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Keating EM, Sakita F, Vonderohe M, Nkini G, Amiri I, Loutzenheiser K, Young B, Rent S, Staton CA, Mmbaga BT, Watt MH. Family caregiver perspectives on strengths and challenges in the care of pediatric injury patients at a tertiary referral hospital in Northern Tanzania. PLoS One 2023; 18:e0286836. [PMID: 38100475 PMCID: PMC10723720 DOI: 10.1371/journal.pone.0286836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/26/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Pediatric injuries are a leading cause of morbidity and mortality in low- and middle-income countries (LMICs). It is important that injured children get quality care in order to improve their outcomes. Injured children are nearly always accompanied by family member caregivers invested in their outcome, and who will be responsible for their recovery and rehabilitation after discharge. OBJECTIVE The purpose of this study was to identify family member caregiver perspectives on strengths and challenges in pediatric injury care throughout hospitalization at a tertiary hospital in Northern Tanzania. METHODS This study was conducted at a zonal referral hospital in Northern Tanzania. Qualitative semi-structured in-depth interviews (IDIs) were conducted by trained interviewers who were fluent in English and Swahili in order to examine the strengths and challenges in pediatric injury care. IDIs were completed from November 2020 to October 2021 with 30 family member caregivers of admitted pediatric injured patients. De-identified transcripts were synthesized in memos and analyzed through a team-based, thematic approach informed by applied thematic analysis. RESULTS Strengths and challenges were identified throughout the hospital experience, including emergency medicine department (EMD) care, inpatient wards care, and discharge. Across the three phases, strengths were identified such as how quickly patients were evaluated and treated, professionalism and communication between healthcare providers, attentive nursing care, frequent re-evaluation of a patient's condition, and open discussion with caregivers about readiness for discharge. Challenges identified related to lack of communication with caregivers, perceived inability of caregivers to ask questions, healthcare providers speaking in English during rounds with lack of interpretation into the caregivers' preferred language, and being sent home without instructions for rehabilitation, ongoing care, or guidance for follow-up. CONCLUSION Caregiver perspectives highlighted strengths and challenges throughout the hospital experience that could lead to interventions to improve the care of pediatric injury patients in Northern Tanzania. These interventions include prioritizing communication with caregivers about patient status and care plan, ensuring all direct communication is in the caregivers' preferred language, and standardizing instructions regarding discharge and follow-up.
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Affiliation(s)
- Elizabeth M. Keating
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Francis Sakita
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Maddy Vonderohe
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Getrude Nkini
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Ismail Amiri
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Kelly Loutzenheiser
- College of Nursing, University of Utah, Salt Lake City, UT, United States of America
| | - Bryan Young
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Sharla Rent
- Department of Pediatrics, Duke School of Medicine, Durham, North Carolina, United States of America
| | - Catherine A. Staton
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Melissa H. Watt
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, United States of America
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Josma D, Morris J, Hopkins R, Quamina A, Siegler AJ, Holland D, Sullivan P, Harrington KRV, Alohan DI, Crawford ND. Comparing open-ended question methods to vignette methods to explore willingness to obtain pre-exposure prophylaxis access in pharmacies among black men who have sex with men. AIDS Care 2023; 35:1955-1962. [PMID: 36892947 PMCID: PMC10491733 DOI: 10.1080/09540121.2023.2185193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023]
Abstract
Black men who have sex with men (BMSM) are at higher risk of HIV transmission than any other group; however, their uptake of the highly effective HIV prevention medication, pre-exposure prophylaxis (PrEP), is low. In collaboration with a communitybased organization in Atlanta, Georgia, we explored ten HIV-negative BMSM's willingness to obtain PrEP in pharmacies using standard open-ended and vignette qualitative methods. Three overarching themes were identified: privacy, patient-pharmacist interactions, and HIV/STI screening. While open-ended questions allowed participants to provide broad answers on their willingness to receive prevention services at a pharmacy, the vignette drew out specific responses to facilitate in-pharmacy PrEP delivery. Using both openended questions and vignette data collection strategies, BMSM reported high willingness to screen for and uptake PrEP in pharmacies. However, the vignette method allowed for greater depth. Open-ended questions elicited responses that highlighted general barriers and facilitators of PrEP dispensing in pharmacies. However, the vignette allowed participants to customize a plan of action that would best fit their needs. Vignette methods are underutilized in HIV research and may be helpful in supplementing standard open-ended interview questions to uncovering unknown challenges about health behaviors and obtain more robust data on highly sensitive research topics in HIV research.
