Provider-patient interaction in rural Cameroon--how it relates to the patient's understanding of diagnosis and prescribed drugs, the patient's concept of illness, and access to therapy.
OBJECTIVE
This cross-sectional survey examines the relation between provider-patient interaction and several patient-outcomes in a rural health district in Cameroon.


METHODS
We used structured patient interviews and the Roter Interaction Analysis System (RIAS) for analysis of audio-recorded consultations.


RESULTS
Data from 130 primary care consultations with 13 health-care providers were analysed. 51% of patients correctly named their diagnoses after the consultation; in 47% of prescribed drugs patients explained correctly the purpose. Patients' ability to recall diagnoses was related to the extent of clarity a provider used in mentioning it during consultation (recall rates: 87.5% if mentioned explicitly, 56.7% if mentioned indirectly and 19.2% if not mentioned at all; p<0.001). Two thirds of patients were able to describe their concept of illness before the consultation, but only 47% of them mentioned it during consultations. On average patients who mentioned their disease concept were faced with more remarks of disapproval from providers (1.73 vs 0.63 per consultation; p<0.01). Although 41% of patients admitted problems with financial resources to buy prescribed drugs, discussion about financial issues was very rare during consultations. Providers issued financial questions in 32%, patients in 21% of consultations.


CONCLUSIONS
This study shows that provider-patient interaction in primary health care in a rural Cameroon district deserves more attention. It might improve the patients' knowledge about their health condition and support them in beneficial health behaviour.


CONCLUSIONS
Our findings should encourage providers to give more medical explanation, to discuss patients' health beliefs in a non-judgmental manner, and to consider financial issues more carefully.
Labhardt
Niklaus Daniel
ND
Office of the Surgeon General Basel-Stadt, Health Department Basel-Stadt, Switzerland. niklaus.labhardt@gmail.com
Schiess
Kaspar
K
Manga
Engelbert
E
Langewitz
Wolf
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002163:Cameroon; D002648:Child; D003142:Communication; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D055553:Prescription Drugs; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D012017:Referral and Consultation; D012424:Rural Population / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013637:Tape Recording; D055815:Young Adult
D055553:Prescription Drugs