Evaluating the effectiveness of patient education and empowerment to improve patient-provider interactions in antiretroviral therapy clinics in Namibia

• Published in: AIDS care 2016-05, Vol.28 (5), p.620-627
• Main Authors: Maclachlan, Ellen W., Shepard-Perry, Mark G., Ingo, Paulina, Uusiku, James, Mushimba, Ruusa, Simwanza, Ricky, Likoro, Joseph, Brandt, Laura J., Thomas, Katherine K., Kasonka, Claude, Hamunime, Ndapewa, O'Malley, Gabrielle
• Format: Article
• Language: English
• Subjects: Adjustment; Adult; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; ART services; Clinics; Communication; Consultation; Curricula; Drug therapy; Educational Measurement; Empowerment; Facilitation; Female; Follow-Up Studies; Health Communication; Health education; HIV; HIV Infections - epidemiology; HIV Infections - psychology; HIV Infections - therapy; Human immunodeficiency virus; Humans; Impact evaluation; Information gathering; Interaction analysis; Intervention; Male; medical dialogue; Middle Aged; Motivation; Namibia - epidemiology; Outcome and Process Assessment (Health Care); Patient education; Patient Education as Topic - methods; Patient Participation; patient-provider communication; Patients; Positive emotions; Power (Psychology); Professional consultation; Professional-Patient Relations; Randomization; randomized controlled trial; Therapy; Training
• ISSN: 0954-0121; 1360-0451
• DOI: 10.1080/09540121.2015.1124975

In order to increase patient active engagement during patient-provider interactions, we developed and implemented patient training sessions in four antiretroviral therapy (ART) clinics in Namibia using a "Patient Empowerment" training curriculum. We examined the impact of these trainings on patient-provider interactions after the intervention. We tested the effectiveness of the intervention using a randomized parallel group design, with half of the 589 enrolled patients randomly assigned to receive the training immediately and the remaining randomized to receive the training 6 months later. The effects of the training on patient engagement during medical consultations were measured at each clinic visit for at least 8 months of follow-up. Each consultation was audiotaped and then coded using the Roter Interaction Analysis System (RIAS). RIAS outcomes were compared between study groups at 6 months. Using intention-to-treat analysis, consultations in the intervention group had significantly higher RIAS scores in doctor facilitation and patient activation (adjusted difference in score 1.19, p = .004), doctor information gathering (adjusted difference in score 2.96, p = .000), patient question asking (adjusted difference in score .48, p = .012), and patient positive affect (adjusted difference in score 2.08, p = .002). Other measures were higher in the intervention group but did not reach statistical significance. We have evidence that increased engagement of patients in clinical consultation can be achieved via a targeted training program, although outcome data were not available on all patients. The patient training program was successfully integrated into ART clinics so that the trainings complemented other services being provided.