Pills of wisdom: an investigation of pharmacist-patient interactions in a South African antiretroviral clinic
Date
2009-02-19T12:11:43Z
Authors
Watermeyer, Jennifer Mary
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Abstract
ABSTRACT
Successful communication with patients in a multicultural, multilinguistic
environment is a challenge to health professionals, particularly in the context of
HIV/Aids and antiretroviral (ARV) treatment. Although the introduction of ARVs
has brought hope, high levels of adherence are required to ensure treatment
success and numerous barriers to adherence exist. Pharmacists play an important
role in encouraging adherence to ARV treatment regimens by providing education
and counselling. However, previous research indicates that interactions are often
dominated by the pharmacist. Also, verification of patients’ understanding of
information is infrequent and that patients are often passive recipients of
instructions. This study aims to identify and describe interactive processes in
pharmacy interactions while considering the impact of the disease and macro
context on communication.
Twenty-six cross-cultural, cross-linguistic pharmacist-patient interactions from a
South African HIV/Aids pharmacy are described. Data collection included video
recordings, interviews with participants and ethnographic observations in the
pharmacy. A hybrid analytical approach incorporated aspects of Conversation
Analysis (CA) and Discourse Analysis (DA).
The results of this study are particularly encouraging. They demonstrate that
despite the presence of cultural, linguistic and other contextual barriers,
pharmacist-patient interactions can be efficient. The use of facilitative verbal and
non-verbal communication strategies ensures that dosage instructions are
successfully communicated by the pharmacist to the patient. In line with prior
research, collaboration is promoted when pharmacists create rapport and focus on
the lifeworld of the patient. The study shows that intuition and sensitivity to
atmosphere in interactions is essential for achieving concordance.
The disease context of HIV/Aids has a profound influence on the pharmacistpatient
interaction and this study demonstrates the significant impact of the macro
ii
context on micro aspects of communication. The evidence suggests that the nature
of humanity and the daily interface between culture and language in South Africa
enables pharmacists and patients to transcend some of the barriers to
communication and collaboration that have been identified in previous studies.
The findings imply that the diversity of South Africa provides both hope and a
resource which can inform policy and future practice.
Description
Keywords
pharmacist, patient, interaction, institutional talk, HIV/AIDS, antiretroviral, South Africa, cross-cultural, Conversational Analysis, Discourse Analysis