Wachira Juddy, Genberg Becky, Kafu Catherine, Braitstein Paula, Laws Michael Barton, Wilson Ira B
Department of Behavioral Sciences, School of Medicine, Moi University, Eldoret, Kenya,
Department of Epidemiology, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA,
Patient Prefer Adherence. 2018 Aug 1;12:1393-1400. doi: 10.2147/PPA.S168664. eCollection 2018.
In resource-limited HIV care settings, effective and innovative interventions that respond to the existing challenges along the HIV care continuum are urgently needed to realize the benefits of antiretroviral therapy (ART). Initiating effective ART adherence dialog in an environment that promotes patient engagement in care is key. It is therefore critical to enhance our understanding about how patients living with HIV in these regions conceptualize and experience patient engagement. This study explores HIV patients' perceptions, experiences and expectations of their engagement in care.
We sampled 86 patients from three Academic Model for Providing Access to Healthcare (AMPATH) sites, one urban and two rural. We conducted 24 in-depth interviews and eight focus group discussions in either Swahili or English. Audio recordings of the interviews were transcribed, and then translated into English. We performed content analysis after thematic coding.
Patients living with HIV in Kenya desire active engagement with care. However, their engagement was inconsistent and varied depending on the provider. Patients had a sense of how provider's interpersonal behaviors influenced their level of engagement. These included various aspects of provider-patient communication and relationship dynamics. Patients also highlighted relational boundaries that influenced the level and kind of information they shared with their providers. Aspects of their psychological, social or economic wellbeing were often viewed as personal and not discussed with their clinicians. Patients identified factors that would promote or impede their engagement with care including those related to patients themselves, providers, and the healthcare system.
Patients living with HIV desired more active engagement in their care. In addition, they desired clinicians to engage in more social behaviors to promote patient engagement. To address existing patient engagement barriers, HIV care systems in the region should apply contextualized patient-centered interventions.
在资源有限的艾滋病护理环境中，迫切需要有效且创新的干预措施来应对艾滋病护理连续过程中存在的挑战，以实现抗逆转录病毒疗法（ART）的益处。在促进患者参与护理的环境中启动有效的ART依从性对话是关键。因此，增强我们对这些地区的艾滋病患者如何理解和体验患者参与的认识至关重要。本研究探讨了艾滋病患者对其参与护理的看法、经历和期望。
我们从三个提供医疗服务的学术模式（AMPATH）站点抽取了86名患者，其中一个是城市站点，两个是农村站点。我们用斯瓦希里语或英语进行了24次深入访谈和8次焦点小组讨论。访谈的录音被转录，然后翻译成英语。我们在进行主题编码后进行了内容分析。
肯尼亚的艾滋病患者希望积极参与护理。然而，他们的参与情况并不一致，且因提供者而异。患者能感觉到提供者的人际行为如何影响他们的参与程度。这些包括医患沟通和关系动态的各个方面。患者还强调了影响他们与提供者分享信息的程度和种类的关系界限。他们心理、社会或经济福祉的方面通常被视为个人隐私，不与临床医生讨论。患者确定了会促进或阻碍他们参与护理的因素，包括与患者自身、提供者和医疗系统相关的因素。
艾滋病患者希望更积极地参与他们的护理。此外，他们希望临床医生参与更多社交行为以促进患者参与。为了解决现有的患者参与障碍，该地区的艾滋病护理系统应采用因地制宜的以患者为中心的干预措施。
