TY - JOUR

T1 - A good patient?

T2 - How notions of 'a good patient' affect patient-nurse relationships and ART adherence in Zimbabwe

AU - Campbell, Catherine

AU - Scott, Kerry

AU - Skovdal, Morten

AU - Madanhire, Claudius

AU - Nyamukapa, Constance

AU - Gregson, Simon

PY - 2015/9/30

Y1 - 2015/9/30

N2 - Background: While patient-provider interactions are commonly understood as mutually constructed relationships,the role of patient behaviour, participation in interactions, and characteristics, particularly ideals surrounding notionsof ‘good’ and ‘bad’ patients, are under-examined. This article examines social representations of ‘a good patient’and how these representations affect patient-healthcare provider relationships and antiretroviral treatment (ART) forpeople living with HIV.Methods: Using thematic network analysis, we examined interview and focus group transcripts involving 25healthcare staff, 48 ART users, and 31 carers of HIV positive children, as well as field notes from over 100 h ofethnographic observation at health centres in rural Zimbabwe.Results: Characteristics of a good patient include obedience, patience, politeness, listening, enthusiasm fortreatment, intelligence, physical cleanliness, honesty, gratitude and lifestyle adaptations (taking pills correctly andcoming to the clinic when told). As healthcare workers may decide to punish patients who do not live up the‘good patient persona’, many patients seek to perform within the confines of the ‘good patient persona’ to accessgood care and ensure continued access to ART.Discussion: The notion of a ‘good ART patient’ can have positive effects on patient health outcomes. It is one ofthe only arenas of the clinic experience that ART patients can influence in their favour. However, for people notconforming to the norms of the ‘good patient persona’, the productive and health-enabling patient-nurserelationship may break down and be detrimental to the patient.Conclusion: We conclude that policy makers need to take heed of the social representations that governpatient-nurse relationships and their role in facilitating or undermining ART adherence.

AB - Background: While patient-provider interactions are commonly understood as mutually constructed relationships,the role of patient behaviour, participation in interactions, and characteristics, particularly ideals surrounding notionsof ‘good’ and ‘bad’ patients, are under-examined. This article examines social representations of ‘a good patient’and how these representations affect patient-healthcare provider relationships and antiretroviral treatment (ART) forpeople living with HIV.Methods: Using thematic network analysis, we examined interview and focus group transcripts involving 25healthcare staff, 48 ART users, and 31 carers of HIV positive children, as well as field notes from over 100 h ofethnographic observation at health centres in rural Zimbabwe.Results: Characteristics of a good patient include obedience, patience, politeness, listening, enthusiasm fortreatment, intelligence, physical cleanliness, honesty, gratitude and lifestyle adaptations (taking pills correctly andcoming to the clinic when told). As healthcare workers may decide to punish patients who do not live up the‘good patient persona’, many patients seek to perform within the confines of the ‘good patient persona’ to accessgood care and ensure continued access to ART.Discussion: The notion of a ‘good ART patient’ can have positive effects on patient health outcomes. It is one ofthe only arenas of the clinic experience that ART patients can influence in their favour. However, for people notconforming to the norms of the ‘good patient persona’, the productive and health-enabling patient-nurserelationship may break down and be detrimental to the patient.Conclusion: We conclude that policy makers need to take heed of the social representations that governpatient-nurse relationships and their role in facilitating or undermining ART adherence.

U2 - 10.1186/s12879-015-1139-x

DO - 10.1186/s12879-015-1139-x

M3 - Journal article

C2 - 26424656

VL - 15

SP - 1

EP - 11

JO - B M C Infectious Diseases

JF - B M C Infectious Diseases

SN - 1471-2334

M1 - 404

ER -