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Improving VA Provider Communication about HIV Testing: A Qualitative Approach to Designing a Communication Intervention

Bokhour BG, Solomon J, Knapp H, McInnes DK, Ching W, Lowe L, McCoy L, Asch SM, Gifford AL. Improving VA Provider Communication about HIV Testing: A Qualitative Approach to Designing a Communication Intervention. Poster session presented at: VA QUERI National Meeting; 2008 Dec 12; Phoenix, AZ.




Abstract:

Objectives: Implementing routine HIV testing is a priority for the VA and a focus of the work of QUERI HIV/Hepatitis. One of the barriers to routine testing is provider communication with patients about this sensitive area. Congruent with HSRandD goals to improve provider education, our goal was to develop an educational intervention to improve provider-patient communication about HIV testing. We show how we developed a one-time communication training reflecting patient and provider perspectives on routine HIV testing. Methods: Two focus groups with primary care providers and four focus groups with patients were conducted at 2 VAMC's in Massachusetts and California. Focus groups were analyzed using grounded thematic analyses. Based on findings, and theories of patient-centered communication, we collaborated with researchers in HIV and patient-provider communication and clinical leaders to design a single 45-minute session and materials for providers on how to best discuss routine HIV testing with primary care patients. We conducted the intervention with PCPs at regularly scheduled staff meetings at each site. We conducted a brief survey post-training to obtain feedback from providers about the training. Results: We designed a multimedia communication intervention, including a didactic presentation of facts about HIV testing and prevalence; a brief presentation of the research findings from focus groups with an emphasis on similarities and differences between patient and provider perspectives; and a rubric for talking about HIV testing called 'the 6 R's for routine testing.' We also presented 3 videos of a provider discussing routine HIV testing representing scenarios raised in focus groups. In post-training surveys providers indicated that they found the skills useful and would be able to use them in the future. Implications: Using qualitative focus group findings is an effective means to create patient-provider communication interventions that address the concerns of both patients and providers. Through the melding of such findings and theoretical constructs around patient-centered communication, we were able to develop an intervention that providers found useful and relevant to their practice. Impacts: As routine HIV testing becomes more central to VA policies, a communication training like the one we developed may enable providers to better communicate in limited available clinical time.





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