Building stronger patient-health care provider relationships in treating HIV: A focus group approach to enquiry

Good adherence to antiretroviral medications in the treatment of HIV can be difficult to achieve because this class of medications has been shown to produce numerous side effects, the regimens can be demanding and complicated to follow and the changes in life style that are required in order to render them effective are difficult to commit to long-term. Poor adherence, though, can result in viral mutations that are resistant to medications. Drug-resistant strains of HIV can be transmitted through high-risk activity to other individuals and this could sustain the AIDS epidemic (Wainberg & Friedland, 1998). Non-adherence to antiretrovirals is estimated to range from 50% to 70% (Chesney, M.A., 2000). What a health care provider says and does in the clinical consultation can positively influence adherence though (Falvo, Woelke, & Deichmann, 1980). In order to better understand these dynamics of communication, the participants in this study responded to questions designed to analyze the clinical relationship they have with their health care provides in a focus group setting (Appendix G). Data collected in these focus groups was used to produce an informative booklet for health care providers who treat HIV positive patients as a resource for enhancing effective and empathic communication skills. This study found that a health care provider's use of empathy can generate within patients an experience of parental transference that motivates patients to trust their medical care provider. The resulting attachment reduced the patient's need for defense mechanisms, which permitted patients and medical care providers to have frank discussions about adherence and to mutually negotiate treatment. The focus group data also generated a companion booklet targeted to HIV positive patients as a guide to enhancing their own effectiveness within the patient to health care provider relationship. The data from the focus groups suggested that the development of a take charge attitude was crucial for living well with HIV. This hands approach to managing every aspect of health was supported by participation in support groups, acquiring education on HIV, learning how to manage side effects, and by learning how to verbally assert one's self in the clinical consultation. The subjects in this study believed that living well with HIV required a radical change in how they managed their health since infection with HIV had such a severe impact on their social, economic, spiritual and physical existence and more passive ways of managing health were rendered ineffective. These results suggest that patients have feelings about the relationships that they have with their medical care providers and that when prompted, they can recognize and discuss the types of supportive communication that they need. These findings highlight the new paradigm of collaboration and power sharing within the patient-health care provider relationship that empowers patients to effectively manage their own health in between clinic visits.