Articles

Quality of care for Black and Latina women living with HIV in the U.S.: a qualitative study

Rice, Whitney S.; Fletcher, Faith E.; Akingbade, Busola; Kan, Mary; Whitfield, Samantha; Ross, Shericia; Gakumo, C. A.; Ofotokun, Igho; Konkle-Parker, Deborah J.; Cohen, Mardge H.; Wingood, Gina M.; Pence, Brian W.; Adimora, Adaora A.; Taylor, Tonya N.; Wilson, Tracey E.; Weiser, Sheri D.; Kempf, Mirjam-Colette; Turan, Bulent; Turan, Janet M.

Background
Ending the HIV epidemic requires that women living with HIV (WLWH) have access to structurally competent HIV-related and other health care. WLWH may not regularly engage in care due to inadequate quality; however, women’s perspectives on the quality of care they receive are understudied.


Methods
We conducted 12 focus groups and three in-depth interviews with Black (90%) and Latina (11%) WLWH enrolled in the Women’s Interagency HIV Study in Atlanta, GA, Birmingham, AL, Brooklyn, NY, Chapel Hill, NC, Chicago, IL, and Jackson, MS from November 2017 to May 2018 (n = 92). We used a semi-structured format to facilitate discussions about satisfaction and dissatisfaction with health care engagement experiences, and suggestions for improvement, which were audio-recorded, transcribed, and coded using thematic analysis.


Results
Themes emerged related to women’s health care satisfaction or dissatisfaction at the provider, clinic, and systems levels and across Institute of Medicine-defined quality of care domains (effectiveness, efficiency, equity, patient-centeredness, safety and timeliness). Women’s degree of care satisfaction was driven by: 1) knowledge-based care resulting in desired outcomes (effectiveness); 2) coordination, continuity and necessity of care (efficiency); 3) perceived disparities in care (equity); 4) care delivery characterized by compassion, nonjudgment, accommodation, and autonomous decision-making (patient-centeredness); 5) attention to avoiding side effects and over-medicalization (safety); and 6) limited wait time (timeliness).


Conclusions
Quality of care represents a key changeable lever affecting engage in care among WLWH. The communities most proximally affected by HIV should be key stakeholders in HIV-related quality assurance. Findings highlight aspects of the health care experience valued by WLWH, and potential participatory, patient-driven avenues for improvement.

Geographic Areas

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Also Published In

Title
International Journal for Equity in Health
DOI
https://doi.org/10.1186/s12939-020-01230-3

More About This Work

Published Here
September 22, 2023

Notes

Quality of health care, Patient satisfaction, Women living with HIV, Engagement in care, HIV/AIDS, Qualitative, African American, Black, Hispanic