Evaluating the effectiveness of patient education and empowerment to improve patient–provider interactions in antiretroviral therapy clinics in Namibia

Figures & data

Figure 1. Schematic of patient education and empowerment impact evaluation study design.

Figure 2. Patient education and empowerment study cascade.

Table 1. Demographic characteristics of the study population by study group.

Participant characteristic	Intervention	Control
Demographics	N = 299	N = 290
Female gender	195 (65%)	199 (69%)
Age – mean (SD)	34 (8.1)	34 (8.2)
– Median (IQR)	33 (29–39)	33 (28–39)
Employed	110 (37%)	102 (35%)
Education
None	16 (5%)	14 (5%)
Primary	83 (28%)	81 (28%)
Secondary	196 (66%)	190 (65%)
Post-secondary	4 (1%)	6 (2%)
Marital status
Single	155 (52%)	153 (53%)
Married	67 (22%)	53 (18%)
Separated or divorced	7 (2%)	9 (3%)
Widowed	10 (3%)	9 (3%)
Live with partner (unmarried)	60 (20%)	66 (23%)
Reproductive characteristics
Using family planning method (women)	93 (48%)	87 (44%)
Pregnant (women)
Yes	28 (14%)	36 (18%)
Don't know	6 (3%)	4 (2%)
Live births (women)
–Mean (SD)	2.11 (1.72)	2.04 (1.63)
–Median (IQR)	2.0 (1–3)	2.0 (1–3)
Children (men)
–Mean (SD)	3.09 (2.15)	2.93 (2.08)
–Median (IQR)	3.0 (1–4)	2.0 (2–4)
HIV characteristics
Months since first pos. HIV test
– Mean (SD)	17.1 (22.9)	19.7 (24.4)
– Median (IQR)	5.1 (1.3–26.8)	6.9 (1.5–33.1)
Unknown or missing	18 (6.0%)	16 (6.0%)
Body mass index (BMI)
– Mean (SD)	21.7 (3.7)	21.8 (4.0)
– Median (IQR)	21.2 (19.1–23.9)	21.5 (18.8–23.9)
Unknown or missing	65 (21.7%)	77 (26.6%)
Weight (kg)
– Mean (SD)	59.2 (10.6)	59.2 (11.2)
– Median (IQR)	58.0 (52.1–64.0)	59.0 (52.0–65.0)
Unknown or missing	19 (6.4%)	24 (8.3%)
WHO clinical stage at ART initiation
Stage 1	161 (57%)	141 (51%)
Stage 2	71 (25%)	98 (36%)a
Stage 3	45 (16%)	33 (12%)
Stage 4	3 (1%)	4 (1%)
Unknown or missing	19 (6.4%)	13 (4.5%)

^aPearson's chi square (1df), p = .005.

Table 2. Six month RIAS and global affect measures by study group.

Patient–provider interaction measure	Group 1, Intervention Mean (SD)	Group 2, Control Mean (SD)	Difference in score (95% CI)	p-Value	Adjusted difference^a (95% CI)	Adjusted p-Value
Doctor RIAS variables
N observations	213	180
N participants	160	129
Physician verbal dominance	0.54 (0.12)	0.55 (0.13)	0.002 (−0.02, 0.02)	0.85	.007 (−0.01, 0.03)	0.54
Facilitation and patient activation	5.64 (5.20)	4.59 (3.86)	1.10 (0.28, 1.92)	0.01	1.19 (0.39, 1.99)	0.004
Doctor positive affect	4.21 (4.92)	3.50 (3.55)	0.66 (−0.14, 1.45)	0.11	0.74 (−0.04, 1.52)	0.06
Patient centeredness	1.18 (1.00)	1.00 (0.99)	0.12 (−.06, .31)	0.18	0.14 (−0.05, 0.33)	0.14
Doctor information gathering	9.52 (9.62)	7.00 (7.28)	2.81 (1.23, 4.39)	0.000	2.96(1.42, 4.50)	0.000
Patient RIAS variables
All patient question asking	2.10 (1.53)	1.05 (1.44)	0.51 (0.12, 0.89)	0.01	0.48 (0.11, 0.85)	0.012
Patient activation and engagement	0.91 (1.38)	0.98 (1.36)	0.02 (−0.26, 0.30)	0.90	0.03 (−0.25, 0.32)	0.81
Patient positive affect	8.94 (8.77)	6.68 (6.40)	2.11 (.80, 3.42)	0.002	2.08 (0.79, 3.36)	0.002
Global affect
N observations	207	174
N participants	159	127
Doctor global affect
Positive affect	10.73 (2.76)	10.21 (2.76)	.60 (.08, 1.12)	0.024	0.60 (0.08, 1.11)	0.02
Dominance/assertiveness	3.36 (.74)	3.30 (.73)	.07 (−.05, .18)	0.25	0.07 (−0.04, 0.18)	0.22
Interactivity	3.67 (.77)	3.57 (.73)	.13(−.01, .27)	0.07	0.13(−0.005, 0.26)	0.06
Patient global affect
Positive affect	14.75 (3.05)	14.37 (2.84)	.34 (−.17, .85)	0.19	0.33(−0.16, 0.83)	0.19
Interactivity	3.34 (.87)	3.28 (.79)	.09 (−.06, .24)	0.23	0.09(−0.05, 0.23)	0.22

^aAdjusted for site, length of consultation, nurse versus doctor, provider, provider sex, patient gender, and whether an interpreter was present.