Abstract
BackgroundWhile patient-provider interactions are commonly understood as mutually constructed relationships, the role of patient behaviour, participation in interactions, and characteristics, particularly ideals surrounding notions of ‘good’ and ‘bad’ patients, are under-examined. This article examines social representations of ‘a good patient’ and how these representations affect patient-healthcare provider relationships and antiretroviral treatment (ART) for people living with HIV.MethodsUsing thematic network analysis, we examined interview and focus group transcripts involving 25 healthcare staff, 48 ART users, and 31 carers of HIV positive children, as well as field notes from over 100 h of ethnographic observation at health centres in rural Zimbabwe.ResultsCharacteristics of a good patient include obedience, patience, politeness, listening, enthusiasm for treatment, intelligence, physical cleanliness, honesty, gratitude and lifestyle adaptations (taking pills correctly and coming to the clinic when told). As healthcare workers may decide to punish patients who do not live up the ‘good patient persona’, many patients seek to perform within the confines of the ‘good patient persona’ to access good care and ensure continued access to ART.DiscussionThe notion of a ‘good ART patient’ can have positive effects on patient health outcomes. It is one of the only arenas of the clinic experience that ART patients can influence in their favour. However, for people not conforming to the norms of the ‘good patient persona’, the productive and health-enabling patient-nurse relationship may break down and be detrimental to the patient.ConclusionWe conclude that policy makers need to take heed of the social representations that govern patient-nurse relationships and their role in facilitating or undermining ART adherence.
Highlights
While patient-provider interactions are commonly understood as mutually constructed relationships, the role of patient behaviour, participation in interactions, and characteristics, ideals surrounding notions of ‘good’ and ‘bad’ patients, are under-examined
We conclude that policy makers need to take heed of the social representations that govern patient-nurse relationships and their role in facilitating or undermining antiretroviral treatment (ART) adherence
The study is guided by the following research question: In what ways do social representations of a ‘good patient’ govern nurse-patient relationships and facilitate/hinder ART adherence? To answer this question we draw on a mixed-method and multi-site qualitative research design, enabling an exploration of the various environments in which social representations are constructed and responded to
Summary
While patient-provider interactions are commonly understood as mutually constructed relationships, the role of patient behaviour, participation in interactions, and characteristics, ideals surrounding notions of ‘good’ and ‘bad’ patients, are under-examined. ART requires repeated interactions between HIV positive people and healthcare staff over many years for check-ups, counselling and drug refill This new medical regime presents new opportunities and challenges for the development of patient-healthcare provider relationships. Social representations surrounding ART users (i.e. collective values, beliefs and practices about ARV users, such as how they ought to behave and how they ought to be treated) are being developed throughout Africa in response to the increasing availability of antiretroviral drugs. This new era in HIV care affords a unique opportunity to examine the development of symbols and representations in medical interactions. It is vital to explore how representations of good patients are helping and hindering access and adherence to a lifesaving treatment
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