Health System Factors Constrain HIV Care Providers in Delivering High-Quality Care: Perceptions from a Qualitative Study of Providers in Western Kenya

The burden on health systems due to increased volume of patients with HIV continues to rapidly increase. The goal of this study was to examine the experiences of HIV care providers in a high patient volume HIV treatment and care program in eastern Africa. Sixty care providers within the Academic Model Providing Access to Healthcare program in western Kenya were recruited into this qualitative study. We conducted in-depth interviews focused on providers’ perspectives on health system factors that impact patient engagement in HIV care. Results from thematic analysis demonstrated that providers perceive a work environment that constrained their ability to deliver high-quality HIV care and encouraged negative patient–provider relationships. Providers described their roles as high strain, low control, and low support. Health system strengthening must include efforts to improve the working environment and easing burden of care providers tasked with delivering antiretroviral therapy to increasing numbers of patients in resource-constrained settings.

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Patient Safety Communication Among Differently Educated Nurses: Converging and Diverging Meaning Systems

Western Journal of Nursing Research ◽

10.1177/0193945917747600 ◽

2017 ◽

Vol 41 (2) ◽

pp. 171-190 ◽

Cited By ~ 3

Author(s):

Allison Brandt Anbari ◽

Amy Vogelsmeier ◽

Debbie S. Dougherty

Keyword(s):

Patient Safety ◽

Qualitative Study ◽

Health System ◽

Local Level ◽

Interview Data ◽

Safety Communication ◽

Meaning Systems ◽

Systemic Level ◽

Theory Of Language ◽

System Factors

Studies that suggest an increased number of bachelor’s prepared nurses (BSNs) at the bedside improves patient safety do not stratify their samples into traditional bachelor’s and associates (ADN) to BSN graduates. This qualitative study investigated potential differences in patient safety meaning among BSNs and ADN to BSN graduates. Guided by the theory of Language Convergence/Meaning Divergence, interview data from eight BSN and eight ADN to BSN graduates were analyzed. Findings indicate there are two meaning levels or systems, the local level and the systemic level. At the local level, the meaning of patient safety is focused at the patient’s bedside and regulated by the nurse. The systemic level included the notion that health system factors such as policies and staffing are paramount to keeping patients safe. More frequently, ADN to BSN graduates’ meaning of patient safety was at the local level, while BSNs’ meaning centered at the systemic level.

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Barriers to increase surgical productivity in Sierra Leone: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2021-056784 ◽

2021 ◽

Vol 11 (12) ◽

pp. e056784

Author(s):

Juul Bakker ◽

A J van Duinen ◽

Wouter W E Nolet ◽

Peter Mboma ◽

Tamba Sam ◽

...

Keyword(s):

Qualitative Study ◽

Health System ◽

Sierra Leone ◽

Health Workers ◽

Health System Strengthening ◽

Financial Barriers ◽

Public And Private ◽

Factors Influencing ◽

Surgical Workforce ◽

Training Opportunities

ObjectiveTo explore factors influencing surgical provider productivity and identify barriers against and opportunities to increase individual surgical productivity in Sierra Leone, in order to explain the observed increase in unmet surgical need from 92.2% to 92.7% and the decrease in surgical productivity to 1.7 surgical procedures per provider per week between 2012 and 2017.Design and methodsThis explanatory qualitative study consisted of in-depth interviews about factors influencing surgical productivity in Sierra Leone. Interviews were analysed with a thematic network analysis and used to develop a conceptual framework.Participants and setting21 surgical providers and hospital managers working in 12 public and private non-profit hospitals in all regions in Sierra Leone.ResultsSurgical providers in Sierra Leone experience a broad range of factors within and outside the health system that influence their productivity. The main barriers involve both patient and facility financial constraints, lack of equipment and supplies, weak regulation of providers and facilities and a small surgical workforce, which experiences a lack of recognition. Initiation of a Free Health Care Initiative for obstetric and paediatric care, collaborations with partners or non-governmental organisations, and increased training opportunities for highly motivated surgical providers are identified as opportunities to increase productivity.DiscussionBroader nationwide health system strengthening is required to facilitate an increase in surgical productivity and meet surgical needs in Sierra Leone. Development of a national strategy for surgery, obstetrics and anaesthesia, including methods to reduce financial barriers for patients, improve supply-mechanisms and expand training opportunities for new and established surgical providers can increase surgical capacity. Establishment of legal frameworks and appropriate remuneration are crucial for sustainability and retention of surgical health workers.

