The Provider Role in Client Engagement in HIV Care

Abstract

This multisite, qualitative study examined the process by which persons living with HIV/AIDS (PLWHA) engage in primary HIV medical care for treatment. Using a grounded theory approach, the analysis of narrative data from semi-structured in-depth interviews with PLWHA (n = 76) led to the development of a model describing a cyclic process of engaging in--and falling out of--care. Perceptions of the client-provider relationship emerged as a central element of the process by which persons with HIV engaged--or remained--in care. Provider behaviors that were characterized as engaging, validating, and partnering facilitated engagement and retention in care; behaviors described as paternalistic served as barriers to care. Participants indicated that they desired a care partnership with an empathetic provider who had effective communication skills. These findings provide recommendations for health providers to engage and retain hard-to-reach PLWHA in timely and appropriate HIV care and services.

A conceptual review of engagement in healthcare and rehabilitation

“…Identifying these components would be beneficial to support clinicians to operationalize them. The temporal aspects we have highlighted concerning the process of engagement do not appear to be well-captured by existing measures, commonly administered by the clinician at only one time point despite the literature indicating engagement may fluctuate over time [43,44]. It may also be that it is beneficial to measure engagement at different time-points.…”

“…Communication appeared central [10,48] with the patient feeling able to talk and tell their story and sensing this was listened to [40,43,45,48,50] and understood [48,50]. Also identified as key to 'engaging with' were responsiveness to the patient [50], seeing them as a person rather than a diagnosis or impairment [30,43,45,46,48,49,52,53], demonstrating a genuine interest in getting to know the person and their story [50,53], addressing core needs [33,47], valuing their expertise [29,30,43,46] and strengths [31].As such, 'engaging with' was considered to be a way of working on the part of the clinician or service [31,44,45,53]. Clinician interest was perceived to be demonstrated through behaviors such as sitting down with the patient to talk about their story, being present, respectful, attentive, going above and beyond, doing more than just the bare basics of the job [43,46,52] [37,52,55].…”

“…Also identified as key to 'engaging with' were responsiveness to the patient [50], seeing them as a person rather than a diagnosis or impairment [30,43,45,46,48,49,52,53], demonstrating a genuine interest in getting to know the person and their story [50,53], addressing core needs [33,47], valuing their expertise [29,30,43,46] and strengths [31].…”

“…It did not appear to cease once the patient became involved with the service or in a therapy task; instead it was fluid and could further develop, or in fact diminish over time without on-going work and from both parties [10,30,43,44,48,58]. It was said to be maintained through an internal feedback loop, which involved the patient making on-going decisions to remain engaged [58] and through the clinician's way of working [52,57]; this could include periods of intermittent disengagement from services [43].With regard to published measures of engagement, the interaction and relationship between clinician and patient was considered within some measures, for example, the 'quality of the relationship' [32,34] 'attitudes toward staff ' [33], and the 'client's perception of being listened to' [40]. Of note is that items in the measures commonly focused on the patient's actions and perceived attitudes despite the body of evidence detailed above emphasizing the clinician's actions and perceived attitudes.…”

REACH: a mixed-methods study to investigate the measurement, prediction and improvement of retention and engagement in outpatient HIV care

“…Similarly, a paternalistic approach to patients was found to be a barrier to care. 79 Opportunity to enact behaviour is shaped by the social environment, and the actual or expected interaction with clinic staff had an impact on attendance, as described above in relation to adherence to ART. Patients want to feel that staff are listening to them 80 and our findings reflect previous research indicating that HIV patients were less likely to miss appointments when care was patient centred and they were known as individuals.…”