Research has shown that race and ethnicity may be associated with differences in how healthcare providers communicate with patients. “In HIV, a key component to outcomes is adherence to antiretroviral therapy (ART),” says Michael Barton Laws, PhD, MA. “Investigators have hypothesized that clinical communication may be a factor in how well or poorly HIV patients adhere to ART regimens.”
In a study published in AIDS and Behavior, Dr. Laws and colleagues reviewed more than 400 routine outpatient visits by people with HIV. Three themes emerged from the analysis of patient–provider conversations, depending on patients’ race and ethnicity:
1) Speech patterns: African Americans spoke less to their providers than Caucasians or Hispanics. Hence, there was greater provider verbal dominance in their discussions. They also less frequently expressed their goals or values. Healthcare providers asked Hispanics fewer open-ended questions.
2) ART adherence: Visits with African-American and Hispanic patients included more dialogue about adherence than visits with Caucasian patients. This difference occurred regardless of how adherent patients reported being to their ART
regimens or whether laboratory tests showed that HIV was under control.
3) Problem solving: The more extensive dialogue about ART adherence between patients and healthcare providers was directive rather than problem solving. “There was more discussion about ART adherence with African Americans and Hispanics,” adds Dr. Laws, “but no more discussion about strategies to improve adherence.”
Dr. Laws says that several factors may influence why healthcare providers talked more with minority patients than with Caucasians about adherence. “It’s possible that healthcare providers are trying to compensate for what they’ve seen in studies about lower adherence among minorities,” he says. “It’s also possible that there is a lack of trust in African Americans and Hispanics to be adherent to ART regimens. Although studies have reported on this adherence trend, it’s not because these patients are African American or Hispanic.”
The findings suggest that there is room for improvement in the patient–provider dialogue. “More time should be spent finding out whether patients face barriers to adhering to ART and striving to find solutions,” Dr. Laws says. “This requires asking more open-ended questions and listening more to what patients say. We should also keep in mind how culture and background may affect communication. More research is needed to understand if provider communication styles can be changed to improve outcomes. By learning more about these interactions, hopefully we can improve medication adherence in HIV.”
Readings & Resources (click to view)
Laws MB, Lee Y, Rogers WH, et al. Provider-patient communication about adherence to anti-retroviral regimens differs by patient race and ethnicity. AIDS Behav. 2014 Jan 25. [Epub ahead of print]. Available at: http://link.springer.com/article/10.1007%2Fs10461-014-0697-z.
Laws MB, Beach MC, Lee Y, et al. Provider-patient adherence dialogue in HIV care: results of a multisite study. AIDS Behav. 2013;17:148-159.
Norton WE, Amico KR, Fisher WA, et al. Information-motivation-behavioral skills barriers associated with intentional versus unintentional ARV non-adherence behavior among HIV+ patients in clinical care. AIDS Care. 2010; 22:979-987.
Wilson IB, Laws MB, Safren SA, et al. Provider-focused intervention increases adherence-related dialogue but does not improve antiretroviral therapy adherence in persons with HIV. J Acquir Immune Defic Syndr. 2010;53:338-347.