Sexual History Taking: Perspectives on Doctor-Patient Interactions During Routine Consultations in Rural Primary Care in South Africa
ABSTRACT: Background: Sexual history taking for risk behavior contributes to improving health outcomes in primary care. Giving the high numbers of people living with AIDS, every patient in South Africa should be offered an HIV test, which implies that a comprehensive sexual history must be taken. A...
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| Format: | Article |
| Language: | English |
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Oxford University Press
2021-08-01
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| Series: | Sexual Medicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2050116121000696 |
| _version_ | 1797713914206617600 |
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| author | Deidré Pretorius, MSc (Psych) PhD-candidate Ian Couper, Prof, MFamMed Motlatso Mlambo, Dr, PhD |
| author_facet | Deidré Pretorius, MSc (Psych) PhD-candidate Ian Couper, Prof, MFamMed Motlatso Mlambo, Dr, PhD |
| author_sort | Deidré Pretorius, MSc (Psych) PhD-candidate |
| collection | DOAJ |
| description | ABSTRACT: Background: Sexual history taking for risk behavior contributes to improving health outcomes in primary care. Giving the high numbers of people living with AIDS, every patient in South Africa should be offered an HIV test, which implies that a comprehensive sexual history must be taken. Aim: To describe the optimal consultation process, as well as associated factors and skills required to improve disclosure of sexual health issues during a clinical encounter with a doctor in primary health care settings in North West province, South Africa. Methods: This qualitative study, based on grounded theory, involved the video-recording of 151 consultations of adult patients living primarily with hypertension and diabetes. This article reports on the 5 consultations where some form of sexual history taking was observed. Patient consultations were analyzed thematically, which entailed open coding, followed by focused and verbatim coding using MaxQDA 2018 software. Confirmability was ensured by 2 generalist doctors, a public health specialist and the study supervisors. Main Outcome Measure: Sexual history was not taken and patients living with sexual dysfunction were missed. If patients understand how disease and medication contribute to their sexual wellbeing, this may change their perceptions of the illness and adherence patterns. Results: Sexual history was taken in 5 (3%) out of 151 consultations. Three themes emerged from these 5 consultations. In the patient-doctor relationship theme, patients experienced paternalism and a lack of warmth and respect. The consultation context theme included the seating arrangements, ineffective use of time, and privacy challenges due to interruptions and translators. Theme 3, consultation content, dealt with poor coverage of the components of the sexual health history. Conclusion: Overall, sexual dysfunction in patients was totally overlooked and risk for HIV was not explored, which had a negative effect on patients’ quality of life and long-term health outcomes. The study provided detailed information on the complexity of sexual history taking during a routine consultation and is relevant to primary health care in a rural setting. Pretorius D, Couper I, Mlambo M. Sexual History Taking: Perspectives on Doctor-Patient Interactions During Routine Consultations in Rural Primary Care in South Africa. Sex Med 2021;9:100389. |
| first_indexed | 2024-03-12T07:43:55Z |
| format | Article |
| id | doaj.art-bfd3e48c12b64c1e80d23da02c2c5141 |
| institution | Directory Open Access Journal |
| issn | 2050-1161 |
| language | English |
| last_indexed | 2024-03-12T07:43:55Z |
| publishDate | 2021-08-01 |
| publisher | Oxford University Press |
| record_format | Article |
| series | Sexual Medicine |
