Table 4.

Proposed adaptive changes to the ATHENA intervention for the Hunan cultural context

THEORETCAL FRAMEWORK (Freire, 1986)
	Core element	Adaptation for Hunan cultural context
Stage 1: Listening	Identification of the patient’s priorities through careful listening.	Inclusion of family in discussion and planning.
	Identification of the context of the patient’s life.	Assessment of patient and family context and level of HIV treatment knowledge.
Stage 2: Participatory dialogue	Discovery of key concepts reflective of patient’s central concerns.	Query family regarding family’s concerns, including fear of discrimination from neighbors.
	Problem-posing and critical thinking about identified concerns.	Provide information and educational materials to patients and families, with an emphasis on how HIV is and is not transmitted and on the benefits and side effects of ARV.
	Identification of problems in relation to adherence.
	Syntheses and preparation of written and visual materials which symbolize the concerns.	Include the family in all problem- posing and problem-solving activities.
	Presentation of these materials to the patient for discussion.
	Development of potential solutions.
Stage 3: Praxis/Action	Implementation of solutions followed by reflection on the effectiveness of actions and, if appropriate, new action steps.	Include the family in the process of action and reflection.
	Primary responsibility in this step rests with patient.	Primary responsibility in this step rests with patient and family.