Shared decision-making and person-centred care approaches in three African regions

Gogovor, Amédé; Fakhfakh, Maya; Bouba, Dalil Asmaou; Acakpo, Owolabi; Ayivi-Vinz, Gloria; Musabyimana, Angèle; Garvelink, Mirjam M.

doi:10.1016/j.zefq.2022.04.023

Cited by 11 publications

(7 citation statements)

References 28 publications

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“…This may be a manifestation of the time and cognitive/emotional effort often required for these behaviours, which can be limited in overburdened facilities [ 31 , 37 , 50 ]. Nevertheless, the use of shared decision‐making and discretionary power can facilitate alignment of care delivery with clients’ needs and preferences, and thus may have meaningful impacts on the client experience [ 7 , 15 , 19 , 20 , 21 , 22 , 23 , 25 , 32 ]. Third, we find that providers practice rapport building (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…counselling incorporating PCC behaviours like empathy, validation), use of shared decision‐making and leveraging discretionary power (i.e. using discretion in decision‐making to better meet client needs) [ 1 , 4 , 15 , 19 , 20 , 21 , 22 , 23 , 25 ].…”

Section: Methodsmentioning

confidence: 99%

“…differentiated service delivery) have primarily focused on changing the care infrastructure [16][17][18], but relatively less emphasis has been placed on targeting the underlying nature of client−provider interactions and integration of person-centred communication (PCC) behaviours (e.g. shared decision-making, attention to empathy, open-ended questions and using discretionary power to accommodate client needs) [15,[19][20][21][22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

“…differentiated service delivery) have primarily focused on changing the care infrastructure [ 16 , 17 , 18 ], but relatively less emphasis has been placed on targeting the underlying nature of client−provider interactions and integration of person‐centred communication (PCC) behaviours (e.g. shared decision‐making, attention to empathy, open‐ended questions and using discretionary power to accommodate client needs) [ 15 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. A deeper understanding of these interactions and patterns, frequencies and typologies of client−provider communication behaviours can help inform strategies to improve the person‐centredness and quality of care delivery, and, ultimately, long‐term outcomes in public health HIV facilities [ 7 , 10 , 15 , 19 , 26 , 27 , 28 , 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

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Patterns of person‐centred communications in public HIV clinics: a latent class analysis using the Roter interaction analysis system

et al. 2023

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Introduction:Poor client−provider communication is a critical barrier to long-term retention in care among people living with HIV. However, standardized assessments of this key metric are limited in Africa. We used the Roter Interaction Analysis System (RIAS) to quantitatively characterize patterns of person-centred communication (PCC) behaviours in Zambia. Methods:We enrolled pairs of people living with HIV making routine HIV follow-up visit and their providers at 24 Ministry of Health-facilities supported by the Centre for Infectious Disease Research in Zambia in Lusaka province between August 2019 and November 2021. Client−provider encounters were audio-recorded and coded using RIAS by trained research staff. We performed latent class analysis to identify interactions with distinctive patterns of provider PCC behaviours (i.e. rapport building, person-centred counselling, PCC micropractices [e.g. brief empathy statements], assessing barriers to care, shared decision-making and leveraging discretionary power) and compared their distribution across client, provider, interaction and facility characteristics. Results: We enrolled 478 people living with HIV and 139 providers (14% nurses, 73.6% clinical officers, 12.3% were medical officers). We identified four distinct profiles: (1) "Medically Oriented Interaction, Minimal PCC Behaviours" (47.6% of interactions) was characterized by medical discussion, minimal psychosocial/non-medical talk and low use of PCC behaviours; (2) "Balanced Medical/Non-medical Interaction, Low PCC Behaviours" (21.0%) was characterized by medical and non-medical discussion but limited use of other PCC behaviours; (3) "Medically Oriented Interaction, Good PCC Behaviours" (23.9%) was characterized by medically oriented discussion, more information-giving and increased use of PCC behaviours; and (4) "Highly person-centred Interaction" (7.5%) was characterized by both balanced medical/non-medical focus and the highest use of PCC behaviours. Nurse interactions were more likely to be characterized by more PCC behaviours (i.e. Class 3 or 4) (44.8%), followed by medical officers (33.9%) and clinical officers (27.3%) (p = 0.031). Longer interactions were also more likely to integrate more PCC behaviours (p < 0.001). Conclusions: PCC behaviours are relatively uncommon in HIV care in Zambia, and often limited to brief rapport-building statements and PCC micropractices. Strengthening PCC, such as shared decision-making and leveraging discretionary power to better accommodate client needs and preferences, may be an important strategy for improving the quality in HIV treatment programmes.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patterns of person‐centred communications in public HIV clinics: a latent class analysis using the Roter interaction analysis system

et al. 2023

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“…Despite these challenges, an increasing number of studies examine PCC in SSA [4 ▪▪ ,7 ▪▪ ,8 ▪▪ ,9,10,19 ▪▪ ,20,21]. A systematic review of 31 studies from 12 SSA countries identified three major domains to incorporate in defining PCC practices in HIV care facilities: (1) staffing, (2) service delivery standards, (3) direct client support services [7 ▪▪ ].…”

Section: Lesson Learned From Patient Centered Care In Sub-saharan Africamentioning

confidence: 99%

Promoting patient-centered care within HIV care settings in sub-Saharan Africa

Wachira

Genberg

Wilson

2022

Current Opinion in HIV and AIDS

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Purpose of reviewPatient centered care (PCC) in human immunodeficiency virus (HIV) care systems in sub-Saharan Africa (SSA) may improve outcomes for persons with HIV (PWH). We review the progress the region has made in promoting PCC and highlight some of the implementation challenges and potential areas of research. Recent findingsStudies show growing interest in promoting PCC across HIV care programs in SSA. Effective implementation of PCC, however, is hampered by: (1) lack of consensus on the conceptualization of PCC, including definition, frameworks, measures, and implementation strategies; (2) limited regional studies on the adoption and sustainability of PCC interventions; and (3) healthcare structural challenges including limited capital and human resources, poor provider-patient dynamics, high provider turnover, and lack of continuity in care. Recent studies in the region have focused on identifying key PCC domains addressable in resource limited settings, understanding the PCC experiences and expectations of PWH and their providers, and testing innovative interventions. We highlight the need for additional studies to address the existing gaps.

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