Date Published: April 16, 2018
Author(s): Vincent K. Cubaka, Michael Schriver, Janvier B. Kayitare, Phil Cotton, Helle T. Maindal, Laetitia Nyirazinyoye, Per Kallestrup.
Patient–provider communication is an interpersonal interaction between a patient and a health care provider.
This study explored patients’ communication preferences and perceptions on what factors influence the patient–provider communication in primary health care settings in Rwanda.
In-depth semi-structured interviews with 15 individuals including 8 with limited literacy. A thematic inductive analysis was used.
Patients valued communication with providers and expressed the need for interacting with caring, empathic providers who can share all the information they want and involve them in their own care. Health literacy and power issues were factors that may influence patient–provider communication. Patients with limited literacy appeared to rely highly on health care providers for making decisions about and managing their health care.
The expressed preferences, including those of patients with limited literacy, aligned well with the patient-centred care model. There were indications of a power imbalance weighing on the provider’s side. Although patients with limited literacy were reliant on providers for decision-making, they were ready to be more involved in the care, suggesting a potential for improved patient involvement even for patients with paternalistic care preferences. These patients’ insights can impact policies and curricula to optimise clinical practice. Generated knowledge will contribute to the indispensable yet underdeveloped field of health communication in sub-Saharan Africa.
Findings call for more inclusion of patient perspectives in the patient–provider encounter. This could require more training of professionals and research on the topic, both in Rwanda and in other regions.
Patient–provider communication (PPC) is a critical component of health care and may influence patients’ health outcomes and well-being directly and indirectly.1,2
We present the findings using exemplary quotes, as these elaborate the points we make while conveying a sense of the study field we could not ourselves paraphrase. The purpose was to give direct voice to an often unheard group: patients.
Patients expressed their communication preferences clearly. They are summarised as a need for a caring provider, for access to more information about their health and health care, and for being involved in their care. These needs are embedded in the patient-centred care model that has impact on health outcomes.16 Patients also revealed perceived factors that may affect PPC and thus require further consideration. Patient-centred care is a leading PPC model, yet there are indications that it is not fully conceptualised and applied in our context where the current practice of care may hamper its understanding and implementation.
To our knowledge this is the first study exploring patients’ perceptions of their communication with PHC providers in OPD in Rwanda. The participants in this study were able to demonstrate shared and consistent views of the perceived factors that influence effective PPC. Patients’ preferences reflect components of the patient-centred care model and include a need for meeting caring, empathic providers, who can inform them about their health and involve them in health care. Patients with limited literacy appeared to rely highly on health care providers for making decisions about and managing their health care on their behalf. They were, however, ready to be more involved, suggesting a potential for improved patient involvement even for patients with paternalistic care preferences. These findings should be considered while planning services, training health care providers, measuring quality and developing health education strategies to empower patients or simply while discussing issues around PPC. The generated knowledge may help advance PPC and health communication in Rwanda and in sub-Saharan Africa.