The Role of Patient–Provider Communication in Engagement and Re-engagement in HIV Treatment in Bamako, Mali

A Qualitative Study

Emily A. Hurley, Steven A Harvey, Peter John Winch, Mariam Keita, Debra Roter, Seydou Doumbia, Nièlè H. Diarra, Caitlin E Kennedy

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1-15
Number of pages15
JournalJournal of Health Communication
DOIs
StateAccepted/In press - Dec 28 2017

Fingerprint

Mali
Communication
HIV
communication
Therapeutics
Patient Participation
Mountings
Africa South of the Sahara
medication
Education
Health
interview
health
Medication Adherence
Lost to Follow-Up
evidence
Values
education
experience
Focus Groups

Keywords

  • adherence
  • antiretroviral therapy
  • patient–provider communication
  • retention
  • sub-Saharan Africa

ASJC Scopus subject areas

  • Health(social science)
  • Communication
  • Public Health, Environmental and Occupational Health
  • Library and Information Sciences

Cite this

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title = "The Role of Patient–Provider Communication in Engagement and Re-engagement in HIV Treatment in Bamako, Mali: A Qualitative Study",
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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