“我没有感到被评判，我没有觉得自己低人一等”——参与并提供支持的医疗服务提供者在感染艾滋病毒的黑人性少数男性的艾滋病毒护理经历中的作用
"I Don't Feel Judged, I Don't Feel Less of a Person" - Engaged and Supportive Providers in the HIV Care Experiences of Black Sexual Minority Men Living with HIV.
作者信息
Kielhold Kirstin, Storholm Erik D, Reynolds Hannah E, Vincent Wilson, Siconolfi Daniel E, Kegeles Susan M, Pollack Lance, Campbell Chadwick K
机构信息
Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA.
School of Public Health, San Diego State University, San Diego, CA, USA.
出版信息
Patient Prefer Adherence. 2024 Aug 5;18:1641-1650. doi: 10.2147/PPA.S467587. eCollection 2024.
BACKGROUND
Black sexual minority men (BSMM) in the Southern region of the United States experience a disproportionate burden of HIV. Research findings suggest that having supportive patient-provider relationships are critical for sustained HIV care engagement. The present study explores the role of supportive healthcare providers in the care engagement among BSMM living with HIV (BSMM+) in the US South.
METHODS
Semi-structured qualitative interviews were conducted with BSMM+ in Texas (n=27) to explore perceived barriers and facilitators of sustained care engagement. Interviews lasted 60 minutes on average, were transcribed, coded, and analyzed using applied thematic analysis.
FINDINGS
Participants described how important having relationships with engaged and supportive HIV care and service providers is to sustained engagement in care and positive HIV clinical outcomes. Supportive providers were characterized as non-judgmental, meeting patients' needs, and making patients feel "seen". Less supportive providers were described as making their patients "feel like a number" and having lack of follow through on proposed support and resources. Supportive providers were associated with increased care engagement of their patients while less supportive providers often led to patients switching providers, losing touch with services, and getting off track with their care.
DISCUSSION
We found that among BSMM+ an important facilitator of sustained care engagement was having positive, affirming, and knowledgeable healthcare providers, while negative and dismissive experiences with providers was a notable barrier to care engagement. This work highlights the need for a scale up of comprehensive, ongoing trainings in patient-centered and person-first communication for providers. Further, manageable provider caseloads can facilitate more thorough patient interactions where tailored HIV care and education can be provided in a safe and non-judgmental environment.
背景
美国南部的黑人性少数群体男性（BSMM）承受着不成比例的艾滋病毒负担。研究结果表明，拥有支持性的医患关系对于持续参与艾滋病毒护理至关重要。本研究探讨了支持性医疗服务提供者在美国南部感染艾滋病毒的黑人性少数群体男性（BSMM+）的护理参与中的作用。
方法
对德克萨斯州的BSMM+进行了半结构化定性访谈（n = 27），以探讨持续护理参与的感知障碍和促进因素。访谈平均持续60分钟，进行了转录、编码，并使用应用主题分析法进行了分析。
结果
参与者描述了与积极参与且支持性的艾滋病毒护理和服务提供者建立关系对于持续参与护理和取得积极的艾滋病毒临床结果有多重要。支持性的提供者的特点是不评判、满足患者需求，并让患者感到“被关注”。不太支持性的提供者被描述为让患者“感觉像个数字”，并且对提议的支持和资源缺乏跟进。支持性的提供者与患者增加护理参与度相关，而不太支持性的提供者往往导致患者更换提供者、与服务失去联系，并在护理中偏离正轨。
讨论
我们发现，在BSMM+中，持续护理参与的一个重要促进因素是拥有积极、肯定且知识渊博的医疗服务提供者，而与提供者的负面和轻视性经历是护理参与的一个显著障碍。这项工作强调了需要为提供者扩大以患者为中心和以人为本的沟通方面的全面、持续培训。此外，可管理的提供者工作量可以促进更彻底的患者互动，在安全且不评判的环境中提供量身定制的艾滋病毒护理和教育。
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