A lot of evidence shows that a patients' race or ethnicity is associated with differences in how health care providers communicate with them, the health care they receive, and their health outcomes. In HIV care, a key to those outcomes is whether people take their medications as prescribed. A new study of the doctor-patient dialogue about HIV drug adherence found several specific differences in those conversations depending on patients' race and ethnicity.
The study, which appears online Jan. 25 in the journal AIDS and Behavior, is based on a highly structured analysis of recorded office visits between 45 health care providers and 404 patients, 245 of whom were black and 59 of whom were Hispanic. Researchers used the Generalized Medical Interaction Analysis, which divides the dialogue into units called "utterances" based on speech acts such as asking questions, giving information, giving instructions, making requests, or expressing desires. It also classifies the topic or subject matter of each utterance.
Lead author M. Barton Laws, assistant professor (research) of health services policy and practice in the Brown University School of Public Health, and his colleagues produced three main findings:
Different speech patterns: Because black patients spoke less to their providers than either white or Hispanic patients, they experienced significantly greater provider dominance in their discussions. Black patients and their providers exchanged fewer expressions of goals or values than did Hispanics and whites. Meanwhile, providers asked Hispanic patients fewer open-ended questions and their discussions involved less humor.
More dialogue about HIV drug adherence with minorities: Providers and either black or Hispanic patients exchanged a higher volume of dialogue - more utterances - about adherence than did providers and white patients. This difference occurred regardless of how adherent patients were to their medication regimens or whether lab tests showed that their disease was under control.
Directives, not problem solving: In those more extensive dialogues between black and Hispanic patients with their providers, there were not any more utterances about problem-solving than for whites. Instead there were more provider directives (e.g. "Take your medicine or you'll get sick") said to the minority patients than to whites.
New hypotheses
Laws said that the research does not reveal why providers - 34 of whom were doctors and 30 of whom were white, with most of the rest of Asian ancestry - talked more with minority patients than with whites about adherence. One hypothesis - yet to be tested - is that the providers may be attempting to compensate for what they read in studies about lower adherence among minorities.