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Affiliation(s)
| | - Joseph Morris
- National Center for Emerging, Zoonotic, and Infectious Diseases, Office of Innovation, Development, Analytics, and Evaluation, Centers for Disease Control and Prevention
| | - Roderick Hopkins
- Division of Global Migration and Quarantine (DGMQ), Community Interventions for Infection Control Unit (CI-ICU), Centers for Disease Control and Prevention
| | | | - Aaron J. Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Daniel I. Alohan
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, GA, USA
| | - Natalie D. Crawford
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, GA, USA
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Sileo KM, Wanyenze RK, Anecho A, Luttinen R, Semei C, Mukasa B, Musoke W, Vermund SH, Dworkin SL, Dovidio JF, Taylor BS, Kershaw TS. Protocol for the pilot quasi-experimental controlled trial of a gender-responsive implementation strategy with providers to improve HIV outcomes in Uganda. Pilot Feasibility Stud 2022; 8:264. [PMID: 36564795 PMCID: PMC9783690 DOI: 10.1186/s40814-022-01202-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 11/09/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Antiretroviral treatment (ART) is the most effective clinical intervention for reducing morbidity and mortality among persons living with HIV. However, in Uganda, there are disparities between men and women in viral load suppression and related HIV care engagement outcomes, which suggests problems with the implementation of ART. Gender norms are a known driver of HIV disparities in sub-Saharan Africa, and patient-provider relationships are a key factor in HIV care engagement; therefore, the role of gender norms is important to consider in interventions to achieve the equitable provision of treatment and the quality of ART counseling. METHODS The overall research objective of this study is to pilot test an implementation strategy (i.e., methods to improve the implementation of an evidence-based intervention) to increase providers' capacity to provide gender-responsive treatment and counseling to men and women on HIV treatment in Uganda. Delivered to HIV providers, this group training adapts evidence-based strategies to reduce gender biases and increase skills to deliver gender-specific and transformative HIV counseling to patients. The implementation strategy will be piloted through a quasi-experimental controlled trial. Clinics will be randomly assigned to either the intervention or control conditions. The trial will assess feasibility and acceptability and explore barriers and facilitators to implementation and future adoption while gathering preliminary evidence on the implementation strategy's effectiveness by comparing changes in patient (N = 240) and provider (N = 80-140) outcomes across intervention and control clinics through 12-month follow-up. Quantitative data will be descriptively analyzed, qualitative data will be analyzed through thematic analysis, and these data will be mixed during the presentation and interpretation of results where appropriate. DISCUSSION This pilot intervention trial will gather preliminary evidence on the acceptability, feasibility, and potential effect of a novel implementation strategy to improve men and women's HIV care engagement, with the potential to reduce gender disparities in HIV outcomes. TRIAL REGISTRATION Clinicaltrials.gov NCT05178979 , retrospectively registered on January 5, 2022.
