A good patient? How notions of ‘a good patient’ affect
patient-nurse relationships and ART adherence in
Zimbabwe
patient-nurse relationships and ART adherence in
Zimbabwe
File(s)
Published version
Author(s)
Type
Journal Article
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 underexamined.
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 hours 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). Many patients seek to
perform within the confines of the ‘good patient persona’ to access good care and ensure
continued access to ART; in this way, the notion of a ‘good ART patient’ can have positive
effects on patient health outcomes. 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.
Conclusion: 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.
constructed relationships, the role of patient behaviour, participation in interactions, and
characteristics, particularly ideals surrounding notions of ‘good’ and ‘bad’ patients, are underexamined.
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 hours 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). Many patients seek to
perform within the confines of the ‘good patient persona’ to access good care and ensure
continued access to ART; in this way, the notion of a ‘good ART patient’ can have positive
effects on patient health outcomes. 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.
Conclusion: 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.
Date Issued
2015-09-30
Date Acceptance
2015-09-21
Citation
BMC Infectious Diseases, 2015, 15
ISSN
1471-2334
Publisher
BioMed Central
Journal / Book Title
BMC Infectious Diseases
Volume
15
Copyright Statement
© 2015 Campbell et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
License URL
Subjects
Patient-provider relationships
ART adherence
HIV/AIDS
social representation
sub-Saharan Africa
Publication Status
Published
Article Number
404