African-Americans' perceptions of health care provider cultural competence that promote HIV medical self-care and antiretroviral medication adherence

Abstract

Most studies of cultural competence in healthcare examine healthcare providers' definitions of cultural competence practices. This study is unique in that it examines the relationship between African-American patients' perceptions of the cultural competence of their HIV healthcare providers and the adherence of these patients to medical self-care and antiretroviral therapy (ART). This cross-sectional, exploratory, descriptive study was conducted at the Ruth Rothstein CORE Center in Chicago, Illinois. The sample consisted of 202 HIV-positive African-Americans who completed surveys during clinic visits. Multiple measures were used, including the Patient Assessments of Cultural Competency survey instrument developed by the Department of Health and Human Services Agency for Healthcare Research and Quality. Medical self-care was measured using the advice and instructions scale and the self-care symptom management for people living with HIV/AIDS categorical scale. ART adherence was measured using the Adherence Behaviors Self-Report and Adherence Self-Report scales. The data revealed many significant correlations between variables. The more patients believed that providers should integrate culture in HIV treatment; the better their reported health (F_1,138=0.151, P=0.05) and the more they followed their provider's advice and instructions (medical self-care; F_1,138=0.029, P=0.05). Participants who trusted their providers engaged in more medical self-care (F_1,138=0.280, P=0.01). More shared treatment decisions were reported among participants who had higher levels of education (F_1,127=0.337, P=0.05). Findings of this study indicate the need for increased attention to the role of cultural competence in HIV/AIDS care. Understanding patient perceptions of provider cultural competence has the potential to improve HIV treatment adherence and health outcomes.

Keywords:

• HIV/AIDS
• African Americans
• cultural competence
• antiretroviral therapy (ART)
• medical self-care

Acknowledgments

I would like to thank my dissertation chair, Dr Christopher G. Mitchell for his support and guidance throughout this research project. Additionally, I would like to thank the UIC Office of the Provost for the Graduate Research Award that partially funded this project.