Pretorius Deidré, Couper Ian, Mlambo Motlatso
Division Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
Division Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa; Ukwanda Centre for Rural Health, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.
Sex Med. 2021 Aug;9(4):100389. doi: 10.1016/j.esxm.2021.100389. Epub 2021 Jul 15.
Sexual history taking for risk behavior contributes to improving health outcomes in primary care. Giving the high numbers of people living with AIDS, every patient in South Africa should be offered an HIV test, which implies that a comprehensive sexual history must be taken.
To describe the optimal consultation process, as well as associated factors and skills required to improve disclosure of sexual health issues during a clinical encounter with a doctor in primary health care settings in North West province, South Africa.
This qualitative study, based on grounded theory, involved the video-recording of 151 consultations of adult patients living primarily with hypertension and diabetes. This article reports on the 5 consultations where some form of sexual history taking was observed. Patient consultations were analyzed thematically, which entailed open coding, followed by focused and verbatim coding using MaxQDA 2018 software. Confirmability was ensured by 2 generalist doctors, a public health specialist and the study supervisors.
Sexual history was not taken and patients living with sexual dysfunction were missed. If patients understand how disease and medication contribute to their sexual wellbeing, this may change their perceptions of the illness and adherence patterns.
Sexual history was taken in 5 (3%) out of 151 consultations. Three themes emerged from these 5 consultations. In the patient-doctor relationship theme, patients experienced paternalism and a lack of warmth and respect. The consultation context theme included the seating arrangements, ineffective use of time, and privacy challenges due to interruptions and translators. Theme 3, consultation content, dealt with poor coverage of the components of the sexual health history.
Overall, sexual dysfunction in patients was totally overlooked and risk for HIV was not explored, which had a negative effect on patients' quality of life and long-term health outcomes. The study provided detailed information on the complexity of sexual history taking during a routine consultation and is relevant to primary health care in a rural setting. Pretorius D, Couper I, Mlambo M. Sexual History Taking: Perspectives on Doctor-Patient Interactions During Routine Consultations in Rural Primary Care in South Africa. Sex Med 2021;9:100389.
询问性行为风险史有助于改善初级保健中的健康结局。鉴于南非艾滋病感染者数量众多，应为每位患者提供HIV检测，这意味着必须全面了解其性史。
描述在南非西北省初级卫生保健机构中，与医生进行临床接触时，改善性健康问题披露的最佳咨询过程、相关因素和所需技能。
这项基于扎根理论的定性研究，对主要患有高血压和糖尿病的成年患者的151次咨询进行了视频记录。本文报告了观察到某种形式性史询问的5次咨询。对患者咨询进行了主题分析，包括开放编码，随后使用MaxQDA 2018软件进行聚焦编码和逐字编码。由2名全科医生、1名公共卫生专家和研究监督员确保可证实性。
未询问性史，漏诊了性功能障碍患者。如果患者了解疾病和药物对其性健康的影响，这可能会改变他们对疾病的认知和依从模式。
151次咨询中有5次（3%）询问了性史。这5次咨询出现了三个主题。在医患关系主题中，患者感受到家长式作风，缺乏温暖和尊重。咨询背景主题包括座位安排、时间利用效率低下以及因中断和翻译导致的隐私挑战。第三个主题“咨询内容”涉及性健康史各组成部分的涵盖不足。
总体而言，患者的性功能障碍完全被忽视，未探讨HIV风险，这对患者的生活质量和长期健康结局产生了负面影响。该研究提供了关于常规咨询中性史询问复杂性的详细信息，与农村地区的初级卫生保健相关。普雷托里乌斯D、库珀I、姆兰博M。性史询问：南非农村初级保健常规咨询中医患互动的视角。性医学2021；9：100389。
