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Keene CM, Euvrard J, Amico KR, Ragunathan A, English M, McKnight J, Orrell C. Conceptualising engagement with HIV care for people on treatment: the Indicators of HIV Care and AntiRetroviral Engagement (InCARE) Framework. BMC Health Serv Res 2023; 23:435. [PMID: 37143067 PMCID: PMC10161576 DOI: 10.1186/s12913-023-09433-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 04/14/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND As the crisis-based approach to HIV care evolves to chronic disease management, supporting ongoing engagement with HIV care is increasingly important to achieve long-term treatment success. However, 'engagement' is a complex concept and ambiguous definitions limit its evaluation. To guide engagement evaluation and development of interventions to improve HIV outcomes, we sought to identify critical, measurable dimensions of engagement with HIV care for people on treatment from a health service-delivery perspective. METHODS We used a pragmatic, iterative approach to develop a framework, combining insights from researcher experience, a narrative literature review, framework mapping, expert stakeholder input and a formal scoping review of engagement measures. These inputs helped to refine the inclusion and definition of important elements of engagement behaviour that could be evaluated by the health system. RESULTS The final framework presents engagement with HIV care as a dynamic behaviour that people practice rather than an individual characteristic or permanent state, so that people can be variably engaged at different points in their treatment journey. Engagement with HIV care for those on treatment is represented by three measurable dimensions: 'retention' (interaction with health services), 'adherence' (pill-taking behaviour), and 'active self-management' (ownership and self-management of care). Engagement is the product of wider contextual, health system and personal factors, and engagement in all dimensions facilitates successful treatment outcomes, such as virologic suppression and good health. While retention and adherence together may lead to treatment success at a particular point, this framework hypothesises that active self-management sustains treatment success over time. Thus, evaluation of all three core dimensions is crucial to realise the individual, societal and public health benefits of antiretroviral treatment programmes. CONCLUSIONS This framework distils a complex concept into three core, measurable dimensions critical for the maintenance of engagement. It characterises elements that the system might assess to evaluate engagement more comprehensively at individual and programmatic levels, and suggests that active self-management is an important consideration to support lifelong optimal engagement. This framework could be helpful in practice to guide the development of more nuanced interventions that improve long-term treatment success and help maintain momentum in controlling a changing epidemic.
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Affiliation(s)
- Claire M Keene
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Jonathan Euvrard
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - K Rivet Amico
- Health Behaviour and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Ayesha Ragunathan
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mike English
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jacob McKnight
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Catherine Orrell
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Keene CM, Ragunathan A, Euvrard J, English M, McKnight J, Orrell C. Measuring patient engagement with HIV care in sub-Saharan Africa: a scoping study. J Int AIDS Soc 2022; 25:e26025. [PMID: 36285618 PMCID: PMC9597383 DOI: 10.1002/jia2.26025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Engagement with HIV care is a multi-dimensional, dynamic process, critical to maintaining successful treatment outcomes. However, measures of engagement are not standardized nor comprehensive. This undermines our understanding of the scope of challenges with engagement and whether interventions have an impact, complicating patient and programme-level decision-making. This study identified and characterized measures of engagement to support more consistent and comprehensive evaluation. METHODS We conducted a scoping study to systematically categorize measures the health system could use to evaluate engagement with HIV care for those on antiretroviral treatment. Key terms were used to search literature databases (Embase, PsychINFO, Ovid Global-Health, PubMed, Scopus, CINAHL, Cochrane and the World Health Organization Index Medicus), Google Scholar and stakeholder-identified manuscripts, ultimately including English evidence published from sub-Saharan Africa from 2014 to 2021. Measures were extracted, organized, then reviewed with key stakeholders. RESULTS AND DISCUSSION We screened 14,885 titles/abstracts, included 118 full-texts and identified 110 measures of engagement, categorized into three engagement dimensions ("retention," "adherence" and "active self-management"), a combination category ("multi-dimensional engagement") and "treatment outcomes" category (e.g. viral load as an end-result reflecting that engagement occurred). Retention reflected status in care, continuity of attendance and visit timing. Adherence was assessed by a variety of measures categorized into primary (prescription not filled) and secondary measures (medication not taken as directed). Active self-management reflected involvement in care and self-management. Three overarching use cases were identified: research to make recommendations, routine monitoring for quality improvement and strategic decision-making and assessment of individual patients. CONCLUSIONS Heterogeneity in conceptualizing engagement with HIV care is reflected by the broad range of measures identified and the lack of consensus on "gold-standard" indicators. This review organized metrics into five categories based on the dimensions of engagement; further work could identify a standardized, minimum set of measures useful for comprehensive evaluation of engagement for different use cases. In the interim, measurement of engagement could be advanced through the assessment of multiple categories for a more thorough evaluation, conducting sensitivity analyses with commonly used measures for more comparable outputs and using longitudinal measures to evaluate engagement patterns. This could improve research, programme evaluation and nuanced assessment of individual patient engagement in HIV care.
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Affiliation(s)
- Claire M. Keene
- Health Systems CollaborativeOxford Centre for Global Health ResearchNuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Ayesha Ragunathan
- Health Systems CollaborativeOxford Centre for Global Health ResearchNuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Jonathan Euvrard
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public Health and Family MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Mike English
- Health Systems CollaborativeOxford Centre for Global Health ResearchNuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Jacob McKnight
- Health Systems CollaborativeOxford Centre for Global Health ResearchNuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Catherine Orrell
- Department of MedicineFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
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Bluemer-Miroite S, Potter K, Blanton E, Simmonds G, Mitchell C, Barnaby K, Zeribi KA, Babb D, Skyers N, O'Malley G, Anderson C. “Nothing for Us Without Us”: An Evaluation of Patient Engagement in an HIV Care Improvement Collaborative in the Caribbean. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00390. [PMID: 36332062 PMCID: PMC9242602 DOI: 10.9745/ghsp-d-21-00390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/05/2022] [Indexed: 11/20/2022]
Abstract
This evaluation suggests that it is both possible and valuable to include patients as partners in quality improvement efforts, especially when resources must be prioritized for the highest impact efforts. Patient engagement in the improvement process is particularly powerful when addressing illnesses that may be stigmatized such as HIV. Introduction: Patient engagement is increasingly recognized as a key strategy to promote patient-centered care and accelerate health care improvements. Ensuring patient participation in improvement efforts is particularly important with stigmatized illnesses and marginalized populations. Despite the attention it has garnered, patient engagement is still not widely implemented and has not been well documented in global health literature. Methods: We implemented a patient-engagement strategy to involve people living with HIV in quality improvement efforts. As part of the Caribbean Regional Quality Improvement Collaborative, quality improvement teams from Barbados (1 team), Jamaica (20 teams), Suriname (3 teams), and Trinidad and Tobago (2 teams) engaged health care providers from care facilities and people living with HIV to serve as community representatives (CRs) to lead the improvement efforts alongside them. This strategy was evaluated via a mixed method design that included 2 rounds of semistructured, in-depth interviews with patients and providers. Results: Findings suggest that the patient engagement strategy had several key strengths: it promoted the collection, use, and appreciation of patient input to inform health care improvements at the facility level; facilitated the empowerment of CRs; enhanced mutual understanding and empathy between CRs and providers; and helped to dispel HIV stigma and discrimination in health care settings. Moreover, both health care providers and CRs reported that CR opinions and perspectives are as important as providers' and that CR participation in the improvement process was beneficial.