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Affiliation(s)
- K M Sileo
- Department of Public Health, The University of Texas at San Antonio, San Antonio, TX, USA.
| | - R K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - A Anecho
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - R Luttinen
- Department of Demography, The University of Texas at San Antonio, San Antonio, TX, USA
| | - C Semei
- Mildmay Uganda, Kampala, Uganda
| | | | | | - S H Vermund
- Yale School of Public Health, New Haven, CT, USA
| | - S L Dworkin
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, USA
| | - J F Dovidio
- Department of Psychology, Yale University, New Haven, CT, USA
| | - B S Taylor
- Division of Infectious Diseases, Department of Medicine, Joe R. & Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - T S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Hook K, Ametaj A, Cheng Y, Serba EG, Henderson DC, Hanlon C, Ng LC. Psychotherapy in a resource-constrained setting: Understanding context for adapting and integrating a brief psychological intervention into primary care. Psychotherapy (Chic) 2021; 58:557-575. [PMID: 34410763 PMCID: PMC8664957 DOI: 10.1037/pst0000364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Low- and middle-income countries have few mental health professionals, and efforts to increase access to treatment are a global priority. A key gap is the lack of integration of psychotherapy interventions as a part of accessible evidence-based care. Current recommendations suggest that the integration of mental health treatments, including psychotherapy, into existing primary care pathways may serve as a means to address this disparity. Understanding the cultural and contextual factors that affect this process is a critical step in identifying necessary adaptations. The aim of this qualitative study was to identify contextual factors associated with integrating psychotherapy in primary care in a predominantly rural district in south-central Ethiopia. Purposive sampling was used to recruit 48 mental health service users, caregivers, health care providers, and community leaders. Semistructured interviews were conducted, recorded, and transcribed in Amharic and translated into English. Although challenges (e.g., stigma, job strain, lack of belief in formal treatments) are present, other existing strengths (e.g., openness to seeking treatment, increasing knowledge about mental health treatment, familiarity with practices similar to therapy) support subsequent psychotherapy adaptation and implementation. These findings suggest possible mechanisms to improve delivery and adaptation in the effort to lower the existing global treatment gap. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Kimberly Hook
- Boston Medical Center, Department of Psychiatry, Boston, MA, USA
- Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
| | - Amantia Ametaj
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, USA
| | | | - Eyerusalem G. Serba
- Addis Ababa University, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa, Ethiopia
| | - David C. Henderson
- Boston Medical Center, Department of Psychiatry, Boston, MA, USA
- Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA
| | - Charlotte Hanlon
- Addis Ababa University, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa, Ethiopia
- King’s College London, Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lauren C. Ng
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
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Comparison of Patient Versus Trained Observer Assessments of Healthcare Providers' Use of Motivational Interviewing Techniques for Patients Experiencing Depression and Anxiety in the Dominican Republic. J Clin Psychol Med Settings 2021; 29:206-219. [PMID: 34143354 PMCID: PMC8211715 DOI: 10.1007/s10880-021-09781-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 11/17/2022]
Abstract
In settings with limited mental health system capacity, integrated care and the improvement of patient-provider communication surrounding common mental disorders is critical to advancing treatment outcomes. We trained primary care providers in the Dominican Republic in motivational interviewing (MI) to improve communication with patients experiencing depression and anxiety. Providers were randomized to an intervention group, which received MI training, or a control group. To evaluate the training’s effectiveness, patients assessed their clinical encounters using the Motivational Interviewing Measure of Staff Interaction (MIMSI). Trained research assistants (RAs) rated a sub-set of those interactions using an adapted MIMSI instrument. Overall, patients (n = 36) perceived their interactions with providers (n = 10) very positively; however, the RAs’ ratings strongly indicated that providers’ application of MI behaviors was insufficient. Patients generally could not distinguish between intervention and control providers. Findings underscore the need to carefully consider optimal training delivery and cultural influences surrounding the implementation of MI mental health interventions in settings where directive communication is highly valued.
