Satisfaction with innovative community and university health clinic programs for groups of traditionally underserved individuals with HIV/AIDS: empirical models

"You've gotta know the community": minority women make recommendations about community-focused health research

OBJECTIVES

To determine what ethnic and racial minority women recommend as the best approaches to participatory health research in their communities. To achieve this goal, this study focused on HIV prevention research.

METHODS

In 2003, Seven African American and seven Latina women (ages 33 to 52), all members of an HIV Prevention Collaborative Board, participated in individual interviews, lasting about 90 minutes each. Participants discussed their involvement in participatory research, and made recommendations as to how health researchers might better engage their communities. Data were coded independently by two coders following standard procedure for content analysis.

RESULTS

Women's voices and expertise can help guide health-related research. This study shows that: (1) participatory HIV prevention research should be founded on trust and commitment, leading to social support; (2) research partners ought to come from diverse backgrounds and be knowledgeable about the community and willing to work on common objectives; and (3) collaborative partnerships ought to portray an image of strength and cohesion, and a clear articulation of the mission around a research project.

IMPLICATIONS

To develop meaningful health research, researchers need to establish long-term ongoing relationships with community collaborators, including minority women from diverse backgrounds. Researchers ought to take a holistic approach working with communities, and ought to consider their research interests vis-a-vis the community's needs.

Beyond satisfaction: using the Dynamics of Care assessment to better understand patients' experiences in care

BACKGROUND

Patient perceptions of and satisfaction with care have become important indicators of the quality of services and the relationship of services to treatment outcomes. However, assessment of these indicators continues to be plagued by measurement problems, particularly the lack of variance in satisfaction data. In this article, we present a new approach to better capture patient perceptions of experiences in care, the Dynamics of Care (DoC) assessment. It is an in-depth approach to defining and assessing patients' perspectives at different junctures in care, including their decisions about whether and where to seek care, the barriers encountered, and the treatments and services received.

METHODS

The purpose of this article is to describe, validate, and discuss the benefits and limitations of the DoC, which was administered as part of a longitudinal study to evaluate the New York State HIV Special Needs Plan (SNP), a Medicaid managed care model for people living with HIV/AIDS. Data are from 426 study respondents across two time points.

RESULTS

The results demonstrate the validity and value of the DoC. Help seeking decisions and satisfaction with care appear to be situation-specific, rather than person-specific. However, barriers to care appear to be more cross-situational for respondents, and may be associated with clients' living situations or care arrangements. Inventories in this assessment that were designed to identify potential deterrents to help seeking and difficulties encountered in care demonstrated clear principal component structures, and helped to explain satisfaction with care. The problem resolution index was found to be independent from satisfaction with care and the data were more normally distributed. DoC data were also associated with subsequent utilization and change in quality of life.

CONCLUSION

The DoC was designed to be a flexible, integrated measure to determine individuals' salient service needs, help seeking and experiences in care. One of the many strengths of the assessment is its focus on specific problems in context, thus providing a more sensitive and informative way to understand processes in care from the patient's perspective. This approach can be used to direct new programs and resources to the patients and situations that require them.

HIV-positive women and minority patients' satisfaction with inpatient hospital care

Although patient satisfaction has been examined in relation to HIV services for ambulatory and managed care, less is known about perceptions of hospital care, particularly for HIV-positive women and minorities. The purpose of this study was to examine HIV-positive women and minority patients' satisfaction with hospital care. The study was part of a larger funded study that explored potential health care disparities for HIV-positive women and minority persons in the era of HIV combination drug therapy. A convenience sample of 50 HIV-positive persons was recruited from four medical centers/hospitals in a South Florida community. The multi-ethnic sample included 31 women and 19 men. The survey tool used was Cleary's HIV-Infected Patient's In-Hospital Questionnaire. Findings revealed that participants were generally satisfied with their hospital care. Physicians, nurses, and the hospital environment received satisfactory ratings. However, several problem areas were identified, including pain management and education on side effects of HIV medications, indicating the need for interventions to improve care. Experimental AIDS drugs were discussed with less than half of the participants, suggesting that HIV-positive women and minority patients may not have equal access to clinical drug trials. Further research is also needed to determine whether attitudes conveyed by health care providers influence HIV-positive patients to be wary of advance directives. The competence of nurses experienced in acute-care nursing of persons with HIV/AIDS was an important factor in patient satisfaction. A lack of experienced acute-care AIDS nurses may ultimately lead to a decrease in HIV-positive patients' satisfaction with hospital care.