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Affiliation(s)
| | | | | | - Georgia Simmonds
- Caribbean Training and Education Center for Health, Kingston, Jamaica
| | - Conrad Mitchell
- International Training and Education Center for Health, Port of Spain, Trinidad and Tobago
| | - Kenyatta Barnaby
- Caribbean Training and Education Center for Health, Kingston, Jamaica
| | | | - Dale Babb
- Ladymeade Reference Unit, Barbados Ministry of Health, St. Michael, Barbados
| | - Nicola Skyers
- HIV Programme, Jamaica Ministry of Health, Kingston, Jamaica
| | - Gabrielle O'Malley
- University of Washington, Seattle, WA, USA
- International Training and Education Center for Health, Seattle, WA, USA
| | - Clive Anderson
- International Training and Education Center for Health, Kingston, Jamaica
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The Situated Information, Motivation, and Behavioral Skills Model of HIV Antiretroviral Therapy Adherence Among Persons Living With HIV in Haiti: A Qualitative Study Incorporating Culture and Context. J Assoc Nurses AIDS Care 2022; 33:448-458. [PMID: 35239563 DOI: 10.1097/jnc.0000000000000329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT To inform a clinic-based adherence-promotion intervention, this qualitative study applied the Situated Information, Motivation, and Behavioral Skills Model of Care Initiation and Maintenance to elucidate cultural and contextual factors affecting antiretroviral therapy adherence in Haiti. From the 23 focus group discussions with patients (n = 58) and health care workers (n = 57), culturally specific themes emerged relating to Information (e.g., conflicts with allopathic medicine and heuristics about how treatment failure occurs), Motivation (e.g., protecting family members, health and physical appearance, material advantages, and relationships with health workers), and Behavioral Skills (e.g., managing food intake and side effects, navigating health services utilization, accessing medication, and advocating for care needs). Recommendations include: provide therapeutic education on HIV drug resistance; promote the concept of "undetectable = untransmittable"; develop treatment buddy relationships; invest in training and enforcement of patient privacy, transparency, and fairness in access to services and resources; and provide patient-centered behavioral skills counseling.
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Wachira J, Mwangi A, Chemutai D, Nyambura M, Genberg B, Wilson IB. Higher Clinician-Patient Communication Is Associated With Greater Satisfaction With HIV Care. J Int Assoc Provid AIDS Care 2021; 20:23259582211054935. [PMID: 34787014 PMCID: PMC8606924 DOI: 10.1177/23259582211054935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Provider-patient communication (PPC) skills are key in promoting patient satisfaction. Our study examined the relationship between clinician PPC skills and patient satisfaction with care among virally unsuppressed adult HIV patients in Busia County, Kenya. This cross-sectional study was conducted among 360 HIV patients on first line antiretroviral regimen and having a recent viral load ≥400 copies HIV RNA/ml. We conducted logistic regression analysis. The mean age of participants was 48.2 years [standard deviation (SD): 12.05]. Overall, the mean score on clinician PPC skills was 33.3 (SD: 9.0). A high proportion (85%) of participants reported satisfaction with the HIV care services. After adjusting for covariates, the odds of being satisfied with care increased by 19% (adjusted odds ratio: 1.19, 95% CI: 1.11-1.30) for every one unit increase in the clinician PPC skills score. Promoting good PPC skills may be key to improving patient satisfaction with HIV care.
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Affiliation(s)
- Juddy Wachira
- School of Medicine, College of Health Sciences, 130188Moi University Eldoret, Kenya.,School of Literature, Language and Media, 208666University of Witwatersrand, Johannesburg, South Africa
| | - Ann Mwangi
- Institute of Biomedical Informatics, College of Health Sciences, 107853Moi University, Eldoret, Kenya, USA
| | - Diana Chemutai
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Monica Nyambura
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Becky Genberg
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ira B Wilson
- School of Public Health, Brown University, Providence, RI, USA
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Relationship between Provider Communication Behaviors and the Quality of Life for Patients with Advanced Cancer in Saudi Arabia. Curr Oncol 2021; 28:2893-2901. [PMID: 34436019 PMCID: PMC8395490 DOI: 10.3390/curroncol28040253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/10/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022] Open
Abstract
Context: Patients with advanced cancer from Saudi Arabia are often not well informed about diagnoses, prognoses, and treatment options. Poor communication can lead to health-care decisions that insufficiently meet patients’ preferences, concerns, and needs and that subsequently affect patients’ quality of life. Objectives: The purpose of this study is to examine the relationship between provider communication behaviors and the quality of life of patients with advanced cancer. Method: A cross-sectional, correlation design was used in the present study, in which 159 patients with confirmed diagnoses of stage III or IV solid cancer were surveyed. Results: The mean summary score of the patients’ quality of life was 57.31. We found a significant relationship between provider communication behaviors and patient quality of life (β = 0.18, b = 0.35, SE = 0.15, p = 0.021). In addition, R2 shows that only 3.4% of variance in patient quality of life is predicated on provider communication behaviors. Conclusions: The relationship between provider communication behaviors and patient quality of life was low (r = 0.18). A possible reason for this is that provider communication behaviors are not the only factor that affects patient quality of life; other variables, such as the patient’s age, cancer type, and level of awareness, can also have an effect. Another possible explanation is that communication behaviors between patients and providers may vary depending on the level of cultural contact.
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Ramaiya MK, Haight E, Simoni JM, Chéry JM, Dervis W, Genna W, Dubé JG, Calixte G, Balan JG, Honoré JG, Puttkammer N. Patient-Provider Communication and Information, Motivation, and Behavioral Skills in HIV-Positive Adults Initiating Antiretroviral Therapy in Haiti. J Int Assoc Provid AIDS Care 2021; 19:2325958220952631. [PMID: 32924764 PMCID: PMC7493277 DOI: 10.1177/2325958220952631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
While Haiti has scaled up use of antiretroviral therapy (ART), current studies suggest sub-optimal adherence threatens long-term viral suppression in this understudied setting. Patient-provider communication (PPC) and information, motivation, and behavioral skills (IMB) have been implicated in ART adherence globally. However, no studies have examined their relevance in Haiti. The present mixed-methods study utilized cross-sectional survey data from 128 ART-initiating patients at 2 large HIV treatment sites in Haiti, as well as observational data from 12 clinic visits, to document associations between adherence-related PPC and IMB. Multivariate regression analyses suggested that PPC is associated with IMB constructs. At the bivariate level, more effective PPC was associated with higher levels of adherence-related information and motivation, but not behavioral skills. Observational findings indicate infrequent and non-collaborative adherence support. Taken together, findings lay the groundwork for additional research in the area of PPC, IMB, and ART adherence in Haiti.
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Affiliation(s)
- Megan K Ramaiya
- Department of Psychology, 7284University of Washington, Seattle, WA, USA
| | - Elizabeth Haight
- Department of Global Health, 7284University of Washington, Seattle, WA, USA
| | - Jane M Simoni
- Department of Psychology, 7284University of Washington, Seattle, WA, USA
| | - Jean Marcxime Chéry
- Centre Haïtien pour le Renforcement du Système de Santé (CHARESS), Port-au-Prince, Haiti
| | - Witson Dervis
- Centre Haïtien pour le Renforcement du Système de Santé (CHARESS), Port-au-Prince, Haiti
| | - Wilner Genna
- Justinien University Hospital, Cape Haitian, Haiti
| | | | | | - Jean Gabriel Balan
- Centre Haïtien pour le Renforcement du Système de Santé (CHARESS), Port-au-Prince, Haiti
| | - Jean Guy Honoré
- Centre Haïtien pour le Renforcement du Système de Santé (CHARESS), Port-au-Prince, Haiti
| | - Nancy Puttkammer
- Department of Global Health, 7284University of Washington, Seattle, WA, USA.,International Training & Education Center for Health (I-TECH), Seattle, WA, USA
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Kim GS, Shim MS, Choi JY, Lee JI, Kim JM. Testing a Question Prompt Intervention to Improve Communication between Patients with HIV and Healthcare Providers: A Pilot Study. J Community Health Nurs 2021; 37:153-163. [PMID: 32820975 DOI: 10.1080/07370016.2020.1780045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We tested the feasibility and acceptability of a question prompt intervention for patients recently diagnosed with HIV using a single group pretest-posttest design. Three healthcare providers (HCPs) and 18 patients, enrolled by convenience sampling, participated. Patients chose questions from a list of 14 items about patients' adherence and health problems; then, they were provided with information. Communication time with nurses and number of questions significantly decreased, while health-related quality of life increased. The most frequently asked questions concerned medication adherence, sexual relationships, and the meaning of test results. The intervention facilitated communication with HCPs among patients.