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Jarrett BA, Woznica DM, Tilchin C, Mpungose N, Motlhaoleng K, Golub JE, Martinson NA, Hanrahan CF. Promoting Tuberculosis Preventive Therapy for People Living with HIV in South Africa: Interventions Hindered by Complicated Clinical Guidelines and Imbalanced Patient-Provider Dynamics. AIDS Behav 2020; 24:1106-1117. [PMID: 31549265 DOI: 10.1007/s10461-019-02675-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Isoniazid preventive therapy (IPT) reduces the risk of active tuberculosis among people living with HIV, but implementation of IPT in South Africa and elsewhere remains slow. The objective of this study was to examine both nurse perceptions of clinical mentorship and patient perceptions of in-queue health education for promoting IPT uptake in Potchefstroom, South Africa. We measured adoption, fidelity, acceptability, and sustainability of the interventions using both quantitative and qualitative methods. Adoption, fidelity, and acceptability of the interventions were moderately high. However, nurses believed they could not sustain their increased prescriptions of IPT, and though many patients intended to ask nurses about IPT, few did. Most patients attributed their behavior to an imbalance of patient-provider power. National IPT guidelines should be unambiguous and easily implemented after minimal training on patient eligibility and appropriate medication durations, nurse-patient dynamics should empower the patient, and district-level support and monitoring should be implemented.
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Affiliation(s)
- Brooke A Jarrett
- Department of Epidemiology, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Daniel M Woznica
- Department of Health, Behavior and Society, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Carla Tilchin
- Center for Child and Community Health Research, Johns Hopkins University, 5200 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Nthabiseng Mpungose
- Perinatal HIV Research Unit, SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - Katlego Motlhaoleng
- Perinatal HIV Research Unit, SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan E Golub
- Department of Epidemiology, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, USA
- Johns Hopkins School of Medicine, 33 N Broadway, Baltimore, MD, 21205, USA
| | - Neil A Martinson
- Perinatal HIV Research Unit, SAMRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
| | - Colleen F Hanrahan
- Department of Epidemiology, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, USA
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Searle AR, Hurley EA, Doumbia SO, Winch PJ. "They Merely Prescribe and I Merely Swallow": Perceptions of Antenatal Pharmaceuticals and Nutritional Supplements Among Pregnant Women in Bamako, Mali. Matern Child Health J 2020; 24:110-120. [PMID: 31515675 DOI: 10.1007/s10995-019-02808-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES New international guidelines for antenatal care (ANC) will likely result in an increase in nutritional supplements and preventative medications for pregnant women in low and middle-income countries. Our objective was to understand how pregnant women in Mali perceive and experience multi-drug regimens in ANC in order to reveal factors that may influence uptake and adherence. METHODS We conducted 29 semi-structured interviews and three focus groups with 21 pregnant women in two urban ANC sites in Bamako, Mali. Interviews focused on perception of purpose of ANC pharmaceuticals (particularly iron supplements, sulfadoxine-pyrimethamine as intermittent prevention of malaria and antiretroviral therapy for HIV), beliefs regarding efficacy and risk, and understanding of dosage and regimen. Transcripts were inductively coded and analyzed using the 'Framework' method. RESULTS Participant descriptions of medication purpose, understanding of dosing, and beliefs about risks and efficacy varied widely, revealing that many pregnant women lack complete information about their medications. While some were burdened by side effects or complex regimens, women generally held favorable attitudes toward ANC medications. Responses suggest major barriers to adherence lie in the health system, namely insufficient patient-provider communication and inconsistent prescribing practices. CONCLUSIONS FOR PRACTICE National health programs looking to improve maternal and child health with ANC pharmaceuticals need to place greater attention on patient counseling and consistent implementation of administration guidelines. Communication that positions pharmaceuticals as beneficial to mother and child, while presenting understandable information about purpose, dosing and potential side effects can promote uptake of multi-drug regimens and ANC services in general.