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Barriers to communication between HIV care providers (HCPs) and women living with HIV about child bearing: A qualitative study

Patient Education and Counseling ◽

10.1016/j.pec.2015.11.023 ◽

2016 ◽

Vol 99 (5) ◽

pp. 754-759 ◽

Cited By ~ 11

Author(s):

Ismael Ddumba-Nyanzi ◽

David Kaawa-Mafigiri ◽

Helle Johannessen

Keyword(s):

Qualitative Study ◽

Hiv Care ◽

Care Providers ◽

Women Living With Hiv ◽

Child Bearing ◽

Barriers To Communication ◽

Living With Hiv

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Service user and care giver involvement in mental health system strengthening in Nepal: a qualitative study on barriers and facilitating factors

International Journal of Mental Health Systems ◽

10.1186/s13033-017-0139-1 ◽

2017 ◽

Vol 11 (1) ◽

Cited By ~ 19

Author(s):

Dristy Gurung ◽

Nawaraj Upadhyaya ◽

Jananee Magar ◽

Nir Prakash Giri ◽

Charlotte Hanlon ◽

...

Keyword(s):

Mental Health ◽

Qualitative Study ◽

Health System ◽

Mental Health System ◽

Service User ◽

Health System Strengthening ◽

Care Giver ◽

Facilitating Factors

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Health Care Providers’ Challenges to High-Quality HIV Care and Antiretroviral Treatment Retention in Rural South Africa

Qualitative Health Research ◽

10.1177/1049732320983270 ◽

2021 ◽

Vol 31 (4) ◽

pp. 722-735

Author(s):

Aimée Julien ◽

Sibyl Anthierens ◽

Annelies Van Rie ◽

Rebecca West ◽

Meriam Maritze ◽

...

Keyword(s):

South Africa ◽

Health Care ◽

Health Care Providers ◽

Antiretroviral Treatment ◽

Hiv Care ◽

Care Providers ◽

Framework Analysis ◽

High Quality ◽

Rural South ◽

Rural South Africa

Provision of high-quality HIV care is challenging, especially in rural primary care clinics in high HIV burden settings. We aimed to better understand the main challenges to quality HIV care provision and retention in antiretroviral treatment (ART) programs in rural South Africa from the health care providers’ perspective. We conducted semi-structured qualitative interviews with 23 providers from nine rural clinics. Using thematic and framework analysis, we found that providers and patients face a set of complex and intertwined barriers at the structural, programmatic, and individual levels. More specifically, analyses revealed that their challenges are primarily structural (i.e., health system- and microeconomic context-specific) and programmatic (i.e., clinic- and provider-specific) in nature. We highlight the linkages that providers draw between the challenges they face, the motivation to do their job, the quality of the care they provide, and patients’ dissatisfaction with the care they receive, all potentially resulting in poor retention in care.

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Patient, caregiver, and health care provider perspectives on barriers and facilitators to heart failure care in Kerala, India: A qualitative study

Wellcome Open Research ◽

10.12688/wellcomeopenres.16365.1 ◽

2020 ◽

Vol 5 ◽

pp. 250

Author(s):

Prinu Jose ◽

Ranjana Ravindranath ◽

Linju M. Joseph ◽

Elizabeth C. Rhodes ◽

Sanjay Ganapathi ◽

...

Keyword(s):

Heart Failure ◽

Health Care ◽

Focus Group ◽

Qualitative Study ◽

Health Care Providers ◽

Self Management ◽

Care Providers ◽

Focus Group Discussions ◽

Group Discussions ◽

High Quality

Background: Deficits in quality of care for patients with heart failure (HF) contribute to high mortality in this population. This qualitative study aims to understand the barriers and facilitators to high-quality HF care in Kerala, India. Methods: Semi-structured, in-depth interviews were conducted with a purposive sample of health care providers (n=13), patients and caregivers (n=14). Additionally, focus group discussions (n=3) were conducted with patients and their caregivers. All interviews and focus group discussions were transcribed verbatim. Textual data were analysed using thematic analysis. Results: Patients’ motivation to change their lifestyle behaviours after HF diagnosis and active follow-up calls from health care providers to check on patients’ health status were important enablers of high-quality care. Health care providers’ advice on substance use often motivated patients to stop smoking and consuming alcohol. Although patients expected support from their family members, the level of caregiver support for patients varied, with some patients receiving strong support from caregivers and others receiving minimal support. Emotional stress and lack of structured care plans for patients hindered patients’ self-management of their condition. Further, high patient loads often limited the time health care providers had to provide advice on self-management options. Nevertheless, the availability of experienced nursing staff to support patients improved care within health care facilities. Finally, initiation of guideline-directed medical therapy was perceived as complex by health care providers due to multiple coexisting chronic conditions in HF patients. Conclusions: Structured plans for self-management of HF and more time for patients and health care providers to interact during clinical visits may enable better clinical handover with patients and family members, and thereby improve adherence to self-care options. Quality improvement interventions should also address the stress and emotional concerns of HF patients.

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