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Affiliation(s)
- Gwang Suk Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University , Seoul, Republic of Korea
| | - Mi-So Shim
- Department of Nursing, Graduate School of Yonsei University , Seoul, Republic of Korea
| | - Jun Yong Choi
- Department of Internal Medicine, College of Medicine, Yonsei University , Seoul, Republic of Korea
| | - Jeong In Lee
- Division of Nursing/Infectious Disease, Yonsei University Health System , Seoul, Republic of Korea
| | - Ji Min Kim
- Division of Nursing/Infectious Disease, Yonsei University Health System , Seoul, Republic of Korea
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Yoshida T, Watanabe S, Kono T, Taketa H, Shiotsu N, Shirai H, Nakai Y, Torii Y. What impact does postgraduate clinical training have on empathy among Japanese trainee dentists? BMC MEDICAL EDUCATION 2021; 21:53. [PMID: 33446194 PMCID: PMC7807681 DOI: 10.1186/s12909-020-02481-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Enhancing empathy in healthcare education is a critical component in the development of a relationship between healthcare professionals and patients that would ensure better patient care; improved patient satisfaction, adherence to treatment, patients' medication self-efficacy, improved treatment outcomes, and reduced patient anxiety. Unfortunately, however, the decline of empathy among students has been frequently reported. It is especially common when the curriculum transitions to a clinical setting. However, some studies have questioned the significance and frequency of this decline. Thus, the purpose of this study was to determine the impact of postgraduate clinical training on dental trainees' empathy from cognitive, behavioral, and patients' perspective. METHODS This study included 64 trainee dentists at Okayama University Hospital and 13 simulated patients (SPs). The trainee dentists carried out initial medical interviews with SPs twice, at the beginning and the end of their clinical training. The trainees completed the Japanese version of the Jefferson Scale of Empathy for health professionals just before each medical interview. The SPs evaluated the trainees' communication using an assessment questionnaire immediately after the medical interviews. The videotaped dialogue from the medical interviews was analyzed using the Roter Interaction Analysis System. RESULTS No significant difference was found in the self-reported empathy score of trainees at the beginning and the end of the clinical training (107.73 [range, 85-134] vs. 108.34 [range, 69-138]; p = 0.643). Considering the results according to gender, male scored 104.06 (range, 88-118) vs. 101.06 (range, 71-122; p = 0.283) and female 109.17 (range, 85-134) vs. 111.20 (range, 69-138; p = 0.170). Similarly, there was no difference in the SPs' evaluation of trainees' communication (10.73 vs. 10.38, p = 0.434). Communication behavior in the emotional responsiveness category for trainees in the beginning was significantly higher than that at the end (2.47 vs. 1.14, p = 0.000). CONCLUSIONS Overall, a one-year postgraduate dental training program neither reduced nor increased trainee dentists' empathy levels. Providing regular education support in this area may help trainees foster their empathy.
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Affiliation(s)
- Toshiko Yoshida
- Center for Education in Medicine and Health Sciences (Dental Education), Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kita- ku, 700-8558, Okayama, Okayama, Japan.
| | - Sho Watanabe
- Comprehensive Dental Clinic, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, 700-8558, Okayama, Okayama, Japan
| | - Takayuki Kono
- Comprehensive Dental Clinic, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, 700-8558, Okayama, Okayama, Japan
| | - Hiroaki Taketa
- Comprehensive Dental Clinic, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, 700-8558, Okayama, Okayama, Japan
| | - Noriko Shiotsu
- Comprehensive Dental Clinic, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, 700-8558, Okayama, Okayama, Japan
| | - Hajime Shirai
- Comprehensive Dental Clinic, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, 700-8558, Okayama, Okayama, Japan
| | - Yukie Nakai
- Department of Dental Hygiene, University of Shizuoka, Junior College, 2-2-1 Oshika, Suruga- ku, 422-8021, Shizuoka, Shizuoka, Japan
| | - Yasuhiro Torii
- Comprehensive Dental Clinic, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, 700-8558, Okayama, Okayama, Japan
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Cherop F, Korir M, Bagire V, Wachira J. Patient loyalty to HIV care in an HIV facility in Eldoret, Kenya: A mediated mediation. AAS Open Res 2020. [DOI: 10.12688/aasopenres.13121.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Patient loyalty is the continuous commitment and engagement in care where patients can improve and sustain quality of life through continuous use of medical care. Identifying strengths and weaknesses in providing excellent quality care is a key measure of success of healthcare professionals and hospital management. However, few studies have examined patient loyalty from a strategic leadership perspective within HIV health care systems. The purpose of this study is to determine how patient loyalty to HIV care is influenced by multiple factors in a healthcare system environment. The study employs a mixed-methods approach guided by the complexity theory and the theory of planned behavior. A total of 444 surveys with (50 healthcare providers and 394 adult HIV-infected patients) currently on antiretroviral drugs, as well as 22 in-depth interviews with healthcare providers will be conducted. The study will be done at AMPATH Eldoret Kenya. We will use stratified proportionate and census sampling methods to select study participants for the survey while purposive and convenient sampling techniques will be used for in-depth interviews. Structured questionnaires and interviewer guides will guide data collection. Quantitative data analysis will entail hierarchical regression to test direct effects while multiple regression will test the mediation effects using the Hayes PROCESS Model No.6 in SPSS. Qualitative data analysis will be conducted using a thematic analytical method.
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Wexler C, Maloba M, Brown M, Mabachi N, Goggin K, Gautney B, Odeny B, Finocchario-Kessler S. Factors affecting acceptance of at-birth point of care HIV testing among providers and parents in Kenya: A qualitative study. PLoS One 2019; 14:e0225642. [PMID: 31756242 PMCID: PMC6874324 DOI: 10.1371/journal.pone.0225642] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 11/09/2019] [Indexed: 01/01/2023] Open
Abstract
Background At-birth and point-of-care (POC) HIV testing are emerging strategies to streamline infant HIV diagnosis and expedite ART initiation for HIV-positive infants. The purpose of this qualitative study was to evaluate factors influencing the provision and acceptance of at-birth POC testing among both HIV care providers and parents of HIV-exposed infants in Kenya. Methods We conducted semi-structured interviews with 26 HIV care providers and 35 parents of HIV-exposed infants (including 23 mothers, 6 fathers, and 3 mother-father pairs) at four study hospitals prior to POC implementation. An overview of best available evidence related to POC was presented to participants prior to each interview. Interviews probed about standard EID services, perceived benefits and risk of at-birth and POC testing, and suggested logistics of providing at-birth and POC. Interviews were audio recorded, translated (if necessary), and transcribed verbatim. Using the Transdisciplinary Model of Evidence Based Practice to guide analysis, transcripts were coded based on a priori themes related to environmental context, patient characteristics, and resources. Results Most providers (24/26) and parents (30/35) held favorable attitudes towards at-birth POC testing. The potential for earlier results to improve infant care and reduce parental anxiety drove preferences for at-birth POC testing. Parents with unfavorable views towards at-birth POC testing preferred standard testing at 6 weeks so that mothers could heal after birth and have time to bond with their newborn before–possibly–learning that their child was HIV-positive. Providers identified lack of resources (shortage of staff, expertise, and space) as a barrier. Discussion While overall acceptability of at-birth POC testing among HIV care providers and parents of HIV-exposed infants may facilitate uptake, barriers remain. Applying a task-shifting approach to implementation and ensuring providers receive training on at-birth POC testing may mitigate provider-related challenges. Comprehensive counseling throughout the antenatal and postpartum periods may mitigate patient-related challenges.
