Quality of care for Black and Latina women living with HIV in the U.S.: a qualitative study
Year: 2020
Type: article
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.
Authors: Whitney S. Rice, Faith E. Fletcher, Busola Akingbade, Mary Kan, Samantha Whitfield, Shericia Ross, C. Ann Gakumo, Igho Ofotokun, Deborah J. Konkle-Parker, Mardge H. Cohen, Gina M. Wingood, Brian W. Pence, Adaora A. Adimora, Tonya N. Taylor, Tracey E. Wilson, Sheri D. Weiser, Mirjam-Colette Kempf, Bulent Turan, Janet M. Turan
Institutions: Emory University, University of Alabama at Birmingham, University of Massachusetts Boston, University of Mississippi Medical Center, John H. Stroger, Jr. Hospital of Cook County, Cook County Health and Hospitals System, Columbia University, University of North Carolina at Chapel Hill, SUNY Downstate Health Sciences University, University of California, San Francisco
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,680
Funders: Emory University, Georgia Clinical and Translational Science Alliance, National Institutes of Health, Center for AIDS Research, University of Washington, University of California, San Francisco, Center for AIDS Research, University of Alabama at Birmingham, National Institute on Alcohol Abuse and Alcoholism, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute on Drug Abuse, National Cancer Institute, National Institute on Deafness and Other Communication Disorders, National Institute of Allergy and Infectious Diseases, National Institute of Child Health and Human Development, National Institute of Dental and Craniofacial Research, Office of Research on Women's Health, National Center for Advancing Translational Sciences, National Institute on Minority Health and Health Disparities, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Center for AIDS Research, University of North Carolina at Chapel Hill
Awards: G1913134163, Acute Effects of Cannabis on Cognition and Mobility in Older HIV-Infected and Uninfected Women", Emory WIHS CRS - Longitudinal Cohort, G2675028044, G311558797, The Connie Wofsy Women's HIV Study, Brooklyn Women's Interagency HIV Study (WIHS) V, G3533447256, Miami Womens Interagency HIV Study WIHS, G3869857964, G3942613684, G4371267688, WIHS Data Management and Analysis Center (WDMAC), Southern California Women's Interagency HIV Study Consortium, Chicago WIHS Consortium V (CWC), Washington Women's Interagency HIV/AIDS Study, G5699974340, Clinical and Translational Science Institute, G5900455136, G6113675784, G6300780520, G6384504179, G6509896931, G6990385686, University of North Carolina Womens Interagency HIV Study UNC WIHS, G775892330, G7807729167, Women's Interagency HIV Study (WIHS-V), UAB-MISS WIHS Cohort, G9000034708, G9000080293, UNC MACS/WIHS Combined Cohort Study Clinical Research Site, Center for AIDS Research at Emory University, The University of North Carolina Center for AIDS Research, Clinical Research Sites for the MACS/WIHS Combined Cohort Study (MACS/WIHS-CCS), UAB Center for AIDS Research (CFAR), G929137571, G940002362
OpenAlex ID: W3039060360