title: Evaluating the effectiveness of patient education and empowerment to improve patient-provider interactions in antiretroviral therapy clinics in Namibia.
abstract: In order to increase patient active engagement during patient-provider interactions, we developed and implemented patient training sessions in four antiretroviral therapy (ART) clinics in Namibia using a "Patient Empowerment" training curriculum. We examined the impact of these trainings on patient-provider interactions after the intervention. We tested the effectiveness of the intervention using a randomized parallel group design, with half of the 589 enrolled patients randomly assigned to receive the training immediately and the remaining randomized to receive the training 6 months later. The effects of the training on patient engagement during medical consultations were measured at each clinic visit for at least 8 months of follow-up. Each consultation was audiotaped and then coded using the Roter Interaction Analysis System (RIAS). RIAS outcomes were compared between study groups at 6 months. Using intention-to-treat analysis, consultations in the intervention group had significantly higher RIAS scores in doctor facilitation and patient activation (adjusted difference in score 1.19, p = .004), doctor information gathering (adjusted difference in score 2.96, p = .000), patient question asking (adjusted difference in score .48, p = .012), and patient positive affect (adjusted difference in score 2.08, p = .002). Other measures were higher in the intervention group but did not reach statistical significance. We have evidence that increased engagement of patients in clinical consultation can be achieved via a targeted training program, although outcome data were not available on all patients. The patient training program was successfully integrated into ART clinics so that the trainings complemented other services being provided.
authors.affiliation: a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA.
authors.forename: Ellen W
authors.initials: EW
authors.lastname: Maclachlan
authors.affiliation: a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Shepard-Perry
authors.affiliation: b International Training and Education Center for Health (I-TECH) , Ondangwa , Namibia.
authors.forename: Paulina
authors.initials: P
authors.lastname: Ingo
authors.affiliation: b International Training and Education Center for Health (I-TECH) , Ondangwa , Namibia.
authors.forename: James
authors.initials: J
authors.lastname: Uusiku
authors.affiliation: c International Organization for Migration (IOM) , Windhoek , Namibia.
authors.forename: Ruusa
authors.initials: R
authors.lastname: Mushimba
authors.affiliation: d Ministry of Health and Social Services (MoHSS) , Katima Mulilo , Namibia.
authors.forename: Ricky
authors.initials: R
authors.lastname: Simwanza
authors.affiliation: e The Global Fund to Fight AIDS, Tuberculosis and Malaria , Windhoek , Namibia.
authors.forename: Joseph
authors.initials: J
authors.lastname: Likoro
authors.affiliation: f International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health , Windhoek , Namibia.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Brandt
authors.affiliation: g International Clinical Research Center (ICRC), University of Washington Department of Global Health , Seattle , WA , USA.
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Thomas
authors.affiliation: h Monitoring and Evaluation Unit , Millennium Challenge Account , Lusaka , Zambia.
authors.forename: Claude
authors.initials: C
authors.lastname: Kasonka
authors.affiliation: i Namibia Ministry of Health and Social Services , Directorate of Special Programs (MoHSS/DSP, Windhoek, Namibia).
authors.forename: Ndapewa
authors.initials: N
authors.lastname: Hamunime
authors.affiliation: a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: O'Malley
mesh_terms: D000328:Adult; D003142:Communication; D004521:Educational Measurement; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D058015:Health Communication; D006801:Humans; D008297:Male; D008875:Middle Aged; D009276:Namibia / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation; D011209:Power, Psychological; D011369:Professional-Patient Relations
keywords: ART services; Impact evaluation; empowerment; medical dialogue; patient–provider communication; randomized controlled trial