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Affiliation(s)
- Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
- * E-mail:
| | - May Maloba
- Global Health Innovations, Nairobi, Kenya
| | - Melinda Brown
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Natabhona Mabachi
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Kathy Goggin
- Health Services and Outcomes Research, Children’s Mercy Kansas City, Kansas City, MO, United States of America
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States of America
| | - Brad Gautney
- Global Health Innovations, Dallas, TX, United States of America
| | - Beryne Odeny
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
| | - Sarah Finocchario-Kessler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
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Moucheraud C, Stern AF, Ahearn C, Ismail A, Nsubuga-Nyombi T, Ngonyani MM, Mvungi J, Ssensamba J. Barriers to HIV Treatment Adherence: A Qualitative Study of Discrepancies Between Perceptions of Patients and Health Providers in Tanzania and Uganda. AIDS Patient Care STDS 2019; 33:406-413. [PMID: 31517526 PMCID: PMC6745526 DOI: 10.1089/apc.2019.0053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Previous qualitative studies about antiretroviral therapy (ART) adherence have largely focused on patient experiences. Less is known about the perspective of health care providers-particularly in low-income countries-who serve as gatekeepers and influencers of patients' HIV care experiences. This study explored patients' and providers' perceptions of important ART adherence determinants. Interviews were conducted at HIV treatment sites in Tanzania and Uganda, with adult patients on ART (n = 148), and with health care providers (n = 49). Patients were asked about their experiences with ART adherence, and providers were asked about their perceptions of what adherence challenges are faced by their patients. All interviews were conducted in local languages; transcripts were translated into English and analyzed using a codebook informed by the social ecological model. Themes were examined across and within countries. Adherence-related challenges were frequently reported, but patients and providers did not often agree about the reasons. Many patients cited challenges related to being away from home and therefore away from their pill supply; and, in Uganda, challenges picking up refills (access to care) and related to food sufficiency/diet. Providers also identified these access to care barriers, but otherwise focused on different key determinants (e.g., they rarely mentioned food/diet); instead, providers were more likely to mention alcohol/alcoholism, stigma, and lack of understanding about the importance of adhering. These findings suggest areas of opportunity for future research and for improving clinical care by aligning perceptions of adherence challenges, to deliver better-informed and useful ART counseling and support.
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Affiliation(s)
- Corrina Moucheraud
- Department of Health Policy and Management, University of California Fielding School of Public Health, Los Angeles, California
| | - Amy F. Stern
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC, Chevy Chase, Maryland
| | - Canice Ahearn
- Division of HIV, Infectious Diseases & Global Medicine, Department of Medicine, University of California, San Francisco, California
| | - Anisa Ismail
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC, Chevy Chase, Maryland
| | - Tamara Nsubuga-Nyombi
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC, Kampala, Uganda
| | - Monica M. Ngonyani
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC, Dar es Salaam, Tanzania
| | - Jane Mvungi
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC, Dar es Salaam, Tanzania
| | - Jude Ssensamba
- USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC, Kampala, Uganda
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13
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Kiplagat J, Mwangi A, Chasela C, Huschke S. Challenges with seeking HIV care services: perspectives of older adults infected with HIV in western Kenya. BMC Public Health 2019; 19:929. [PMID: 31296195 PMCID: PMC6624873 DOI: 10.1186/s12889-019-7283-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 07/05/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND While younger adults (15-49 years) form the majority of the population living with HIV, older adults (≥50 years) infected with HIV face multiple challenges related to the aging process and HIV. We explored the experiences of older persons infected with HIV at the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya to understand the challenges faced when seeking HIV care services. METHODS Between November 2016 and April 2017, a total of 57 adults aged 50 years and above were recruited from two AMPATH facilities - one rural and one urban facility. A total of 25 in-depth interviews and four focus group discussions were conducted, audio-recorded, transcribed and thematic analysis performed. RESULTS Study participants raised unique challenges with seeking HIV care that include visits to multiple healthcare providers to manage HIV and comorbidities and as a result impact on their adherence to medication and clinical visits. Challenges with inadequate quality of facilities and poor patient-provider communication were also raised. Participants' preference for matched gender and older age for care providers that serve older patients were identified. CONCLUSION Results indicate multiple challenges faced by older adults that need attention in ensuring continuous engagement in HIV care. Targeted HIV care for older adults would, therefore, significantly improve their access to and experience of HIV care. Of key importance is the integration of other chronic diseases into HIV care and employing staff that matches the needs of older adults.
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Affiliation(s)
- Jepchirchir Kiplagat
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Ann Mwangi
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Charles Chasela
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Right to Care, EQUIP, 1006 Lenchen North Avenue, Centurion, Pretoria, South Africa
| | - Susann Huschke
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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14
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Watanabe S, Yoshida T, Kono T, Taketa H, Shiotsu N, Shirai H, Torii Y. Relationship of trainee dentists' self-reported empathy and communication behaviors with simulated patients' assessment in medical interviews. PLoS One 2018; 13:e0203970. [PMID: 30571709 PMCID: PMC6301708 DOI: 10.1371/journal.pone.0203970] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/04/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives We aimed to clarify the communication behaviors between trainee dentists and simulated patients (SPs), to examine how the level of trainee dentists’ self-reported empathy influences assessment by SPs in medical interviews. Materials and methods The study involved 100 trainee dentists at Okayama University Hospital and eight SPs. The trainee dentists conducted initial interviews with the SPs after completing the Japanese version of the Jefferson Scale of Empathy (JSE). All interviews were recorded and analyzed using the Roter Interaction Analysis System (RIAS). The SPs assessed the trainees’ communication immediately after each interview. The trainee dentists were classified into two groups (more positive and less positive) according to SP assessment scores. Results Compared with less-positive trainees, the more-positive trainees scored higher in the RIAS category of emotional expression and lower in the medical data gathering category. There was no difference in dental data gathering between the two groups. SP ratings for more-positive trainees were higher for use of positive talk and emotional expression and lower for giving medical information and dental information. Trainees with more positive ratings from SPs had significantly higher JSE total scores. Conclusion The results of this study suggest that responding to the emotions of patients is an important behavior in dentist-patient communication, according to SPs’ positive assessment in medical interviews. Further, SPs’ assessment of trainees’ communication was related to trainees’ self-reported empathy, which indicates that an empathic attitude among dentists is a significant determinant of patient satisfaction.
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Affiliation(s)
- Sho Watanabe
- Department of Comprehensive Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Toshiko Yoshida
- Center for Education in Medicine and Health Sciences (Dental Education), Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- * E-mail:
| | - Takayuki Kono
- Comprehensive Dental Clinic, Okayama University Hospital, Okayama, Japan
| | - Hiroaki Taketa
- Comprehensive Dental Clinic, Okayama University Hospital, Okayama, Japan
| | - Noriko Shiotsu
- Comprehensive Dental Clinic, Okayama University Hospital, Okayama, Japan
| | - Hajime Shirai
- Comprehensive Dental Clinic, Okayama University Hospital, Okayama, Japan
| | - Yasuhiro Torii
- Department of Comprehensive Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- Comprehensive Dental Clinic, Okayama University Hospital, Okayama, Japan
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Wachira J, Genberg B, Kafu C, Koech B, Akinyi J, Owino RK, Laws MB, Wilson IB, Braitstein P. The Perspective of HIV Providers in Western Kenya on Provider-Patient Relationships. JOURNAL OF HEALTH COMMUNICATION 2018; 23:591-596. [PMID: 29979930 PMCID: PMC6094379 DOI: 10.1080/10810730.2018.1493061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Enhancing effective adherence dialogue with HIV patients in an environment that promotes good provider-patient relationships, is key to optimizing the benefits of antiretroviral therapy (ART). The study examines the perspectives of HIV providers in western Kenya on provider-patient relationships. Sixty healthcare providers were sampled using convenience sampling methods from three Academic Model for Providing Access to Healthcare (AMPATH) sites (one urban and two rural). In-depth interviews conducted in either Swahili or English were audio recorded, transcribed, and translated into English. Content analysis was performed after thematic coding. Providers perceived that they had good relationships with most patients, and tended to identify negative patient attributes as the source of poor provider-patient relationships. Providers preferred patients who adhered to treatment guidelines. They did not like patients who challenged their authority, and did not see it as their responsibility to find more effective ways of interacting with patients who they found difficult. Structural barriers to collaborative physician-patient relationships included noncontinuity of relationships, lack of specific appointment times, high provider-patient ratio, and management of provider fatigue and job dissatisfaction. There is need for HIV care programs to identify culturally appropriate interventions to enhance better provider-patient relationship.
