February 6, 2014
A Patient’s Race Affects How HIV Docs Discuss Adherence
HIV providers alter their communication methods based on the race of their patients and are more likely to discuss medication adherence with blacks and Latinos than with whites. Publishing their findings in AIDS and Behavior, researchers analyzed recordings of 45 health care providers’ conversations with 404 people with HIV, 245 of whom were black, 59 Latino and 100 white. Out of the provider group, 34 were doctors; 30 of them were white, with the remainder largely Asian Americans.
The investigators used the Generalized Medical Interaction Analysis system to break down the dialogue into fragments known as “utterances,” which designate different types of speech, such as asking questions, providing information, instructing, requesting or expressing a wish.
The African Americans in the study tended not to speak as much to their clinicians when compared with the Latinos or whites; providers tended to dominate the exchange with the black patients. The discussions between the blacks and their providers tended to contain fewer utterances of goals or values than those between Latinos or whites and their clinicians. The clinicians asked Latinos fewer open-ended questions and had dialogues that were less likely to involve humor.
Blacks and Latinos experienced more dialogue about medication adherence than whites. This difference was unrelated to the patients’ actual adherence or whether they had a suppressed viral load. Compared with their dialogues about adherence with white patients, providers were more inclined to instruct minority patients about the importance of adherence rather than engage them in a discussion about problem-solving techniques.
“The possibility that seems most compelling to me is the doctors don’t trust their black and Hispanic patients as much to be adherent,” M. Barton Laws, assistant professor of health services policy and practice in the Brown University School of Public Health, and the study’s lead author, said in a release. “It has been epidemiologically observed that they do tend to be less adherent, but it’s not because they are black or Hispanic.”
To read the release, click here.
To read the study abstract, click here.
Search: HIV, adherence, minorities, AIDS and Behavior, Generalized Medical Interaction Analysis, discussion, M. Barton Laws, Brown University School of Public Health.
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