African American Patient Perceptions of HIV Health Care Provider Cultural Competence That Promote Adherence to Antiretroviral Medication and Self-Care

Purpose and Background: African Americans represent half of the more than one million individuals estimated to be living with HIV in the U.S. African American men are 7.6 times and women are 20 times more likely to die from HIV/AIDS than Whites (OMH, 2009). Disparities in medical care and retention foster dismal long-term health outcomes among this population. Many African Americans do not receive regular HIV  treatment. African Americans have indicated that disparities in treatment may stem from provider bias and cultural insensitivity (Napoles-Springer, Santoyo, Houston, Perez-Stable and Stewart, 2005).

Most studies examine healthcare provider’s definitions of cultural competence practices. The objective of this study was to examine the relationship between African American patients’ perceptions of their healthcare provider’s cultural competence and HIV treatment adherence. Results were also examined by covariates inclusive of the participant’s gender, age, income, education, health status, and length of time engaged in services.

Methodology:  The study was a cross-sectional exploratory descriptive study conducted at the Ruth Rothstein CORE Center in Chicago, Illinois. The sample consisted of 202 participants who self-identified as being African American, were at least 18 years old, received primary medical services from the clinic, had been diagnosed with HIV/AIDS and had been prescribed antiretroviral medication. Participants were recruited from clinic waiting areas and surveys were self-administered one-time. Measures used included the Patient Assessment of Cultural Competency (PACC) survey instrument developed by the Agency for Healthcare Research and Quality (AHRQ). Adherence to medical self-care and antiretroviral medication was measured using three measures. Statistical analyses used included descriptive statistics, Pearson r correlation coefficients, and linear regression.

RESULTS: The majority of the sample was male (N = 119, 58.9%), ages of 45 to 54 years old (N = 75, 37.1%), and poor (less than $5000 per year, N = 84, 41.6%). The more patients believed that providers should integrate culture in HIV treatment; the better their reported health (F1, 138 = 0.151, P = .05) and the more they followed their provider’s advice and instructions (medical self-care; F1, 138 = 0.029, P = .05). Participants who trusted their providers engaged in more medical self-care (F1, 138 = 0.280, P = .01). More shared treatment decisions were reported among participants who had higher levels of education (F1, 127 = 0.337, P = .05). Patients who typically saw nurses F(1,138),=-5.559, p=.01, were less trustful of treatment. 

CONCLUSION: Findings from the study point to the need for increased attention to the role of cultural competence in HIV/AIDS care. Social workers are well suited to develop interventions that address disparities in health care inclusive historical experiences that impede patient-provider trust. Additional research is also needed to better understand the impact of cultural competence on adherence behaviors. Federal policy implications are discussed.

REFERENCES:

Napoles-Springer, A. M., Santoyo, J., Houston, K., Perez-Stable, E. J., & Stewart, A. J.            

            (2005). Patient’s perceptions of cultural factors affecting the quality of their

            medical encounters. Health Expectations, 8, 4-17.

Office of Minority Health (2009). Hiv/aids and african americans. Retrieved April 29,

2013 from http://minorityhealth.hhs.gov/templates/content.aspx?ID= 3019.