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Affiliation(s)
- Juddy Wachira
- a School of Medicine , Moi University , Eldoret , Kenya
- b Academic Model Providing Access to Healthcare (AMPATH) Partnership , Eldoret , Kenya
| | - Becky Genberg
- c Bloomberg School of Public Health , Johns Hopkins University , Baltimore , MD , USA
| | - Catherine Kafu
- b Academic Model Providing Access to Healthcare (AMPATH) Partnership , Eldoret , Kenya
| | - Beatrice Koech
- b Academic Model Providing Access to Healthcare (AMPATH) Partnership , Eldoret , Kenya
| | - Jacqueline Akinyi
- b Academic Model Providing Access to Healthcare (AMPATH) Partnership , Eldoret , Kenya
| | - Regina K Owino
- b Academic Model Providing Access to Healthcare (AMPATH) Partnership , Eldoret , Kenya
| | - Michael Barton Laws
- d Department of Health Services, Policy & Practice , Brown University , Providence, RI, USA
| | - Ira B Wilson
- d Department of Health Services, Policy & Practice , Brown University , Providence, RI, USA
| | - Paula Braitstein
- e Dalla Lana School of Public Health , University of Toronto , Toronto, Ontario , Canada
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Kigen HT, Galgalo T, Githuku J, Odhiambo J, Lowther S, Langat B, Wamicwe J, Too R, Gura Z. Predictors of loss to follow up among HIV-exposed children within the prevention of mother to child transmission cascade, Kericho County, Kenya, 2016. Pan Afr Med J 2018; 30:178. [PMID: 30455807 PMCID: PMC6235513 DOI: 10.11604/pamj.2018.30.178.15837] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/21/2018] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION HIV-exposed infants (HEI) lost-to-follow-up (LTFU) remains a problem in sub Saharan Africa (SSA). In 2015, SSA accounted >90% of the 150,000 new infant HIV infections, with an estimated 13,000 reported in Kenya. Despite proven and effective HIV interventions, many HEI fail to benefit because of LTFU. LTFU leads to delays or no initiation of interventions, thereby contributing to significant child morbidity and mortality. Kenya did not achieve the <5% mother-to-child HIV transmission target by 2015 because of problems such as LTFU. We sought to investigate factors associated with LTFU of HEI in Kericho County, Kenya. METHODS A case-control study was conducted in June 2016 employing 1:2 frequency matching by age and hospital of birth. We recruited HEI from HEI birth cohort registers from hospitals for the months of September 2014 through February 2016. Cases were infant-mother pairs that missed their 3-month clinic appointments while controls were those that adhered to their 3-month follow-up visits. Consent was obtained from caregivers and a structured questionnaire was administered. We used chi-square and Fisher's Exact tests to compare groups, calculated odds ratios (OR) and 95% confidence intervals (CI), and performed logistic regression to identify independent risk factors. RESULTS We enrolled 44 cases and 88 controls aged ≥3 to 18 months: Cases ranged from 7.3-17.8 months old and controls from 6.8-17.2 months old. LTFU cases' caregivers were more likely than controls' caregivers to fear knowing HEI status (aOR= 12.71 [CI 3.21-50.23]), lack knowledge that HEI are followed for 18 months (aOR= 12.01 [CI 2.92-48.83]), avoid partners knowing their HEI status(OR= 11.32 [CI 2.92-44.04]), and use traditional medicine (aOR= 6.42 [CI 1.81-22.91]).Factors that were protective of LTFU included mothers knowing their pre-pregnancy HIV status (aOR= 0.23 [CI 0.05-0.71]) and having household health insurance (aOR= 0.11 [CI 0.01-0.76]). CONCLUSION Caregivers' intrinsic, interpersonal, community and health system factors remain crucial towards reducing HEI LTFU. Early HIV testing among mothers, disclosure support, health education, and partner involvement is advocated. Encouraging households to enroll in health insurance could be beneficial. Further studies on the magnitude and the reasons for use of home treatments among caregiver are recommended.
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Affiliation(s)
- Hudson Taabukk Kigen
- Field Epidemiology and Laboratory Training Program (FELTP), Ministry of Health, Nairobi, Kenya
- County Government of Kericho, Department of Health, Kericho, Kenya
| | - Tura Galgalo
- US Centers for Diseases Prevention and Control (CDC), Division of Global Health Protection (DGHP), Kenya
| | - Jane Githuku
- Field Epidemiology and Laboratory Training Program (FELTP), Ministry of Health, Nairobi, Kenya
| | - Jacob Odhiambo
- National AIDS and STI Control Program (NASCOP), Ministry of Health, Kenya
| | - Sara Lowther
- US Centers for Diseases Prevention and Control (CDC), Division of Global Health Protection (DGHP), Kenya
| | - Betty Langat
- County Government of Kericho, Department of Health, Kericho, Kenya
| | - Joyce Wamicwe
- National AIDS and STI Control Program (NASCOP), Ministry of Health, Kenya
| | - Robert Too
- Moi University, School of Public Health, Eldoret, Kenya
| | - Zeinab Gura
- Field Epidemiology and Laboratory Training Program (FELTP), Ministry of Health, Nairobi, Kenya
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Onyeajam DJ, Xirasagar S, Khan MM, Hardin JW, Odutolu O. Antenatal care satisfaction in a developing country: a cross-sectional study from Nigeria. BMC Public Health 2018; 18:368. [PMID: 29554885 PMCID: PMC5859482 DOI: 10.1186/s12889-018-5285-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 03/08/2018] [Indexed: 12/04/2022] Open
Abstract
Background Utilization of Antenatal Care (ANC) is very low in Nigeria. Self-reported patient satisfaction may be useful to identify provider- and facility-specific factors that can be improved to increase ANC satisfaction and utilization. Methods Exit interview data collected from ANC users and facility assessment survey data from 534 systematically selected facilities in four northern Nigerian states were used. Associations between patient satisfaction (satisfied, not-satisfied) and patient ratings of the provider’s interactions, care processes, out-of-pocket costs, and quality of facility infrastructure were studied. Results Of 1336 mothers, 90% were satisfied with ANC. Patient satisfaction was positively associated with responsive service (prompt, unrushed service, convenient clinic hours and privacy during consultation, AOR 2.42, 95% CI 2.05–2.87), treatment-facilitation (medical care-related provider communication and ease of receiving medicines, AOR 2.03, 95% CI 1.46–2.80), equipment availability (AOR 1.10, 95% CI 1.01–1.21), staff empathy (AOR 1.82, 95% CI 1.03–3.23), non-discriminatory treatment regardless of patient’s socioeconomic status (AOR: 1.87, 95% CI 1.09–3.22), provider assurance (courtesy and patient’s confidence in provider’s competence, AOR 1.48, 95% CI 1.26–1.75), and number of clinical examinations received (AOR 1.28, 95% CI 1.10–1.50). ANC satisfaction was negatively impacted by out-of-pocket payment for care (vs. free care, AOR 0.44, 95% CI 0.23–0.82). Conclusions ANC satisfaction in Nigeria may be enhanced by improving responsiveness to clients, clinical care quality, ensuring equipment availability, optimizing easy access to medicines, and expanding free ANC services. Electronic supplementary material The online version of this article (10.1186/s12889-018-5285-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dumbiri J Onyeajam
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Ste 360, Columbia, SC, 29208, USA.
