title: A good patient? How notions of 'a good patient' affect patient-nurse relationships and ART adherence in Zimbabwe.
abstract: 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 notions of '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) for people living with HIV.
  
  
  METHODS
  Using thematic network analysis, we examined interview and focus group transcripts involving 25 healthcare staff, 48 ART users, and 31 carers of HIV positive children, as well as field notes from over 100 h of ethnographic observation at health centres in rural Zimbabwe.
  
  
  RESULTS
  Characteristics of a good patient include obedience, patience, politeness, listening, enthusiasm for treatment, intelligence, physical cleanliness, honesty, gratitude and lifestyle adaptations (taking pills correctly and coming 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 access good care and ensure continued access to ART.
  
  
  CONCLUSIONS
  The notion of a 'good ART patient' can have positive effects on patient health outcomes. It is one of the only arenas of the clinic experience that ART patients can influence in their favour. However, for people not conforming to the norms of the 'good patient persona', the productive and health-enabling patient-nurse relationship may break down and be detrimental to the patient.
  
  
  CONCLUSIONS
  We conclude that policy makers need to take heed of the social representations that govern patient-nurse relationships and their role in facilitating or undermining ART adherence.
authors.affiliation: Department of Social Psychology, London School of Economics and Political Science, Houghton Street, WC2A 2AE, London, UK. c.campbell@lse.ac.uk.
authors.forename: Catherine
authors.initials: C
authors.lastname: Campbell
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. keescott@jhsph.edu.
authors.forename: Kerry
authors.initials: K
authors.lastname: Scott
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen, Denmark. m.skovdal@gmail.com.
authors.forename: Morten
authors.initials: M
authors.lastname: Skovdal
authors.affiliation: Biomedical Research and Training Institute, Harare, Zimbabwe. cmadanhire@gmail.com.
authors.forename: Claudius
authors.initials: C
authors.lastname: Madanhire
authors.affiliation: School of Public Health, Imperial College, London, UK and Biomedical Research and Training Institute, Harare, Zimbabwe. c.nyamukapa03@imperial.ac.uk.
authors.forename: Constance
authors.initials: C
authors.lastname: Nyamukapa
authors.affiliation: School of Public Health, Imperial College, London, UK and Biomedical Research and Training Institute, Harare, Zimbabwe. sajgregson@aol.com.
authors.forename: Simon
authors.initials: S
authors.lastname: Gregson
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000188:drug therapy*; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D009723:Nurse-Patient Relations; D012424:Rural Population; D015030:Zimbabwe
chemical_list: D019380:Anti-HIV Agents