General Practitioners Beliefs About The Provision Of Behavioral Hiv Risk Assessment And Prevention Counseling To Patients Theory Of Planed Behavior

Background: The magnitude of HIV/AIDS is ever increasing in many parts of the world,rnespecially in Sub-Saharan Africa, despite recent improved access to antiretroviral treatment.rnThis calls for timely, coordinated, and intensified interventions including prevention, care,rnand treatment services. Accordingly, the government of Ethiopia, particularly, Addis Ababarnhealth bureau has planned and been working hard to improve access to HIV prevention andrntreatment services. One strategy which comes to light is to integrate VCT services in tornalready available health service packages. To facilitate the integration process, it would berncrucial to identify and address those determinant factors that may affect clinicians’ provisionrnof HIV risk assessment and prevention advices to their patients.rnObjectives: - The objectives of this study are: (1) to explore whether the GeneralrnPractitioners (GPs) ask patients about their sexual history and assess behavioral risk to HIVrnand provide HIV prevention advices, (2) to describe circumstances under which the GPs askrnpatients about their sexual history and assess behavioral risk to HIV and provide preventionrnadvices to patients, and (3) to identify behavioral, normative and control beliefs of the GPsrnto ask patients about their sexual history and assess behavioral risk to HIV and providernprevention advices to patientsrnMethodology: - The study employed a qualitative study design with individual in-depthrninterviews. An open-ended semi-structured interview guide was developed based on thernframework of the theory of planned behavior (TPB). This guide was translated into Amharicrnand used to conduct the in-depth interviews with the GPs in order to get a thoroughrnunderstanding of the feelings and thoughts of the GPs. The interview guide was used tornvirnelicit from the GPs the factors that may affect their provision of these two clinical services:rn(1) Asking patients specific questions about their sexual history and assessing behavioralrnrisk to HIV, and (2) providing HIV prevention advices to their patients.rnAn elicitation in-depth interview was conducted with twenty eight GPs, which was thernsaturation point for this study, to identify those belief factors which may affect their “Askingrnof patients specific questions about their sexual history and assess behavioral risk to HIV”rnand “providing advice to patients about HIV prevention”. The study was conducted fromrnJanuary to February 2007 in Addis Ababa, Ethiopia.rnAudio tape was used to record the responses of the twenty four GPs based on theirrnwillingness and for the rest four interviews were dictated as these GPs were not willing onrnthe use of a tape recorder. All audio taped interviews were transcribed verbatim. Therndictated interviews were also expanded and organized. The content analysis was conductedrnemploying the thematic qualitative data analysis method to sort out all statements relevant tornthe components of TPB. For each clinical action, summary analysis was made to put thernverbatim statements and the expanded notes related to the behavioral beliefs, normativernbeliefs and control beliefs of the GPs into the following lists respectively: (1) positive andrnnegative behavioral beliefs about the outcomes or attributes of the action, (2) people orrngroups that encourage or discourage the action, and (3) factors or situations that make itrneasier or more difficult to perform the action.rnThe positive and negative behavioral beliefs about the outcomes or attributes of each clinicalrnaction were organized into six major themes or categories. The sources of normativernviirninfluences were grouped as approving and disapproving the behavior. The control beliefsrnwere organized as facilitators and barriers/constraints. Actual phrases of the GPs were usedrnto highlight important findings as needed.rnResults: - According to the study results, most of the GPs stated that they rarely ask patientsrnspecific questions about their sexual history and assess sexual behavioral risk to HIV andrnprovide advice to patients about HIV prevention because of the various beliefs theyrnindicated in relation to providing these services. The GPs indicated that they provide the twornclinical services only to patients they think are at risk of acquiring HIV/AIDS based on thernpatients’ history and findings of physical examination. The GPs stated that they ask patientsrnhistory about sexual behaviors including history of condom use, multiple sexual partners,rnand sexually transmitted diseases (STD) to assess behavioral risk to HIV. They claimed thatrnthese services are provided to patients privately, by being friendly and respectful as much asrnpossible, by letting no one to enter the examination rooms.rnThe GPs have described various behavioral, normative and control beliefs which might havernaffected their provision of these services to patients. The important behavioral beliefs of thernGPs identified were categorized into six different, but not mutually exclusive, themes whichrninclude Patient Confidence, Patient Discomfort, Valuable Patient Care, Impact on Time andrnMoney, Professional Protection and Competence themes.rnPertaining to the normative beliefs, the GPs described various sources of normativerninfluences (referents) which either approve or disapprove the provision of HIV preventionrnservices to patients. These identified referents included: friends, colleagues, patients,rnviiirnpopular media such as TV and Radio, organizations such as PRO-PRIDE, FHI, WHO,rnJOHN HOPKINS which participate in HIV related trainings, Hospital administration andrnAddis Ababa health bureau.rnThe GPs have also described important control beliefs which may facilitate or constrain theirrnprovision of the two clinical services to patients. Among the important facilitating factorsrnidentified include: presence of VCT, ART, & Care and Support services for patients,rntraining on Provider Initiated Counseling and Testing (PICT), having the opportunity to seernpatients without family/friend present, having the opportunity to see young patients who arernopen to the idea, and patients with complaints related to HIV.rnSome of the important factors identified by the GPs to constrain the provision of the twornservices to patients include: lack of private examination rooms, having many patients tornexamine, low salary and poor incentive schemes, cultural barrier to talk about sexualrnmatters openly, and stigma and discrimination against HIV patients by the society.rnConclusion and Recommendation: - According to the results of this study the generalrnpractitioners rarely provide HIV prevention services to their patients because of their variousrnbeliefs identified about the provision of these services. These services are provided only tornthose symptomatic patients presenting with HIV related problems, excluding the vastrnmajority of those asymptomatic patients who may benefit from early detection andrntreatment. This study has tried to identify those behavioral, normative and control beliefsrnwhich are relevant to the population under study (the general practitioners) and theirrnbehavior (the provision of HIV prevention services to patients). The identified belief factorsrnmust be measured quantitatively to understand which factor(s) most affected the behavior.rnixrnThus, in order to bring behavioral change in this area, any intervention developed should berndesigned to target and change the belief factor(s) in such a way that it affects attitude,rnsubjective norm, and perceived behavioral control over the behavior thereby leading to arnchange in intention and behavior.

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