HCWs’ ability to provide appropriate counseling is affected by a number of patient or health care worker related factors or structural issues such as time constraints, fear, lack of space, perceived self efficacy, patients’ age, patients’ gender, patients’
marital status, patients’ socioeconomic status, patients’ education level and these will be reviewed below.
2.6.1. HCWs’ lack of knowledge as a potential barrier to providing appropriate counselling behaviour for HAST
Knowledge about potential barriers to rendering appropriate counselling behaviour for HAST and to developing a therapeutic relationship may be the initial step towards removing the barriers. The Information-Motivation-Behavioural (IMB) model of understanding health behaviour says that information is necessary in order to
33 influence patients’ behaviour. As discussed earlier, studies reported that improved HIV and AIDS knowledge significantly predicted a positive attitude toward VCT for HIV and AIDS (Iliyasu et al. 2006). However, knowledge alone may not be sufficient to change behavior but it may be affected by negative attitudes and or beliefs of the recipients Kalichman et al (2003) reported that a high HIV and AIDS knowledge score amongst the patients, where the mean score was 83%, was not associated with HIV test uptake (Kalichman et al. 2003). Knowledge about VCT and HIV and AIDS may have been influenced by other factors, such as attitude towards VCT and HIV and AIDS. This resulted in reduced HIV testing uptake (Kalichman et al. 2003).
Time constraints may also influence HCWs’ intention to provide appropriate counselling for HAST as reviewed in the section below.
2.6.2. Lack of time as a potential barrier to providing appropriate counselling behaviour for HAST
A shrinking health workforce as reported by Shisana et al (2004) and Uebel et al (2004) may influence how HCWs behave during the consultation. Expected to screen, diagnose, investigate and manage a patient HCWs may hurriedly ask particular questions in order to fit all in the consultation. Little or no time may be allowed for patients to explore and find solutions to their individual problems. To consult as many patients as possible may contribute to HCWs spending less time talking to patients and listening to their issues. HCWs may fail to include patients in the decision making process and patients may leave with decisions made for them by the HCWs which they cannot implement (Mash 2008). HCWs may also fail to empathize with the patients’ situation including their socioeconomic status as discussed in the following section.
2.6.3. Patients’ socioeconomic status as a potential barrier to providing appropriate counselling behaviour for HAST
HCWs’ behaviour may be influenced by the patients’ socioeconomic status as reported by one study where poor patients were found to be spending less time in the consulting room (Bodenheimer 2005). Another study reported that 40% of health professionals believed that they could diagnose an HIV status based on the patients’
appearance and further reported that they would deny health care to these patients (Reis et al. 2005). This can be deceptive where people are very poor or are
34 refugees who are mobile populations are particularly vulnerable and may reluctantly seek care, risking being reported to the authorities and having to return to their home country (SADC Regional Forum of HIV Cross-Border Patient Challenges in the SADC Region 2010). HCWs’ fear may also influence how they counsel patients about HAST as discussed below.
2.6.4. HCW’s fear as a potential barrier to providing appropriate counselling behaviour for HAST
HCWs fear facing litigation from the people who come to seek their help as a case may be built on what the HCW said or wrote. Yet HCWs are required to ensure that adequate and correct information is given to the patient and this is particularly important in SA where 8.6 % of people aged 20 have no schooling (Census 2011).
HCWs may also fear contracting occupational diseases while counselling patients.
Fear may also influence HCWs’ intentions to provide appropriate counselling behaviour as well as their being influenced by stigma and discrimination due to gender and this will be reviewed in the section below.
2.6.5. The patients’ gender, being HIV positive as a potential barrier to providing appropriate counselling behaviour for HAST
There is evidence that discrimination and stigma may also be perpetuated by HCWs as reported in a study in Nigeria, where up to 18% of the health professionals who participated in the study had refused care or hospital admission to a patient because of their sero-status (Reis et al. 2005). HCWs’ intentions not to stigmatize and discriminate may be influenced by reports or experiences of adverse consequences post sero-status disclosure as studies report that 13% of women had experienced violence from a sex partner, 9% reported that their partner had left them, and 3%
said they had to move from their home (Mathews et al. 1999). Other studies concur that gender based discrimination and stigma remain the greatest obstacles to people living with HIV and AIDS (Van Dyk 2008;Kalichman et al.2003; Peltzer et al. 2004;
Spencer 2007). Studies show that women are biologically predisposed to be HIV infected through sexual intercourse as well as through intergenerational and transactional sex or when women are raped (Shisana & Simbayi 2002). HCWs need to empathize in order to discuss gender issues as key drivers of HIV transmission without prejudice.
35 2.6.6. The patients’ age as a potential barrier to providing appropriate