Stakeholder perceptions on patient-centered care at primary health care level in rural eastern Uganda: A qualitative inquiry.

Everlyn Waweru,Jacqueline Broerse,Nandini D P Sarkar,Bart Criel,Marc- Eric Gruénais,Freddie Ssengooba,Holly Seale

doi:10.1371/journal.pone.0221649

Abstract

BackgroundPatient-centered care (PCC) offers opportunities for African health systems to improve quality of care. Nonetheless, PCC continually faces implementation challenges. In 2015, Uganda introduced PCC as a concept in their national quality improvement guidelines. In order to investigate whether and how this is implemented in practice, this study aims to identify relevant stakeholders’ views on the current quality of primary health care services and their understanding of PCC. This is an important step in understanding how the concept of PCC can be implemented in a resource constrained, sub-Saharan context like Uganda.MethodsThis qualitative study was conducted in Uganda at national, district and facility level, with a focus on three public and three private health centres. Data collection consisted of in-depth interviews (n = 49); focus group discussions (n = 7); and feedback meetings (n = 14) across the four main categories of stakeholders identified: patients/communities, health workers, policy makers and academia. Interviews and discussions explored stakeholder perceptions on the interpersonal aspects of quality primary health care and meanings attached to the concept of PCC. A content analysis of Ugandan policy documents mentioning PCC was also conducted. Thematic content analysis was conducted using NVivo 11 to organize and analyze the data.Findings and conclusionWhile Ugandan stakeholder groups have varying perceptions of PCC, they agree on the following: the need to involve patients in making decisions about their health, the key role of healthcare workers in that endeavor, and the importance of context in designing and implementing solutions. For that purpose, three avenues are recommended: Firstly, fora that include a wide range of stakeholders may offer a powerful opportunity to gain an inclusive vision on PCC in Uganda. Secondly, efforts need to be made to ensure that improved communication and information sharing–important components of PCC–translate to actual shared decision making. Lastly, the Ugandan health system needs to strengthen its engagement of the transformation from a community health worker system to a more comprehensive community health system. Cross-cutting the entire analysis, is the need to address, in a culturally-sensitive way, the many structural barriers in designing and implementing PCC policies. This is essential in ensuring the sustainable and effective implementation of PCC approaches in low- and middle-income contexts.

Highlights

Evidence suggests that most health systems in sub-Saharan Africa still struggle to provide quality primary health care to all the members of their population [1]
In order to investigate whether and how this is implemented in practice, this study aims to identify relevant stakeholders’ views on the current quality of primary health care services and their understanding of Patient-centered care (PCC)
Data analysis was categorized into two major areas of exploration: 1) Understanding stakeholder perceptions of the quality of primary health care and 2) Understanding stakeholders perceptions on the patient centered approach and factors that influence its implementation. Within each of these two major areas of exploration, we aimed to look at the structural context; stakeholder perceptions of the processes involved in providing quality PCC; perceptions of their own roles in practicing PCC; and lastly, stakeholder experiences

Summary

Introduction

Evidence suggests that most health systems in sub-Saharan Africa still struggle to provide quality primary health care to all the members of their population [1]. Patient-centered care (PCC) has been proposed as one of the approaches to improve the responsiveness of health systems by focusing on interpersonal, psychosocial and cultural aspects of health care [9, 10]. PCC implies a culture that considers patients and/or caregivers as equal partners in their own health, alongside health professionals in planning, developing and monitoring care in accordance to expected health standards While this is accepted in principle, it provides a cultural challenge in empowering patients to see themselves as equal partners [16]; a professional challenge in prompting health workers to involve patients in decision-making by taking into account their lived experiences as a resource [17]; and last but not least, a research challenge in measuring its implementation [18]. This is an important step in understanding how the concept of PCC can be implemented in a resource constrained, sub-Saharan context like Uganda

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