Adaptive leadership in clinical encounters with women living with HIV

Abstract

Background Women living with HIV (WLWH) report low engagement in health care, missed office visits, and less engagement in the clinical encounter. Strengthening the clinical encounter for WLWH may improve health outcomes and quality of life. The Adaptive Leadership Framework for Chronic Illness offers specific adaptive leadership strategies for providers to improve patient-provider interactions. The purpose of this study was to examine adaptive leadership behaviors that contribute to the development of effective patient-provider communication from the perspectives of WLWH. Methods The descriptive, cross-sectional and qualitative study conducted interviews with 22 WLWH to assess perceptions of the clinical encounter related to HIV-related stigma, engagement in care, medical distrust, and experiences with discrimination and quality of life. Members of the study team using a set of a priori codes analyzed data using NVivo 12.0. Results Participants described two primary themes and subthemes of each for adaptive leadership behaviors. The primary theme for adaptive leadership of providers was “my provider cares about me”; subthemes were communication, trust building takes time, and supportive providers are trusted. The primary theme for adaptive leadership of WLWH themselves was “I care about me; subthemes were self-advocacy and self-empowerment. Conclusions Providers can use adaptive leadership behaviors during clinical encounters to support WLWH, improve patient-provider communication, enhance trust, and improve patient outcomes.

The Provider's Role in Retaining Black Women With HIV in Care: A Scoping Review

“…Not all of the studies described using a theoretical framework, but those that did use the transtheoretical model for change, 33 intersectional theoretical framework, 36 the National Academy of Medicine's quality of care aims, 35 and the Adaptive Leadership Framework for Chronic Illness. 34 …”

“…The participants ranged in age from 21 to 69 and the average age across studies ranged from 42 to 57. 18 , 26 – 36 Not all studies reported on the socioeconomic status of participants, but those that did described a large proportion of participants as having less than a 4-year college degree with many being low income or living below the poverty line. 26 , 27 , 29 , 31 , 32 , 35 …”

“…Randolph, et al 34 used the Adaptive Leadership Framework for Chronic Illness to explore how both providers and women with HIV adjust to become patient- and self-advocates during the clinical encounter. For patients, this can entail changing behaviors or increasing skills and knowledge to adjust to a diagnosis; for providers, this can mean rousing the patient and their family to take action in order to keep ahead of medical and health challenges.…”

“…For patients, this can entail changing behaviors or increasing skills and knowledge to adjust to a diagnosis; for providers, this can mean rousing the patient and their family to take action in order to keep ahead of medical and health challenges. 34 For women with HIV the most outstanding adaptive leadership trait Randolph, et al heard was “my provider cares about me.” 34 This sense of caring, they report, emerges from and is increased by communication and taking time to build trust. Adaptive Leadership in this article aligned closely with concepts of patient-centered care identified in other studies.…”

“We Take Care of Our Young, No Matter What,” Experiences of Engagement in HIV Care Among Black Mothers Parenting Dependent Children in Southwestern Pennsylvania: A Retrospective Descriptive Qualitative Study

“…Recent research on factors hindering or facilitating ART adherence and viral suppression among Black women suggests that poor health care provider relationships (perceived stigma, discrimination) and lack of available providers are associated with suboptimal ART adherence (Rice et al, 2020). Alternatively, Randolph et al (2022), in a study exploring clinical encounters of women with HIV, found that providers who are perceived as supportive were trusted, communication was valued, and trust building takes time.…”