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Affiliation(s)
- Alexandra R Searle
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Emily A Hurley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.,Health Services and Outcomes Research, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Seydou O Doumbia
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA
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Communication in nurse-patient interaction in healthcare settings in sub-Saharan Africa: A scoping review. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2020.100198] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Goba GK. Translation, Adaptation, and Assessment of the Communication Assessment Tool in Tigray, Northern Ethiopia. J Grad Med Educ 2019; 11:141-145. [PMID: 31428271 PMCID: PMC6697305 DOI: 10.4300/jgme-d-18-00711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 02/22/2019] [Accepted: 03/13/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Ethiopia has experienced tremendous growth in medical education beginning in the early 2000s. Research shows a need for emphasis on empathy and compassionate care in this setting. In the United States, the Communication Assessment Tool (CAT) is a widely used, validated survey measuring provider-patient interactions. OBJECTIVE The goal of this study was to translate, culturally adapt, and pilot the CAT to allow it to be used with trainees and patients in Ethiopia. METHODS Bilingual experts translated the CAT into Tigrigna, the primary language of the Tigray region in northern Ethiopia, followed by focus group discussions, back translation, and review by the original author of the CAT. The translated tool was administered to the patients of resident physicians in 6 specialties at Ayder Referral Hospital between December 2016 and February 2017. RESULTS Our translation of the CAT into Tigrigna had semantic, idiomatic, and experiential equivalence. Of 1024 patients recruited, 1002 (98%) completed interviews using the CAT. Mean score was 3.09; 3% of all scores were excellent and 54% were good. Cronbach's alpha score for the full survey was 0.942, demonstrating high reliability. CONCLUSIONS The translated CAT in Tigrigna can be used to assess communication skills in Ethiopian residents. Both mean score and percentage of excellent scores were considerably lower than scores in other countries, suggesting that there may be opportunities for improvement in residents' communication skills.
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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] [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. Electronic supplementary material The online version of this article (10.1186/s12889-019-7283-2) contains supplementary material, which is available to authorized users.
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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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Hurley EA, Doumbia S, Kennedy CE, Winch PJ, Roter DL, Murray SM, Harvey SA. Patient-centred attitudes among medical students in Mali, West Africa: a cross-sectional study. BMJ Open 2018; 8:e019224. [PMID: 29362266 PMCID: PMC5786142 DOI: 10.1136/bmjopen-2017-019224] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND/OBJECTIVE Patient-centred attitudes have been shown to decline during medical training in high-income countries, yet little is known about attitudes among West African medical students. We sought to measure student attitudes towards patient-centredness and examine validity of the 18-item Patient-Practitioner Orientation Scale (PPOS) in this context. PARTICIPANTS/SETTING 430 medical students in years 1, 3, 5 and 6 of a 6-year medical training programme in Bamako, Mali. DESIGN We conducted a cross-sectional survey, compared the proportion of students who agreed with each PPOS item by gender and academic year, and calculated composite PPOS scores. To examine psychometrics of the PPOS and its two subscales ('sharing' and 'caring'), we calculated internal consistency (Cronbach's alpha) and performed confirmatory and exploratory factor analyses (CFA and EFA). RESULTS In seven of the nine 'sharing' items, the majority of students held attitudes favouring a provider-dominant style. For five of the nine 'caring' items, the majority of student responded consistently with patient-centred attitudes, while in the other four, responses indicated a disease-centred orientation. In eight items, a greater proportion of fifth/sixth year students held patient-centred attitudes as compared with first year students; there were few gender differences. Average PPOS scores indicated students were moderately patient-centred, with more favourable attitudes towards the 'caring' aspect than 'sharing'. Internal consistency of the PPOS was inadequate for the full scale (α=0.58) and subscales ('sharing' α=0.37; 'caring' α=0.48). CFA did not support the original PPOS factors and EFA did not identify an improved structure. CONCLUSIONS West African medical students training in Bamako are moderately patient-centred and do not show the same declines in patient-centred attitudes in higher academic years as seen in other settings. Medical students may benefit from training in shared power skills and in attending to patient lifestyle factors. Locally validated tools are needed to guide West African medical schools in fostering patient-centredness among students.
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Affiliation(s)
- Emily A Hurley
- Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, Missouri, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Seydou Doumbia
- Faculté de Medecine et d'OdontoStomatologie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Debra L Roter
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Steven A Harvey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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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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