General Practitioners' Beliefs about the Provision of Behavioral HIV Risk Assessment and Prevention Counseling to Patients: Theory of Planed Behavior
Creators: name: Tafesse, Fikru
Publisher: name: National Academic Digital Repository of Ethiopia
Year: 2007

description: Background: The magnitude of HIV/AIDS is ever increasing in many parts of the world, especially in Sub-Saharan Africa, despite recent improved access to antiretroviral treatment. This calls for timely, coordinated, and intensified interventions including prevention, care, and treatment services. Accordingly, the government of Ethiopia, particularly, Addis Ababa health bureau has planned and been working hard to improve access to HIV prevention and treatment services. One strategy which comes to light is to integrate VCT services in to already available health service packages. To facilitate the integration process, it would be crucial to identify and address those determinant factors that may affect clinicians' provision of HIV risk assessment and prevention advices to their patients. Objectives: - The objectives of this study are: (1) to explore whether the General Practitioners (GPs) ask patients about their sexual history and assess behavioral risk to HIV and provide HIV prevention advices, (2) to describe circumstances under which the GPs ask patients about their sexual history and assess behavioral risk to HIV and provide prevention advices to patients, and (3) to identify behavioral, normative and control beliefs of the GPs to ask patients about their sexual history and assess behavioral risk to HIV and provide prevention advices to patients Methodology: - The study employed a qualitative study design with individual in-depth interviews. An open-ended semi-structured interview guide was developed based on the framework of the theory of planned behavior (TPB). This guide was translated into Amharic and used to conduct the in-depth interviews with the GPs in order to get a thorough understanding of the feelings and thoughts of the GPs. The interview guide was used to vi elicit from the GPs the factors that may affect their provision of these two clinical services: (1) Asking patients specific questions about their sexual history and assessing behavioral risk to HIV, and (2) providing HIV prevention advices to their patients. An elicitation in-depth interview was conducted with twenty eight GPs, which was the saturation point for this study, to identify those belief factors which may affect their "Asking of patients specific questions about their sexual history and assess behavioral risk to HIV" and "providing advice to patients about HIV prevention". The study was conducted from January to February 2007 in Addis Ababa, Ethiopia. Audio tape was used to record the responses of the twenty four GPs based on their willingness and for the rest four interviews were dictated as these GPs were not willing on the use of a tape recorder. All audio taped interviews were transcribed verbatim. The dictated interviews were also expanded and organized. The content analysis was conducted employing the thematic qualitative data analysis method to sort out all statements relevant to the components of TPB. For each clinical action, summary analysis was made to put the verbatim statements and the expanded notes related to the behavioral beliefs, normative beliefs and control beliefs of the GPs into the following lists respectively: (1) positive and negative behavioral beliefs about the outcomes or attributes of the action, (2) people or groups that encourage or discourage the action, and (3) factors or situations that make it easier or more difficult to perform the action. The positive and negative behavioral beliefs about the outcomes or attributes of each clinical action were organized into six major themes or categories. The sources of normative vii influences were grouped as approving and disapproving the behavior. The control beliefs were organized as facilitators and barriers/constraints. Actual phrases of the GPs were used to highlight important findings as needed. Results: - According to the study results, most of the GPs stated that they rarely ask patients specific questions about their sexual history and assess sexual behavioral risk to HIV and provide advice to patients about HIV prevention because of the various beliefs they indicated in relation to providing these services. The GPs indicated that they provide the two clinical services only to patients they think are at risk of acquiring HIV/AIDS based on the patients' history and findings of physical examination. The GPs stated that they ask patients history about sexual behaviors including history of condom use, multiple sexual partners, and sexually transmitted diseases (STD) to assess behavioral risk to HIV. They claimed that these services are provided to patients privately, by being friendly and respectful as much as possible, by letting no one to enter the examination rooms. The GPs have described various behavioral, normative and control beliefs which might have affected their provision of these services to patients. The important behavioral beliefs of the GPs identified were categorized into six different, but not mutually exclusive, themes which include Patient Confidence, Patient Discomfort, Valuable Patient Care, Impact on Time and Money, Professional Protection and Competence themes. Pertaining to the normative beliefs, the GPs described various sources of normative influences (referents) which either approve or disapprove the provision of HIV prevention services to patients. These identified referents included: friends, colleagues, patients, viii popular media such as TV and Radio, organizations such as PRO-PRIDE, FHI, WHO, JOHN HOPKINS which participate in HIV related trainings, Hospital administration and Addis Ababa health bureau. The GPs have also described important control beliefs which may facilitate or constrain their provision of the two clinical services to patients. Among the important facilitating factors identified include: presence of VCT, ART, &amp; Care and Support services for patients, training on Provider Initiated Counseling and Testing (PICT), having the opportunity to see patients without family/friend present, having the opportunity to see young patients who are open to the idea, and patients with complaints related to HIV. Some of the important factors identified by the GPs to constrain the provision of the two services to patients include: lack of private examination rooms, having many patients to examine, low salary and poor incentive schemes, cultural barrier to talk about sexual matters openly, and stigma and discrimination against HIV patients by the society. Conclusion and Recommendation: - According to the results of this study the general practitioners rarely provide HIV prevention services to their patients because of their various beliefs identified about the provision of these services. These services are provided only to those symptomatic patients presenting with HIV related problems, excluding the vast majority of those asymptomatic patients who may benefit from early detection and treatment. This study has tried to identify those behavioral, normative and control beliefs which are relevant to the population under study (the general practitioners) and their behavior (the provision of HIV prevention services to patients). The identified belief factors must be measured quantitatively to understand which factor(s) most affected the behavior. ix Thus, in order to bring behavioral change in this area, any intervention developed should be designed to target and change the belief factor(s) in such a way that it affects attitude, subjective norm, and perceived behavioral control over the behavior thereby leading to a change in intention and behavior.