Quality of care for Black and Latina women living with HIV in the U.S.: a qualitative study

Whitney S Rice; Faith E Fletcher; Busola Akingbade; Mary Kan; Samantha Whitfield; Shericia Ross; C Ann Gakumo; Igho Ofotokun; Deborah J Konkle-Parker; Mardge H Cohen; Gina M Wingood; Brian W Pence; Adaora A Adimora; Tonya N Taylor; Tracey E Wilson; Sheri D Weiser; Mirjam-Colette Kempf; Bulent Turan; Janet M Turan

doi:10.1186/s12939-020-01230-3

Quality of care for Black and Latina women living with HIV in the U.S.: a qualitative study

Int J Equity Health. 2020 Jul 6;19(1):115. doi: 10.1186/s12939-020-01230-3.

Authors

Whitney S Rice¹, Faith E Fletcher², Busola Akingbade³, Mary Kan⁴, Samantha Whitfield⁵, Shericia Ross⁵, C Ann Gakumo⁶, Igho Ofotokun⁷, Deborah J Konkle-Parker⁸, Mardge H Cohen⁹, Gina M Wingood¹⁰, Brian W Pence¹¹, Adaora A Adimora¹¹, Tonya N Taylor¹², Tracey E Wilson¹², Sheri D Weiser¹³, Mirjam-Colette Kempf^{2

14

15

16}, Bulent Turan¹⁷, Janet M Turan^{5

15}

Affiliations

¹ Department of Behavioral, Social and Health Education Sciences, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA. whitney.s.rice@emory.edu.
² Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA.
³ Hubert Department of Global Health, Emory University, Atlanta, GA, USA.
⁴ Department of Psychology, Emory University, Atlanta, GA, USA.
⁵ Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA.
⁶ Department of Nursing, University of Massachusetts Boston, Boston, MA, USA.
⁷ Department of Medicine, Emory University, Atlanta, GA, USA.
⁸ Department of Medicine and School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA.
⁹ Department of Medicine, Stroger Hospital of Cook County, Chicago, IL, USA.
¹⁰ Department of Sociomedical Sciences, Lerner Center for Public Health Promotion, Columbia University Mailman School of Public Health, New York, NY, USA.
¹¹ School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹² Department of Community Health Sciences, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA.
¹³ Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
¹⁴ School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁵ Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁶ Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁷ Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.

Abstract

Background: Ending the HIV epidemic requires that women living with HIV (WLWH) have access to structurally competent HIV-related and other health care. WLWH may not regularly engage in care due to inadequate quality; however, women's perspectives on the quality of care they receive are understudied.

Methods: We conducted 12 focus groups and three in-depth interviews with Black (90%) and Latina (11%) WLWH enrolled in the Women's Interagency HIV Study in Atlanta, GA, Birmingham, AL, Brooklyn, NY, Chapel Hill, NC, Chicago, IL, and Jackson, MS from November 2017 to May 2018 (n = 92). We used a semi-structured format to facilitate discussions about satisfaction and dissatisfaction with health care engagement experiences, and suggestions for improvement, which were audio-recorded, transcribed, and coded using thematic analysis.

Results: Themes emerged related to women's health care satisfaction or dissatisfaction at the provider, clinic, and systems levels and across Institute of Medicine-defined quality of care domains (effectiveness, efficiency, equity, patient-centeredness, safety and timeliness). Women's degree of care satisfaction was driven by: 1) knowledge-based care resulting in desired outcomes (effectiveness); 2) coordination, continuity and necessity of care (efficiency); 3) perceived disparities in care (equity); 4) care delivery characterized by compassion, nonjudgment, accommodation, and autonomous decision-making (patient-centeredness); 5) attention to avoiding side effects and over-medicalization (safety); and 6) limited wait time (timeliness).

Conclusions: Quality of care represents a key changeable lever affecting engage in care among WLWH. The communities most proximally affected by HIV should be key stakeholders in HIV-related quality assurance. Findings highlight aspects of the health care experience valued by WLWH, and potential participatory, patient-driven avenues for improvement.

Keywords: African American; Black; Engagement in care; HIV/AIDS; Hispanic; Patient satisfaction; Qualitative; Quality of health care; Women living with HIV.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Attitude of Health Personnel
Attitude*
Black or African American*
Consumer Behavior*
Female
Focus Groups
HIV Infections / ethnology*
HIV Infections / therapy
Health Equity*
Hispanic or Latino*
Humans
Middle Aged
Midwestern United States
New England
Patient Participation
Patient Safety
Qualitative Research
Quality of Health Care*
Southeastern United States
Women's Health

Abstract

Publication types

MeSH terms

Grants and funding