Poor adherence to treatment is a major barrier to the effectiveness of HIV medicines. The aim of this study was to explore and conceptualise patterns and difficulties in doctors' work related to patient adherence to HIV medication. No previous studies on this topic have directly observed doctors' behaviour. Doctors were observed during their clinical work and then interviewed with a semi-structured interview guide. Discovered, that doctors and patients rarely discussed adherence in depth, the study focused on adherence communication and its barriers. The main patterns in doctors' communication with patients about adherence were similar in both cases. A significant barrier to in-depth communication about adherence was that some doctors felt it would be uncomfortable to explore the possibility of non-adherence if there were no objective signs of treatment failure, as patients might feel 'accused'. To overcome this awkwardness, some physicians consciously tried to 'deter' patients for non-adherence. A simple four-step, three-factor model of doctors' communication about adherence was developed. Difficulties in communication were a major barrier in doctors' work related to patients' adherence to HIV medication. The proposed model of physicians' communication with patients about adherence - and the identification of awkwardness and trustworthiness as key issues - may help rethink this topic for use in clinical practice and future research.
Physicians' communication with patients about adherence to HIV medication in San Francisco and Copenhagen: a qualitative study using Grounded Theory
19 December 2022