| spelling | doaj.art-bfd3e48c12b64c1e80d23da02c2c51412023-09-02T21:10:12ZengOxford University PressSexual Medicine2050-11612021-08-0194100389Sexual History Taking: Perspectives on Doctor-Patient Interactions During Routine Consultations in Rural Primary Care in South AfricaDeidré Pretorius, MSc (Psych) PhD-candidate0Ian Couper, Prof, MFamMed1Motlatso Mlambo, Dr, PhD2Division Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa; Corresponding Author: Deidré Pretorius, Room 412 4th Floor, The Phillip Tobias Health Sciences Building, 29 Princess of Wales Street (Corner York Road), Parktown 2193, South Africa. Tel: +27 11 717 2477Division Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa; Ukwanda Centre for Rural Health, Department of Global Health, Stellenbosch University, Stellenbosch, South AfricaDivision Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa; Department of Institutional Research and Business Intelligence, University of South Africa, Pretoria, South AfricaABSTRACT: Background: Sexual history taking for risk behavior contributes to improving health outcomes in primary care. Giving the high numbers of people living with AIDS, every patient in South Africa should be offered an HIV test, which implies that a comprehensive sexual history must be taken. Aim: To describe the optimal consultation process, as well as associated factors and skills required to improve disclosure of sexual health issues during a clinical encounter with a doctor in primary health care settings in North West province, South Africa. Methods: This qualitative study, based on grounded theory, involved the video-recording of 151 consultations of adult patients living primarily with hypertension and diabetes. This article reports on the 5 consultations where some form of sexual history taking was observed. Patient consultations were analyzed thematically, which entailed open coding, followed by focused and verbatim coding using MaxQDA 2018 software. Confirmability was ensured by 2 generalist doctors, a public health specialist and the study supervisors. Main Outcome Measure: Sexual history was not taken and patients living with sexual dysfunction were missed. If patients understand how disease and medication contribute to their sexual wellbeing, this may change their perceptions of the illness and adherence patterns. Results: Sexual history was taken in 5 (3%) out of 151 consultations. Three themes emerged from these 5 consultations. In the patient-doctor relationship theme, patients experienced paternalism and a lack of warmth and respect. The consultation context theme included the seating arrangements, ineffective use of time, and privacy challenges due to interruptions and translators. Theme 3, consultation content, dealt with poor coverage of the components of the sexual health history. Conclusion: Overall, sexual dysfunction in patients was totally overlooked and risk for HIV was not explored, which had a negative effect on patients’ quality of life and long-term health outcomes. The study provided detailed information on the complexity of sexual history taking during a routine consultation and is relevant to primary health care in a rural setting. Pretorius D, Couper I, Mlambo M. Sexual History Taking: Perspectives on Doctor-Patient Interactions During Routine Consultations in Rural Primary Care in South Africa. Sex Med 2021;9:100389.http://www.sciencedirect.com/science/article/pii/S2050116121000696Sexual History TakingSexual DysfunctionPatient CenterednessCommunicationSexual Risk ScreeningHIV Screening |
| spellingShingle | Deidré Pretorius, MSc (Psych) PhD-candidate Ian Couper, Prof, MFamMed Motlatso Mlambo, Dr, PhD Sexual History Taking: Perspectives on Doctor-Patient Interactions During Routine Consultations in Rural Primary Care in South Africa Sexual Medicine Sexual History Taking Sexual Dysfunction Patient Centeredness Communication Sexual Risk Screening HIV Screening |
| title | Sexual History Taking: Perspectives on Doctor-Patient Interactions During Routine Consultations in Rural Primary Care in South Africa |
| title_full | Sexual History Taking: Perspectives on Doctor-Patient Interactions During Routine Consultations in Rural Primary Care in South Africa |
| title_fullStr | Sexual History Taking: Perspectives on Doctor-Patient Interactions During Routine Consultations in Rural Primary Care in South Africa |
| title_full_unstemmed | Sexual History Taking: Perspectives on Doctor-Patient Interactions During Routine Consultations in Rural Primary Care in South Africa |
| title_short | Sexual History Taking: Perspectives on Doctor-Patient Interactions During Routine Consultations in Rural Primary Care in South Africa |
| title_sort | sexual history taking perspectives on doctor patient interactions during routine consultations in rural primary care in south africa |
| topic | Sexual History Taking Sexual Dysfunction Patient Centeredness Communication Sexual Risk Screening HIV Screening |
| url | http://www.sciencedirect.com/science/article/pii/S2050116121000696 |
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