quotient will have an effect on their

attitude in dealing with the cure of their illness. A

positive attitude towards the cure of their illness

helps the patient to a more constructive coping and

increasing expectations, with extrinsic motivation in

the form of social support, assisting the patient in

expressing feelings when first diagnosed, helping the

patient to respect themself and accept the condition

sincerely, the importance of the patient to others and

direct the patient to remain active in following

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beneficial activities, and can be useful for others.

This optimistic attitude will synergize all activities

to improve the health of the patients themselves,

regular visits, obedience in taking ARVs, and other

activities that support healing. It turned out to be

proved by the results of data analysis conducted in

this study. The results show the existence of

extrinsic motivation influence on Adversity Quotient

in HIV AIDS patients.

Table 2 shows the effect of extrinsic motivation

on the control response in HIV & AIDS patients,

with significance (p) = 0.027. These results indicate

that the ability of the patient to reverse the difficulty

and then turn into opportunity and change the sense

of helplessness to empowerment still varies.

However, the trend shows a relatively moderate

value. The control response shows how a person

controls an event that causes difficulties in their life.

Control response in HIV & AIDS patients shows an

improvement as seen in the patients' better feelings

when doctors state the diagnosis, and the patient

remains convinced that every disease has its own

remedy and believes there is a way out of the

problem.

The spirit to keep on fighting, even with positive

HIV, is present after the provision of extrinsic

motivation. Control begins with the understanding

that anything can be done. Patients with high AQ

feel higher control over their illness than patients

with low AQ. As a result, the patient takes action

that results in more control. Significance value of

control response had (p) = 0.027, indicating that

people with HIV & AIDS have control over events

when they were diagnosed. Welles (2000) says that

people who have good control tend to have a high

AQ. They do not blame others for their illness and

have responsibility for what they did in the past.

Finally, individuals who have a high AQ assume that

the problem they face is in a small sphere and they

are confident to deal with it.

Stolz (2004) argues that control is one of the

most important origins in feelings, which is

reinforced by Seligman's optimistic theory of

optimism which takes account of the impact a

person has on responding and handling adversity.

Good self-control enables the patient to control

themself against adverse situations, both from illness

or from the environment, including the stigma of

society towards people with HIV. Good control can

shape optimism in the face of adversity.

Table 3 shows the effect of extrinsic motivation

on the origin dimension in HIV & AIDS patients,

with significance (p) = 0.028. Patients with low AQ

tend to place undue guilt over the bad events that

occur. Low origin responses can stop feedback

because of the constant burden of self-blame. Like

critics, guilt and regret will be of little use. If guilt is

too great it can be debilitating and deconstructive,

destroying energy, hope, self esteem and the

immune system.

This result gives an illustration of the degree of

recognition of the patients that the self as the origin

of a difficulty (current illness) experienced

(expressed with guilt and regret). The sense of

responsibility for the consequences of a difficulty

was at a moderate level. Original response reveals

who or what causes a difficulty. This variable has a

link to guilt. Guilt has two important functions. First,

if the guilt is of the right level, that feeling will

cause a person to act towards improvement and help

in a state of healing. Second, if the guilt leads to

regret, it will cause a sense of destruction.

Destructive guilt destroys hope, motivation and

energy. The response of origin in HIV & AIDS

patients increased, indicated by the guilt of the

patients to the family and close friends due to HIV

positive diagnosis. The origin response is a

perception of the origin of the difficulty (starting

from the beginning of HIV) until the patient is able

to place guilt as constructive or destructive.

Table 4 shows there is no effect of extrinsic

motivation on the dimension of ownership in people

with HIV & AIDS. Although the average value

showed an increase, the (p) was 0.334. Stolz (2004)

argues that the lower the level of recognition, the

more likely it is not to recognize the consequences.

The tendency to dismiss bad events or avoid

responsibility is an unwelcome attitude.

Ownership responses reveal aspects of

recognition of adversity. Patients with high AQ tend

to acknowledge the consequences of difficulty, often

able to remember the cause. Such a sense of

responsibility forces them to act, making the patient

improve their health level more. The significance

value of ownership variable was (p) = 0.334. From

the results of this study it can be assumed that

people with HIV & AIDS less recognize the cause of

the arising difficulties, but there is still a sense of

responsibility to overcome these conditions. The

absence of influence on this dimension is due to the

inability of the patient to affirm the importance of

themself to others. Response of ownership of HIV &

AIDS is indicated in responsibility and acceptance

of the disease suffered.

Table 5 shows the effect of extrinsic motivation

on the reach dimension in HIV & AIDS patients.

Although the mean score indicates an increase, the

(p) was 0.129, and the significance of the Mann-

Effect of Extrinsic Motivation on Adversity Quotient in Patients With HIV AIDS

289

Whitney test showed the significance difference of

post-treatment group values and post-control group

values with (p) = 0.003.

Stolz (2004) states that responses with low AQ

will cause the difficulties to extend to other facets of

life. Conversely, the range limitations will be even

greater. These results illustrate the ability of HIV &

AIDS patients to limit the adverse effects of the

progression of their illness to other parts of their life

at a moderate level. Reach describes the level of

arising difficulties that reaches other parts of one's

life. The significance value was 0.129, so it was

assumed that people with HIV & AIDS responded to

adversity in an unlimited and widespread way.

Response reach in patients is indicated by the

family caring for the patient. On the other hand, the

patient themself feels that they themself have

troubled the others. Reach here covers the closeness

of the patient with family and close friends. The

patient will fall and drop if the family blames the

patient for their illness being the result of their own

fault.

Stoltz (2004) argues that a person with a high

endurance response rate assumes that the cause of

adversity is temporary, rapidly passes and less likely

to occur, which means not significant. Extrinsic

motivation has no effect on the endurance dimension

because the difficult times experienced by HIV &

AIDS patients are permanent. This is because the

patient must consume drugs continuously and

always keep the body condition so as not to decline.

4 CONCLUSIONS

Extrinsic motivation with social support

interventions has a positive effect on Adversity

Quotient improvement in HIV & AIDS patients. The

level of Adversity Quotient of HIV & AIDS patients

will have an effect on their attitude in dealing with

the cure of their illness. HIV & AIDS patients who

are extrinsically motivated will affect the control

response to the disease. The responsiveness of the

control dimension is influenced by the perception of

control over the bad situations, both from oneself

and the environment, and optimism in the face of

adversity.

Extrinsic motivation positively affects the

response of the origin dimension in HIV & AIDS

patients. This dimensional response is influenced by

feelings of guilt as constructive, supported by nurses

who can provide feedback on their behavior.

Patients with HIV & AIDS who had extrinsic

motivation did not show any change in response of

ownership dimension. This ownership dimension

response is influenced by the efforts of nurses in

affirming the importance of the patient to others

(family or friends).

Patients with HIV & AIDS who received

extrinsic motivation showed no significant change in

response to reach dimension and endurance

dimensions. The response to reach is influenced by

the impact of specific or extended difficulties, while

the endurance response is affected by time in the

face of adversity and the expectations in the face of

adversity itself.

ACKNOWLEGEMENTS

I am grateful to all of those with whom I have had

pleasure to work during this project. Each of the

members of my thesis committee has provided me

with extensive personal and professional guidance

and taught me a great deal about both scientific

research and life in general. I would especially like

to thank Dr. Nursalam, the chairman of my

committee. As my teacher and mentor, he has shown

me, by his example, what a good researcher should

be.

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