The temporal nature of social context: Insights from the daily lives of patients with HIV

Autor: Allen L. Gifford, Gemmae M. Fix, Barbara G. Bokhour, Eileen M. Dryden, Nancy R. Kressin, Jacqueline Boudreau
Jazyk: angličtina
Rok vydání: 2021
Předmět:
RNA viruses
Male
Gerontology
Aging
Epidemiology
Physiology
Aging and Cancer
Electronic Medical Records
HIV Infections
Pathology and Laboratory Medicine
Social Environment
0302 clinical medicine
Immunodeficiency Viruses
Adverse Childhood Experiences
Activities of Daily Living
Medicine and Health Sciences
Public and Occupational Health
030212 general & internal medicine
Social isolation
Multidisciplinary
Cancer Risk Factors
HIV diagnosis and management
Middle Aged
Social engagement
Oncology
Social Isolation
Medical Microbiology
HIV epidemiology
Viral Pathogens
Viruses
Medicine
Pathogens
medicine.symptom
Information Technology
Behavioral and Social Aspects of Health
0305 other medical science
Psychology
Research Article
Computer and Information Sciences
Science
Context (language use)
Microbiology
Narrative inquiry
03 medical and health sciences
Retroviruses
Mental Health and Psychiatry
medicine
Humans
Social determinants of health
Microbial Pathogens
Aged
030505 public health
Lentivirus
Organisms
Biology and Life Sciences
HIV
Social environment
Health Information Technology
Mental health
Diagnostic medicine
Health Care
Long-term care
Attitude
Medical Risk Factors
Physiological Processes
Organism Development
Developmental Biology
Zdroj: PLoS ONE, Vol 16, Iss 2, p e0246534 (2021)
PLoS ONE
ISSN: 1932-6203
Popis: 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.
Databáze: OpenAIRE
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