Skip to main content

Research Repository

Advanced Search

Doing patient-centredness versus achieving public health targets: a critical review of interactional dilemmas in ART adherence support

De Kok, B.C.; Widdicombe, S.; Pilnick, Alison; Laurier, E.

Authors

B.C. De Kok

S. Widdicombe

ALISON PILNICK alison.pilnick@nottingham.ac.uk
Professor of Language, medicine Andsociety

E. Laurier



Abstract

Anti-retroviral Therapy (ART) transformed HIV into a chronic disease but its individual and public health benefits depend on high levels of adherence. The large and rising number of people on ART, now also used as prevention, puts considerable strain on health systems and providers in low and middle as well as high-income countries, which are our focus here. Delivering effective adherence support is thus crucial but challenging, especially given the promotion of patient-centredness and shared decision making in HIV care. To illuminate the complexities of ART adherence support delivered in and through clinical encounters, we conducted a multi-disciplinary interpretative literature review. We reviewed and synthesized 82 papers published post 1997 (when ART was introduced) belonging to three bodies of literature: public health and psychological studies of ART communication; anthropological and sociological studies of ART; and conversation analytic studies of patient-centredness and shared decision-making. We propose three inter-related tensions which make patient-centredness particularly complex in this infectious disease context: achieving trust versus probing about adherence; patient-centredness versus reaching public health targets; and empowerment versus responsibilisation as ‘therapeutic citizens’. However, there is a dearth of evidence concerning how precisely ART providers implement patient-centredness, shared-decision making in practice, and enact trust and therapeutic citizenship. We show how conversation analysis could lead to new, actionable insights in this respect.

Citation

De Kok, B., Widdicombe, S., Pilnick, A., & Laurier, E. (2018). Doing patient-centredness versus achieving public health targets: a critical review of interactional dilemmas in ART adherence support. Social Science and Medicine, 205, https://doi.org/10.1016/j.socscimed.2018.03.030

Journal Article Type Article
Acceptance Date Mar 21, 2018
Online Publication Date Mar 23, 2018
Publication Date May 31, 2018
Deposit Date Mar 27, 2018
Publicly Available Date Mar 24, 2019
Journal Social Science & Medicine
Print ISSN 0277-9536
Electronic ISSN 0277-9536
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 205
DOI https://doi.org/10.1016/j.socscimed.2018.03.030
Keywords Patient-centredness; Shared decision-making; Therapeutic citizenship; HIV; ART; Adherence; Adherence support; Conversation analysis
Public URL http://eprints.nottingham.ac.uk/id/eprint/50716
Publisher URL https://www.sciencedirect.com/science/article/pii/S0277953618301485
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0

Files


Doing patient centredness vs achieving PH targetsFINAL_revision 2_clean.pdf (959 Kb)
PDF

Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0





You might also like



Downloadable Citations