Provider–patient interaction in rural Cameroon—How it relates to the patient's understanding of diagnosis and prescribed drugs, the patient's concept of illness, and access to therapy

Abstract

Objective This cross-sectional survey examines the relation between provider–patient interaction and several patient-outcomes in a rural health district in Cameroon. Methods We used structured patient interviews and the Roter Interaction Analysis System (RIAS) for analysis of audio-recorded consultations. Results Data from 130 primary care consultations with 13 health-care providers were analysed. 51% of patients correctly named their diagnoses after the consultation; in 47% of prescribed drugs patients explained correctly the purpose. Patients’ ability to recall diagnoses was related to the extent of clarity a provider used in mentioning it during consultation (recall rates: 87.5% if mentioned explicitly, 56.7% if mentioned indirectly and 19.2% if not mentioned at all; p < 0.001). Two thirds of patients were able to describe their concept of illness before the consultation, but only 47% of them mentioned it during consultations. On average patients who mentioned their disease concept were faced with more remarks of disapproval from providers (1.73 vs 0.63 per consultation; p < 0.01). Although 41% of patients admitted problems with financial resources to buy prescribed drugs, discussion about financial issues was very rare during consultations. Providers issued financial questions in 32%, patients in 21% of consultations. Conclusion This study shows that provider–patient interaction in primary health care in a rural Cameroon district deserves more attention. It might improve the patients’ knowledge about their health condition and support them in beneficial health behaviour. Practice implications Our findings should encourage providers to give more medical explanation, to discuss patients’ health beliefs in a non-judgemental manner, and to consider financial issues more carefully.