title: Reflections on informed choice in resource-poor settings: the case of infant feeding counselling in PMTCT programmes in Tanzania.
abstract: A growing emphasis on patient involvement in health care has brought 'informed choice' to the core of the debate on provider-patient interaction in global health-care programmes. How the principles of patient involvement and informed choice are implemented and experienced in diverging health systems and cultural contexts are issues of increasing interest. Infant feeding and infant feeding counselling of HIV-positive women have posed particular challenges related to choice. Based on ethnographic research conducted from 5 November 2008 to 5 August 2009 within prevention of mother-to-child transmission of HIV (PMTCT) programmes in two hospitals in rural and semi-urban Tanzania, this study explores nurse counsellors' and HIV-positive women's experiences of infant feeding counselling and patient choice. One of the hospitals (hospital A) promoted exclusive breastfeeding as the only infant feeding option, while the other hospital (hospital B) aimed to follow the Tanzanian PMTCT infant feeding guidelines of 2007 promoting patient choice in infant feeding methods. Women in hospital A expressed trust in the advice given and confidence in their own ability to practice exclusive breastfeeding, while women in hospital B expressed great uncertainty and confusion about how best to feed their infants. This paper reflects on the feasibility of a counselling procedure that promotes choice of infant feeding methods in PMTCT programmes in severely resource-poor settings where HIV-positive women have limited access to resources and to up-to-date knowledge on HIV and infant feeding outside the counselling room. We suggest that a universalistic procedure presenting the same unambiguous message on infant feeding to all women enrolled in the PMTCT programme in this and similar settings is likely to produce more confidence, less confusion and, hence, better results in terms of HIV-free survival of the baby.
authors: Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway; Department of Health Studies, University of Stavanger, 4036 Stavanger, Norway. Electronic address: Bodil.B.Vaga@uis.no.
authors: Bodil Bø
authors: BB
authors: Våga
authors: Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway; Faculty of Health and Social Science, Bergen University College, P.O. Box 7030, 5020 Bergen, Norway.
authors: Karen Marie
authors: KM
authors: Moland
authors: Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway; Department of Obstetrics and Gynaecology, Sørlandet Hospital, Flekkefjord, Norway.
authors: Bjørg
authors: B
authors: Evjen-Olsen
authors: Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway.
authors: Astrid
authors: A
authors: Blystad
mesh_terms: D001942:Breast Feeding / Q000523:psychology; D002755:Choice Behavior; D003376:Counseling / Q000379:methods*; D005240:Feasibility Studies; D005247:Feeding Behavior / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009723:Nurse-Patient Relations; D010358:Patient Participation; D011203:Poverty; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D036301:Qualitative Research; D013636:Tanzania
keywords: Counselling; Individual patient choice; Nursing; Patient participation; Prevention of mother-to-child transmission of HIV (PMTCT) programme; Qualitative research; Tanzania