De-shaming for believability A Grounded Theory of physicians’ communication with patients about adherence to HIV medication in San Francisco and Copenhagen
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Abstract
To be “adherent” to a medication means to take the medicine as agreed upon. Poor adherence is the main barrier to the effectiveness of HIV medication. Communication between patient and physicians is a major factor in adherence. We found that this communication is very often awkward and superficial, if not completely lacking. According to the proposed theory, it is a core determinant of adherence communication whether or not physicians use a “deshaming” communication strategy. When physicians do not, they receive answers with low believability, and may even abstain from exploring the possibility of non-adherence. Furthermore, physicians have difficulty in handling low believability of patient statements, and their more or less beneficial strategies may have negative consequences for the relation between patient and physician, and for the patient’s adherence. The here proposed theory “de-shaming for believability” suggests that communication with patients about adherence can be under- stood as four steps governed mainly by three factors. The four steps are: deciding whether to ask about adherence or not, pre-questioning preparations, phrasing the question, and re- sponding to the patient’s answer. The three factors/determinants are: the communicator’s per-ceptions of adherence, awkwardness, and believability.
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