Stakeholder perceptions on patient-centered care at primary health care level in rural eastern Uganda: A qualitative inquiry

Abstract

Background Patient-centered care (PCC) offers opportunities for African health systems to improve quality of care. Nonetheless, PCC continually faces implementation challenges. In 2015, Uganda introduced PCC as a concept in their national quality improvement guidelines. In order to investigate whether and how this is implemented in practice, this study aims to identify relevant stakeholders’ views on the current quality of primary health care services and their understanding of PCC. This is an important step in understanding how the concept of PCC can be implemented in a resource constrained, sub-Saharan context like Uganda. Methods This qualitative study was conducted in Uganda at national, district and facility level, with a focus on three public and three private health centres. Data collection consisted of in-depth interviews (n = 49); focus group discussions (n = 7); and feedback meetings (n = 14) across the four main categories of stakeholders identified: patients/communities, health workers, policy makers and academia. Interviews and discussions explored stakeholder perceptions on the interpersonal aspects of quality primary health care and meanings attached to the concept of PCC. A content analysis of Ugandan policy documents mentioning PCC was also conducted. Thematic content analysis was conducted using NVivo 11 to organize and analyze the data. Findings and conclusion While Ugandan stakeholder groups have varying perceptions of PCC, they agree on the following: the need to involve patients in making decisions about their health, the key role of healthcare workers in that endeavor, and the importance of context in designing and implementing solutions. For that purpose, three avenues are recommended: Firstly, fora that include a wide range of stakeholders may offer a powerful opportunity to gain an inclusive vision on PCC in Uganda. Secondly, efforts need to be made to ensure that improved communication and information sharing–important components of PCC–translate to actual shared decision making. Lastly, the Ugandan health system needs to strengthen its engagement of the transformation from a community health worker system to a more comprehensive community health system. Cross-cutting the entire analysis, is the need to address, in a culturally-sensitive way, the many structural barriers in designing and implementing PCC policies. This is essential in ensuring the sustainable and effective implementation of PCC approaches in low- and middle-income contexts.

Shared Decision-making between health care providers and patients at a Tertiary Hospital Diabetic Clinic in Tanzania

“…Participants in this study, both patients and providers, expressed their view of the importance of shared decision making, and their participation in this important process, which ensure patients autonomy and safeguard rights of patients. These ndings are consistent with ndings from Ghana by Boateng et al and Waweru et al from Ghana and Uganda Respectively which have pointed out the need for decision making by patients (24)(25)(26). Involvement in decision-making is a positive step in improving care of patients and has implication in self-management and adherence to treatment plans as these are mutually agreed on (18,27).…”

Shared Decision-making between health care providers and patients at a Tertiary Hospital Diabetic Clinic in Tanzania

“…These ndings are consistent with ndings from Ghana and Waweru et al from Uganda , which have pointed out the need for decision-making among patients with chronic conditions in order to have some control of their care. (20,21). Involvement in decision-making is a positive step in improving care of patients and has implication in self-management and adherence to treatment plans as these are mutually agreed on (22,23).…”

Patient perspectives on interpersonal aspects of healthcare and patient-centeredness at primary health facilities: A mixed methods study in rural Eastern Uganda

“…However, in order for PCC interventions to progress, patients and health workers need to be involved from the design stages, stakeholders should also be involved in recommending contextualized indicators of progress and participate in the evaluation of interventions. However, before all the above can be accomplished, patients need to be empowered and have a shared vision with other stakeholders on PCC [ 39 ]. Training on interpersonal aspects of health care and provision of incentives to health workers to encourage psycho-social care provision could be a worthwhile avenue in promoting the implementation of PCC.…”

“…We decided therefore to exclude it from our analysis. Further detailed descriptions of the stakeholders involved in the provision of PCC at primary health care level in Uganda can be found in a paper by Waweru et al [39].…”

“…In 2015, the Ugandan Ministry of health included PCC as one of the objectives of the health sector development plan and quality improvement strategy [37,38]. However, its conceptualization is varied, implementation remains largely unmonitored and its impact on Uganda's health consumers and providers remains unmeasured [39].…”