UMMS Affiliation

Department of Population and Quantitative Health Sciences

Publication Date

2021-02-11

Document Type

Article

Disciplines

Epidemiology | Health Information Technology | Health Services Administration | Health Services Research | Mental and Social Health | Virus Diseases

Abstract

BACKGROUND: Patients' life contexts are increasingly recognized as important, as evidenced by growing attention to the Social Determinants of Health (SDoH). This attention may be particularly valuable for patients with complex needs, like those with HIV, who are more likely to experience age-related comorbidities, mental health or substance use issues. Understanding patient perceptions of their life context can advance SDoH approaches.

OBJECTIVES: We sought to understand how aging patients with HIV think about their life context and explored if and how their reported context was documented in their electronic medical records (EMRs).

DESIGN: We combined life story interviews and EMR data to understand the health-related daily life experiences of patients with HIV. Patients over 50 were recruited from two US Department of Veterans Affairs HIV clinics. Narrative analysis was used to organize data by life events and health-related metrics.

KEY RESULTS: EMRs of 15 participants documented an average of 19 diagnoses and 10 medications but generally failed to include social contexts salient to patients. In interviews, HIV was discussed primarily in response to direct interviewer questions. Instead, participants raised past trauma, current social engagement, and concern about future health with varying salience. This led us to organize the narratives temporally according to past-, present-, or future-orientation. "Past-focused" narratives dwelled on unresolved experiences with social institutions like the school system, military or marriage. "Present-focused" narratives emphasized daily life challenges, like social isolation. "Future-focused" narratives were dominated by concerns that aging would limit activities.

CONCLUSIONS: A temporally informed understanding of patients' life circumstances that are the foundation of their individualized SDoH could better focus care plans by addressing contextual concerns salient to patients. Trust-building may be a critical first step in caring for past-focused patients. Present-focused patients may benefit from support groups. Future-focused patients may desire discussing long term care options.

Keywords

patients, life contexts, Social Determinants of Health, HIV, Electronic medical records, HIV diagnosis and management, HIV epidemiology

Rights and Permissions

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

DOI of Published Version

10.1371/journal.pone.0246534

Source

Fix GM, Dryden EM, Boudreau J, Kressin NR, Gifford AL, Bokhour BG. The temporal nature of social context: Insights from the daily lives of patients with HIV. PLoS One. 2021 Feb 11;16(2):e0246534. doi: 10.1371/journal.pone.0246534. PMID: 33571283; PMCID: PMC7877603. Link to article on publisher's site

Journal/Book/Conference Title

PloS one

Related Resources

Link to Article in PubMed

PubMed ID

33571283

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons 1.0 Public Domain Dedication.

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