Dialogue on HIV medicine adherence differs by ethnicity, race
In HIV care, how healthcare providers communicate with patients can determine whether patients take their medications as prescribed. The researchers found that in dialogue between doctors and minority patients there were different speech patterns, more provider directives and there was more dialogue about HIV drug adherence.
The researchers conducted analysis of recorded office visits between 45 healthcare providers and 404 patients, 245 of whom were black and 59 of whom were Hispanic.
In the study, the research team found that because black patients spoke less to their providers than either white or Hispanic patients, they experienced greater provider dominance in their discussions and there were fewer expressions of goals or values than in conversations with whites and Hispanics. Providers asked Hispanic patients fewer open-ended questions and there was less humor in their discussions.
There was more discussion about medicine adherence with black and Hispanic patients than with white patients. Barton Laws, a member of the Brown research team, hypothesized that providers may be attempting to compensate for what they read in studies about lower adherence among minorities.
"The possibility that seems most compelling to me is the doctors don't trust their black and Hispanic patients as much to be adherent," Laws said. "It has been epidemiologically observed that they do tend to be less adherent, but it's not because they are black or Hispanic."
The study also found that in more extensive dialogues between black and Hispanic patients and their providers, there were more provider directives said to the minority patients than to whites. An example of a provider directive is the phrase, "Take your medicine or you'll get sick."
Laws said the current study does not examine whether racial differences in the dialogue result in different clinical outcomes. He said now that question can be investigated.
Future work in this area will assess whether provider communication styles can be altered and how communication patterns relate to outcomes.