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Quality of care for Black and Latina women living with HIV in the U.S.: a qualitative study.
Rice, Whitney S; Fletcher, Faith E; Akingbade, Busola; Kan, Mary; Whitfield, Samantha; Ross, Shericia; Gakumo, C Ann; Ofotokun, Igho; Konkle-Parker, Deborah J; Cohen, Mardge H; Wingood, Gina M; Pence, Brian W; Adimora, Adaora A; Taylor, Tonya N; Wilson, Tracey E; Weiser, Sheri D; Kempf, Mirjam-Colette; Turan, Bulent; Turan, Janet M
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International journal for equity in health
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2020-07-06
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19
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1
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115
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s12939-020-01230-3.pdf
Adobe PDF, 605.89 KB
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Abstract
Background: Ending the HIV epidemic requires that women living with HIV (WLWH) have access to structurally competent HIV-related and other health care. WLWH may not regularly engage in care due to inadequate quality; however, women's perspectives on the quality of care they receive are understudied.
Methods: We conducted 12 focus groups and three in-depth interviews with Black (90%) and Latina (11%) WLWH enrolled in the Women's Interagency HIV Study in Atlanta, GA, Birmingham, AL, Brooklyn, NY, Chapel Hill, NC, Chicago, IL, and Jackson, MS from November 2017 to May 2018 (n = 92). We used a semi-structured format to facilitate discussions about satisfaction and dissatisfaction with health care engagement experiences, and suggestions for improvement, which were audio-recorded, transcribed, and coded using thematic analysis.
Results: Themes emerged related to women's health care satisfaction or dissatisfaction at the provider, clinic, and systems levels and across Institute of Medicine-defined quality of care domains (effectiveness, efficiency, equity, patient-centeredness, safety and timeliness). Women's degree of care satisfaction was driven by: 1) knowledge-based care resulting in desired outcomes (effectiveness); 2) coordination, continuity and necessity of care (efficiency); 3) perceived disparities in care (equity); 4) care delivery characterized by compassion, nonjudgment, accommodation, and autonomous decision-making (patient-centeredness); 5) attention to avoiding side effects and over-medicalization (safety); and 6) limited wait time (timeliness).
Conclusions: Quality of care represents a key changeable lever affecting engage in care among WLWH. The communities most proximally affected by HIV should be key stakeholders in HIV-related quality assurance. Findings highlight aspects of the health care experience valued by WLWH, and potential participatory, patient-driven avenues for improvement.
Methods: We conducted 12 focus groups and three in-depth interviews with Black (90%) and Latina (11%) WLWH enrolled in the Women's Interagency HIV Study in Atlanta, GA, Birmingham, AL, Brooklyn, NY, Chapel Hill, NC, Chicago, IL, and Jackson, MS from November 2017 to May 2018 (n = 92). We used a semi-structured format to facilitate discussions about satisfaction and dissatisfaction with health care engagement experiences, and suggestions for improvement, which were audio-recorded, transcribed, and coded using thematic analysis.
Results: Themes emerged related to women's health care satisfaction or dissatisfaction at the provider, clinic, and systems levels and across Institute of Medicine-defined quality of care domains (effectiveness, efficiency, equity, patient-centeredness, safety and timeliness). Women's degree of care satisfaction was driven by: 1) knowledge-based care resulting in desired outcomes (effectiveness); 2) coordination, continuity and necessity of care (efficiency); 3) perceived disparities in care (equity); 4) care delivery characterized by compassion, nonjudgment, accommodation, and autonomous decision-making (patient-centeredness); 5) attention to avoiding side effects and over-medicalization (safety); and 6) limited wait time (timeliness).
Conclusions: Quality of care represents a key changeable lever affecting engage in care among WLWH. The communities most proximally affected by HIV should be key stakeholders in HIV-related quality assurance. Findings highlight aspects of the health care experience valued by WLWH, and potential participatory, patient-driven avenues for improvement.
Citation
Rice WS, Fletcher FE, Akingbade B, Kan M, Whitfield S, Ross S, Gakumo CA, Ofotokun I, Konkle-Parker DJ, Cohen MH, Wingood GM, Pence BW, Adimora AA, Taylor TN, Wilson TE, Weiser SD, Kempf MC, Turan B, Turan JM. Quality of care for Black and Latina women living with HIV in the U.S.: a qualitative study. Int J Equity Health. 2020 Jul 6;19(1):115. doi: 10.1186/s12939-020-01230-3. PMID: 32631424; PMCID: PMC7336413.