Patient-provider communication styles in HIV treatment programs in Bamako, Mali: A mixed-methods study to define dimensions and measure patient preferences

Emily A. Hurley, Steven A Harvey, Mariam Keita, Caitlin E Kennedy, Debra Roter, Sounkalo Dao, Seydou Doumbia, Peter John Winch

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)539-548
Number of pages10
JournalSSM - Population Health
Volume3
DOIs
StatePublished - Dec 1 2017

Fingerprint

Mali
Patient Preference
Communication
HIV
communication
balance of power
Therapeutics
Africa South of the Sahara
group discussion
recording
income

Keywords

  • Antiretroviral therapy
  • HIV
  • Mali
  • Patient engagement
  • Patient-centeredness
  • Patient-provider communication
  • Sub-Saharan Africa
  • Vignette survey

ASJC Scopus subject areas

  • Health(social science)
  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

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title = "Patient-provider communication styles in HIV treatment programs in Bamako, Mali: A mixed-methods study to define dimensions and measure patient preferences",
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.",
keywords = "Antiretroviral therapy, HIV, Mali, Patient engagement, Patient-centeredness, Patient-provider communication, Sub-Saharan Africa, Vignette survey",
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T2 - A mixed-methods study to define dimensions and measure patient preferences

AU - Hurley, Emily A.

AU - Harvey, Steven A

AU - Keita, Mariam

AU - Kennedy, Caitlin E

AU - Roter, Debra

AU - Dao, Sounkalo

AU - Doumbia, Seydou

AU - Winch, Peter John

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KW - Sub-Saharan Africa

KW - Vignette survey

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