Challenges and strategies in advice and information giving by hiv nurse counsellors

Abstract

HIV counselling is a communication process between trained HIV nurse counsellors and patients to discuss and assist patients to deal with HIV-related problems. Despite the training undertaken by these nurses, communicating issues such as sensitive matters, medication adherence, and misconceptions about HIV, remains a challenging task in the Malaysian setting. Due to the lack of research examining the structure of HIV counselling in Malaysia, this study investigated the problem. Moreover, past studies revealed that there are problems with advice and information giving in HIV counselling, hence, this study investigated the advice and information giving challenges, the sequence as well as the strategies. Data were gathered from twenty-four audio recordings of HIV counselling sessions and six focus group discussions from three government hospitals in Malaysia. Thematic analysis of the structure of HIV counselling revealed that the structure differed in terms of its themes and sequence from structures found in past studies. Next, thematic analysis of advice and information giving challenges identified that the most prominent issues were communicating with patients about sensitive matters, and dealing with patients’ medication adherence and misconceptions about HIV. In addition, thematic analysis of advice and information giving sequence identified that these challenges have impact on structural prioritization. Finally, discourse analysis of advice and information giving strategies revealed that apology, inclusive ‘we’, metaphor, and interrogation were the most prominent strategies employed by these nurses. To conclude, based on the findings, recommendations are made by presenting guidelines for advice and information giving strategies in HIV counselling to improve HIV nurse counsellors’ advice and information giving skills.