| | - Sudha Xirasagar
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Ste 360, Columbia, SC, 29208, USA
| | - Mahmud M Khan
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Ste 360, Columbia, SC, 29208, USA
| | - James W Hardin
- Biostatistics Division, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
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18
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Tong C, Suzan-Monti M, Sagaon-Teyssier L, Mimi M, Laurent C, Maradan G, Mengue MT, Spire B, Kuaban C, Vidal L, Boyer S. Treatment interruption in HIV-positive patients followed up in Cameroon's antiretroviral treatment programme: individual and health care supply-related factors (ANRS-12288 EVOLCam survey). Trop Med Int Health 2018; 23:315-326. [PMID: 29327419 DOI: 10.1111/tmi.13030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Decreasing international financial resources for HIV and increasing numbers of antiretroviral treatment (ART)-treated patients may jeopardise treatment continuity in low-income settings. Using data from the EVOLCam ANRS-12288 survey, this study aimed to document the prevalence of unplanned treatment interruption for more than 2 consecutive days (TI>2d) and investigate the associated individual and health care supply-related factors within the Cameroonian ART programme. METHODS A cross-sectional mixed methods survey was carried out between April and December 2014 in 19 HIV services of the Centre and Littoral regions. A multilevel logistic model was estimated on 1885 ART-treated patients in these services to investigate factors of TI>2d in the past 4 weeks. RESULTS Among the study population, 403 (21%) patients reported TI>2d. Patients followed up in hospitals reporting ART stock-outs were more likely to report TI>2d while those followed up in the Littoral region, in medium- or small-sized hospitals and in HIV services proposing financial support were at lower risk of TI>2d. The following individual factors were also associated with a lower risk of TI>2d: living in a couple, having children, satisfaction with attention provided by doctor, tuberculosis co-infection and not having consulted a traditional healer. CONCLUSIONS Besides identifying individual factors of TI>2d, our study highlighted the role of health care supply-related factors in shaping TI in Cameroon's ART programme, especially the deleterious effect of ART stock-outs. Our results also suggest that the high proportion of patients reporting TI could jeopardise progress in the fight against HIV in the country, unless effective measures are quickly implemented like ensuring the continuity of ART supply.
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Affiliation(s)
- Christelle Tong
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques, & Sociales de la Santé & Traitement de l'Information Médicale, Université Aix Marseille, Marseille, France
| | - Marie Suzan-Monti
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques, & Sociales de la Santé & Traitement de l'Information Médicale, Université Aix Marseille, Marseille, France.,Observatoire régional de la santé Provence Alpes Côte d'Azur, Marseille, France
| | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques, & Sociales de la Santé & Traitement de l'Information Médicale, Université Aix Marseille, Marseille, France.,Observatoire régional de la santé Provence Alpes Côte d'Azur, Marseille, France
| | - Mohamed Mimi
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques, & Sociales de la Santé & Traitement de l'Information Médicale, Université Aix Marseille, Marseille, France.,Observatoire régional de la santé Provence Alpes Côte d'Azur, Marseille, France
| | - Christian Laurent
- TransVIHMI, IRD UMI 233, INSERM U1175 & Université de Montpellier, Montpellier, France
| | - Gwenaëlle Maradan
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques, & Sociales de la Santé & Traitement de l'Information Médicale, Université Aix Marseille, Marseille, France.,Observatoire régional de la santé Provence Alpes Côte d'Azur, Marseille, France
| | | | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques, & Sociales de la Santé & Traitement de l'Information Médicale, Université Aix Marseille, Marseille, France.,Observatoire régional de la santé Provence Alpes Côte d'Azur, Marseille, France
| | - Christopher Kuaban
- Department of Internal Medicine and Subspecialties, University of Yaoundé I, Yaoundé, Cameroon
| | - Laurent Vidal
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques, & Sociales de la Santé & Traitement de l'Information Médicale, Université Aix Marseille, Marseille, France
| | - Sylvie Boyer
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques, & Sociales de la Santé & Traitement de l'Information Médicale, Université Aix Marseille, Marseille, France.,Observatoire régional de la santé Provence Alpes Côte d'Azur, Marseille, France
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19
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Hurley EA, Harvey SA, Winch PJ, Keita M, Roter DL, Doumbia S, Diarra NH, Kennedy CE. The Role of Patient-Provider Communication in Engagement and Re-engagement in HIV Treatment in Bamako, Mali: A Qualitative Study. JOURNAL OF HEALTH COMMUNICATION 2017; 23:129-143. [PMID: 29281593 DOI: 10.1080/10810730.2017.1417513] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Mounting evidence in sub-Saharan Africa suggests poor patient-provider communication (PPC) negatively impacts patient engagement (retention in care and adherence to medication) in antiretroviral therapy (ART) programs. In Bamako, Mali, where 36% of ART patients are lost to follow-up within 12 months of initiating treatment, we aimed to define features of positive PPC according to patient values and explore the mechanisms by which these features may sustain engagement and re-engagement according to patient and provider experiences. We conducted 33 in-depth interviews and 7 focus groups with 69 patients and 17 providers in five ART clinics. Regarding sustaining engagement, participants highlighted "establishing rapport" as a foundational feature of effective PPC, but also described how "responding to emotional needs", "eliciting patient conflicts and perspective" and "partnering to mitigate conflicts" functioned to address barriers to engagement and increase connectedness to care. Patients who had disengaged felt that "communicating reacceptance" may have prompted them re-engage sooner and that tailored "partnering to mitigate conflicts" would be more effective in sustaining re-engagement than the standard adherence education providers typically offer. Optimizing provider skills related to these key PPC features may help maximize ART patient engagement, ultimately improving health outcomes and decreasing HIV transmission in sub-Saharan Africa.
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Affiliation(s)
- Emily A Hurley
- a Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
- b Health Services and Outcomes Research , Children's Mercy Hospital , Kansas City , MO , USA
| | - Steven A Harvey
- a Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Peter J Winch
- a Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Mariam Keita
- c Faculté de Medecine et d'OdontoStomatologie , Université des Sciences, des Techniques et des Technologies de Bamako , Bamako , Mali
| | - Debra L Roter
- d Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Seydou Doumbia
- c Faculté de Medecine et d'OdontoStomatologie , Université des Sciences, des Techniques et des Technologies de Bamako , Bamako , Mali
| | - Nièlè H Diarra
- c Faculté de Medecine et d'OdontoStomatologie , Université des Sciences, des Techniques et des Technologies de Bamako , Bamako , Mali
| | - Caitlin E Kennedy
- a Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Roy M, Czaicki N, Holmes C, Chavan S, Tsitsi A, Odeny T, Sikazwe I, Padian N, Geng E. Understanding Sustained Retention in HIV/AIDS Care and Treatment: a Synthetic Review. Curr HIV/AIDS Rep 2017; 13:177-85. [PMID: 27188300 DOI: 10.1007/s11904-016-0317-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Sustained retention represents an enduring and evolving challenge to HIV treatment programs in Africa. We present a theoretical framework for sustained retention borrowing from ecologic principles of sustainability and dynamic adaptation. We posit that sustained retention from the patient perspective is dependent on three foundational principles: (1) patient activation: the acceptance, prioritization, literacy, and skills to manage a chronic disease condition, (2) social normalization: the engagement of a social network and harnessing social capital to support care and treatment, and (3) livelihood routinization: the integration of care and treatment activities into livelihood priorities that may change over time. Using this framework, we highlight barriers specific to sustained retention and review interventions addressing long-term, sustained retention in HIV care with a focus on Sub-Saharan Africa.
