Health Care Provider Communication Styles during an Adolescent HIV Care Training Intervention in Kenya: A qualitative analysis

Abstract

Introduction:Adolescents living with HIV (ALHIV) have low retention in care compared to other age groups. In Kenya, ALHIV reported health care stigma and fear of judgment as major causes. Health providers similarly identified their own values and beliefs as potential barriers to effective communication with ALHIV. Better understanding of provider communication strategies and empathy expression is required for future patient centered communication training efforts. Methods: This qualitative study was conducted within a stepped-wedge randomized controlled trial designed to evaluate a clinical training intervention utilizing standardized patients (SPs) to improve provider skills of communication and empathy when caring for HIV positive adolescents and young adults (AYA) in Kenya. The training involved didactic sessions in adolescent care and communication skills, followed by 7 videotaped encounters with SPs portraying different ALHIV cases. This analysis focused on 48 out of 200 video sessions. Directed content analysis of the sessions and code counting were conducted to identify providers’ variable communication styles and empathy expression. Results: Analysis revealed that early and ongoing investment in rapport building, non-judgmental behaviors, and empathy expression were critical for ensuring effective socio-emotional communication. Sensitive topics and medication-focused discussions were common barriers to achieving patient-centered communication, and lastly, ineffective non-verbal and verbal communication strategies negatively impacted information collection, information sharing, and development of shared plans of care. Conclusion: There is a need to address providers’ communication challenges with ALHIV in order to increase linkage and retention in care. Patient-centered communication trainings should address stigmatizing statements, as well as non-verbal and verbal communication strategies, to promote high-quality, adolescent-friendly, HIV care.