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Affiliation(s)
- Monika Roy
- University of California San Francisco, San Francisco, USA.
| | | | - Charles Holmes
- Centre for Infectious Diseases Research Zambia, Zambia, Africa.,Johns Hopkins University, Baltimore, USA
| | - Saurabh Chavan
- University of California San Francisco, San Francisco, USA
| | | | - Thomas Odeny
- Kenya Medical Research Institute, Center for Microbiology Research, Nairobi, Kenya.,University of Washington, Seattle, USA
| | | | - Nancy Padian
- University of California Berkeley, Berkeley, USA
| | - Elvin Geng
- University of California San Francisco, San Francisco, USA
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21
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Gugsa S, Potter K, Tweya H, Phiri S, Sande O, Sikwese P, Chikonda J, O’Malley G. Exploring factors associated with ART adherence and retention in care under Option B+ strategy in Malawi: A qualitative study. PLoS One 2017. [PMID: 28636669 PMCID: PMC5479573 DOI: 10.1371/journal.pone.0179838] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Although several studies have documented challenges related to inadequate adherence to antiretroviral therapy (ART) and high loss to follow-up (LTFU) among Option B+ women, there is limited understanding of why these challenges occur and how to address them. This qualitative study examines women's experiences with ART adherence and retention in care. Between July and October 2015, in-depth interviews were conducted with 39 pregnant and lactating women who initiated ART at Bwaila Hospital in Lilongwe, Malawi. Study participants included 14 in care and 25 out of care women, according to facility records. Data were analyzed using an inductive, open-coding approach to thematic analysis. Ten of the respondents (7 out of care, 3 in-care) had stopped and re-started treatment before the interview date. One of the most important factors influencing adherence and retention was the strength of women's support systems. In contrast to women in-care, most out-of-care women lacked emotional and financial support from male partners, received minimal counseling from providers at initiation, lacked designated guardians to assist with medication refills or clinic appointments, and were highly mobile. Mobility led to difficulties in accessing treatment in new settings. The most common reasons women re-started treatment following interruptions were due to providers' counseling and encouragement and the mother's desire to be healthy. Improved counseling at initiation, active follow-up counseling, women's economic empowerment interventions, promotion of peer counseling schemes and meaningful engagement of male partners can help in addressing the identified barriers and promoting sustained retention of Option B+ women.
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Affiliation(s)
- Salem Gugsa
- Lighthouse Trust, Lilongwe, Malawi
- International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health, Seattle, Washington, United States of America
- * E-mail:
| | - Katy Potter
- International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health, Seattle, Washington, United States of America
| | - Hannock Tweya
- Lighthouse Trust, Lilongwe, Malawi
- The International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Sam Phiri
- Lighthouse Trust, Lilongwe, Malawi
- University of North Carolina, School of Medicine, Department of Medicine, Chapel Hill, North Carolina, United States of America
- University of Malawi, College of Medicine, School of Public Health and Family Medicine, Department of Public Health, Lilongwe, Malawi
| | | | | | - Janet Chikonda
- Ministry of Health, District Health Office, Lilongwe, Malawi
| | - Gabrielle O’Malley
- International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health, Seattle, Washington, United States of America
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Patient-provider communication styles in HIV treatment programs in Bamako, Mali: A mixed-methods study to define dimensions and measure patient preferences. SSM Popul Health 2017; 3:539-548. [PMID: 29270460 PMCID: PMC5734639 DOI: 10.1016/j.ssmph.2017.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Effective patient-provider communication (PPC) promotes patient adherence and retention in long-term care. Sub-Saharan Africa faces unprecedented demand for chronic care for HIV patients on antiretroviral therapy (ART), yet adherence and retention remain challenging. In high-income countries, research describing patient preferences for different PPC styles has guided interventions to improve PPC and patient outcomes. However, research on PPC preferences in sub-Saharan Africa is limited. We sought to define PPC dimensions relevant to ART programs in Bamako, Mali through recordings of clinical interactions, in-depth interviews and focus-group discussions with 69 patients and 17 providers. To assess preferences toward contrasting PPC styles within dimensions, we conducted a vignette-based survey with 141 patients across five ART facilities. Qualitative analysis revealed two PPC dimensions similar to those described in the literature on patient-centered communication (level of psychosocial regard, balance of power), and one unique dimension that emerged from the data (guiding patient behavior: easy/tough/sharp). Significantly more survey participants chose the vignette demonstrating high psychosocial regard (52.2%) compared to a biomedical style (22.5%) (p<0.001). Within balance of power, a statistically similar proportion of participants chose the vignette demonstrating shared power (40.2%) compared to a provider-dominated style (35.8%). In guiding patient behavior, a similar proportion of participants preferred the vignette depicting the “easy” (38.4%) and/or “tough” style (40.6%), but significantly fewer preferred the “sharp” style (14.5%) (p<0.001). Highly educated participants chose biomedical and shared power styles more frequently, while less educated participants more frequently indicated “no preference”. Working to understand, develop, and tailor PPC styles to patients in chronic care may help support patient retention and ultimately, clinical outcomes. Emphasis on developing skills in psychosocial regard and on adapting styles of power balance and behavioral guidance to individual patients is likely to yield positive results and should be considered a high priority for ART providers. Examines patient preferences among culturally-relevant PPC styles. Most patients preferred the “high psychosocial regard” over the “biomedical” style. Patients were split in preference for “shared power” versus “provider-dominant”. Preferences were split between “easy” versus “tough” style of recommending behavior change. Patients with lower education were more likely to indicate “no preference” among PPC styles.
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Identifying common barriers and facilitators to linkage and retention in chronic disease care in western Kenya. BMC Public Health 2016; 16:741. [PMID: 27503191 PMCID: PMC4977618 DOI: 10.1186/s12889-016-3462-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 08/05/2016] [Indexed: 11/27/2022] Open
Abstract
Background Sub-Saharan Africa is increasingly being challenged in providing care and treatment for chronic diseases, both communicable and non-communicable. In order to address the challenges of linkage to and retention in chronic disease management, there is the need to understand the factors that can influence engagement in care. We conducted a qualitative study to identify barriers and facilitators to linkage and retention in chronic care for HIV, tuberculosis (TB) and Hypertension (HTN) as part of the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya. Methods In-depth interviews and focus group discussions were conducted July 2012-August 2013. Study participants were purposively sampled from three AMPATH clinics and included patients within the AMPATH program receiving HIV, TB, and HTN care, as well as caregivers of children with HIV, community leaders, and healthcare providers. A set of interview guides were developed to explore perceived barriers and facilitators to chronic disease management, particularly related to linkage to and retention in HIV, TB and HTN care. Data were coded and various themes were identified. We organized the concepts and themes generated using the Andersen-Newman Framework of Health Services Utilization. Results A total of 235 participants including 110 individuals living with HIV (n = 50), TB (n = 39), or HTN (n = 21); 24 caregivers; 10 community leaders; and 62 healthcare providers participated. Barriers and facilitators were categorized as predisposing characteristics, enabling resources and need factors. Many of the facilitators and barriers reported in this study were consistently reported across disease categories including personal drive, patient-provider relationships and the need for social and peer support. Conclusions Our findings provide insight into the individual as well as broader structural factors that can deter or encourage linkage and retention that are relevant across communicable and non-communicable chronic diseases. The findings of the present study suggest that interventions should consider the logistical aspects of accessing care in addition to predisposing and need factors that may affect an individuals’ decision to seek out and remain in appropriate care.
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MacLachlan EW, Potter K, Hamunime N, Shepard-Perry MG, Uusiku J, Simwanza R, Brandt LJ, O’Malley G. "We Are Now Free to Speak": Qualitative Evaluation of an Education and Empowerment Training for HIV Patients in Namibia. PLoS One 2016; 11:e0153042. [PMID: 27054712 PMCID: PMC4824517 DOI: 10.1371/journal.pone.0153042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 03/22/2016] [Indexed: 11/19/2022] Open
Abstract
Although numerous studies provide evidence that active patient engagement with health care providers improves critical outcomes such as medication adherence, very few of these have been done in low resource settings. In Namibia, patient education and empowerment trainings were conducted in four antiretroviral (ART) clinics to increase patient engagement during patient-provider interactions. This qualitative study supplements findings from a randomized controlled trial, by analyzing data from 10 in-depth patient interviews and 94 training evaluation forms. A blended approach of deductive and inductive coding was used to understand training impact. Findings indicated the trainings increased patients’ self-efficacy through a combination of improved HIV-related knowledge, greater communication skills and enhanced ability to overcome complex psychosocial barriers, such as fear of speaking up to providers. This study suggests patient empowerment training may be a powerful method to engage HIV patients in their own care and treatment.
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Affiliation(s)
- Ellen W. MacLachlan
- PATH, Reproductive Health Program, Seattle, Washington, United States of America
- International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health, Seattle, Washington, United States of America
| | - Katy Potter
- International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health, Seattle, Washington, United States of America
| | - Ndapewa Hamunime
- Namibia Ministry of Health and Social Services (MoHSS), Windhoek, Namibia
| | - Mark G. Shepard-Perry
- International Training and Education Center for Health (I-TECH) Namibia, Windhoek, Namibia
| | - James Uusiku
- International Training and Education Center for Health (I-TECH) Namibia, Windhoek, Namibia
| | - Ricky Simwanza
- Namibia Ministry of Health and Social Services (MoHSS), Windhoek, Namibia
| | - Laura J. Brandt
- International Training and Education Center for Health (I-TECH) Namibia, Windhoek, Namibia
| | - Gabrielle O’Malley
- International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health, Seattle, Washington, United States of America
- * E-mail:
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Maclachlan EW, Shepard-Perry MG, Ingo P, Uusiku J, Mushimba R, Simwanza R, Likoro J, Brandt LJ, Thomas KK, Kasonka C, Hamunime N, O'Malley G. Evaluating the effectiveness of patient education and empowerment to improve patient-provider interactions in antiretroviral therapy clinics in Namibia. AIDS Care 2015; 28:620-7. [PMID: 26695005 PMCID: PMC4841015 DOI: 10.1080/09540121.2015.1124975] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 11/23/2015] [Indexed: 11/04/2022]
Abstract
In order to increase patient active engagement during patient-provider interactions, we developed and implemented patient training sessions in four antiretroviral therapy (ART) clinics in Namibia using a "Patient Empowerment" training curriculum. We examined the impact of these trainings on patient-provider interactions after the intervention. We tested the effectiveness of the intervention using a randomized parallel group design, with half of the 589 enrolled patients randomly assigned to receive the training immediately and the remaining randomized to receive the training 6 months later. The effects of the training on patient engagement during medical consultations were measured at each clinic visit for at least 8 months of follow-up. Each consultation was audiotaped and then coded using the Roter Interaction Analysis System (RIAS). RIAS outcomes were compared between study groups at 6 months. Using intention-to-treat analysis, consultations in the intervention group had significantly higher RIAS scores in doctor facilitation and patient activation (adjusted difference in score 1.19, p = .004), doctor information gathering (adjusted difference in score 2.96, p = .000), patient question asking (adjusted difference in score .48, p = .012), and patient positive affect (adjusted difference in score 2.08, p = .002). Other measures were higher in the intervention group but did not reach statistical significance. We have evidence that increased engagement of patients in clinical consultation can be achieved via a targeted training program, although outcome data were not available on all patients. The patient training program was successfully integrated into ART clinics so that the trainings complemented other services being provided.
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Affiliation(s)
- Ellen W Maclachlan
- a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA
| | - Mark G Shepard-Perry
- a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA
| | - Paulina Ingo
- b International Training and Education Center for Health (I-TECH) , Ondangwa , Namibia
| | - James Uusiku
- b International Training and Education Center for Health (I-TECH) , Ondangwa , Namibia
| | - Ruusa Mushimba
- c International Organization for Migration (IOM) , Windhoek , Namibia
| | - Ricky Simwanza
- d Ministry of Health and Social Services (MoHSS) , Katima Mulilo , Namibia
| | - Joseph Likoro
- e The Global Fund to Fight AIDS, Tuberculosis and Malaria , Windhoek , Namibia
| | - Laura J Brandt
- f International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health , Windhoek , Namibia
| | - Katherine K Thomas
- g International Clinical Research Center (ICRC), University of Washington Department of Global Health , Seattle , WA , USA
| | - Claude Kasonka
- h Monitoring and Evaluation Unit , Millennium Challenge Account , Lusaka , Zambia
| | - Ndapewa Hamunime
- i Namibia Ministry of Health and Social Services , Directorate of Special Programs (MoHSS/DSP, Windhoek, Namibia)
| | - Gabrielle O'Malley
- a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA
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Bigna JJR, Noubiap JJN, Plottel CS, Kouanfack C, Koulla-Shiro S. Factors associated with non-adherence to scheduled medical follow-up appointments among Cameroonian children requiring HIV care: a case-control analysis of the usual-care group in the MORE CARE trial. Infect Dis Poverty 2014; 3:44. [PMID: 25671122 PMCID: PMC4322435 DOI: 10.1186/2049-9957-3-44] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 11/12/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A better understanding of why HIV-exposed/infected children fail to attend their scheduled follow-up medical appointments for HIV-related care would allow for interventions to enhance the delivery of care. The aim of this study was to determine characteristics of the caregiver-child dyad (CCD) associated with children's non-adherence to scheduled follow-up medical appointments in HIV programs in Cameroon. METHODS We conducted a case-control analysis of the usual-care group of CCDs from the MORE CARE trial, in which the effect of mobile phone reminders for HIV-exposed/infected children in attending follow-up appointments was assessed from January to March 2013. For this study, the absence of a child at their appointment was considered a case and the presence of a child at their appointment was defined as a control. We used three multivariate binary logistic regression analyses. The best-fit model was the one which had the smallest chi-square value with the Hosmer-Lemeshow test (HLχ²). Magnitudes of associations were expressed by odds ratio (OR), with a p-value <0.05 considered as statistically significant. RESULTS We included 30 cases and 31 controls. Our best-fit model which considered the sex of the adults and children separately (HL χ²=3.5) showed that missing scheduled medical appointments was associated with: lack of formal education of the caregiver (OR 29.1, 95% CI 1.1-777.0; p=0.044), prolonged time to the next appointment/follow-up (OR [1 week increase] 1.4, 95% CI 1.03-2.0; p=0.032), and being a female child (OR 5.2, 95% CI 1.2-23.1; p=0.032). One model (HLχ²=10.5) revealed that woman-boy pairs adhered less to medical appointments compared to woman-girl pairs (OR 4.9, 95% CI 1.05-22.9; p=0.044). Another model (HLχ²=11.1) revealed that man-boy pairs were more likely to attend appointments compared to woman-girl pairs (OR 0.23, 95% CI 0.06-0.93; p=0.039). There were no statistical associations for the ages of the children or the caregivers, the study sites, or the HIV status (confirmed vs. suspected) of the children. CONCLUSION The profile of children who would not attend follow-up medical appointments in an HIV program was: a female, with a caregiver who has had no formal education, and with a longer follow-up appointment interval. There is a possibility that female children are favored by female caregivers and that male children are favored by male caregivers when they come to medical care.
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Affiliation(s)
- Jean Joel R Bigna
- />Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaoundé, Cameroon
- />Faculty of Medicine, University of Montpellier 1, Montpellier, France
- />Preventing Mother to Child Transmission Unit, Goulfey District Hospital, Goulfey, Cameroon
| | | | - Claudia S Plottel
- />Department of Medicine, New York University Langone Medical Center, New York, USA
| | - Charles Kouanfack
- />Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaoundé, Cameroon
- />Accredited Treatment Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Sinata Koulla-Shiro
- />Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaoundé, Cameroon
- />Infectious Diseases Unit, Yaoundé Central Hospital, Yaoundé, Cameroon
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