| What makes the interaction work |
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Patient expectations |
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1. It is only a few health care providers who can do what patients wish […] Implementing patient preferences is not the culture Pr 4
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2. We must respect the patient’s preferences as long as they make a choice that lead to the solution of the problem that they have. Pr3
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3. During our conversation, I ask her/him: what is helpful for you, what is going well, what do you think it is not helpful for you? This is a guide to have a mutual understanding so that you provide a good care for her/him. Pr 2
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Patient comfort |
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4. Health care providers should remain humble and kind towards patients so that they can feel comfortable enough to tell them about their problems. Pr 5
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5. There are health care providers whose behaviors are so strange that patients do not feel satisfied or they do not feel comfortable with them. Pr8
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6. We should feel comfortable each other, familiar one another so that the patient feels talking everything. Therefore, such a conversation will be of a great value. Pr1
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Hope |
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7. The friendly conversation is already half the cure of their illness […]. They go home saying, “There is hope of recovery because what the health care provider has done for me is good. Pr7
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8. An opportunity of welcoming a patient and having a conversation with her/him, it is said that it creates a hope for the patient. That hope is like a half for the patient to recover from her/his illness. Pr2
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9. When you make him/her understand it enables him/her to have acceptance and life continue. Pr9
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Provider attention |
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10. The best thing is to let the patients express themselves […] If the patients talk when I am listening to my mobile phone, the patients will realize that I am not listening to them. Pr 3
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11. When someone comes suffering you have to show that you are listening to him/her. Pr9
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12. When you give attention to someone it shows that you care for him/her which shows that you don’t value other things than him/her. Pr6
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Emotions |
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13. When a patient cries, you normally let them cry for a while until you see that they have cooled down to some extent and then you try to resume the conversation. Pr 1
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14. The health care provider should keep a balanced feeling. Pr 8
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15. I can look at emotions in two ways: an emotion that shows that you feel the patient’s pains and the emotions that make you blame the patient, which is bad and unfavourable for the patient. Pr 3
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16. That is why there is a need of skills in managing the emotions, skills in how to talk to patients Pr4
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| What comes out of effective interaction |
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Disclosure, trust and confidentiality |
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17. They cannot tell you anything unless they are comfortable with you. Pr 7
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18. Health care providers should keep patients’ stories with high confidentiality. Pr 8
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19. The patient can evade to explain well about their illness because they see that there is no secrecy there. Pr 4
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20. There is a good relationship between the health care provider and the patient when they have had a good conversation. Additionally, the conversation allows mutual understanding and trust. Pr3
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21. We play two roles at the health centre […]. The conversation that we have is about the patient’s illness or about the advice they are seeking. Pr 4
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Patient engagement |
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22. It is necessary that people also get involved in the solution of their problems so that we have a long term solution for the illnesses. Pr 3
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23. You help someone else to help themselves […]. We make a common decision so that we avoid any conflicts between us […]. Both the patient and health care providers reach an agreement before doing anything. Pr 8
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24. Explaining to them helps them to know how to care for their health or if they have a particular problem, they get to know how they have to behave according to their situation. Pr 4
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Patient education |
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25. When you do not explain to them, they can relapse anytime and they can return to see you and yet, the more patients return to the health facility, the more our work increases. Pr 1
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26. It would be necessary if you provide the patient with information about his/her health [omission] It would help her/him recover from the illness, and help for the prevention for other illnesses either for her/himself or for his/her family members or his/her environment. Pr2
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27. What I see is that they [patients] don’t even want to ask information […]. Even though they say that they are given little information, you find out that they are not interested in knowing more information than what was given. Pr 6
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Holistic care |
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28. If you have a long conversation, they can tell you many things concerning their life in the community, and from that story you can for example find out that it is an illness that is ravaging the whole community. Pr 1
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29. Someone may come complaining of headache and the headache being caused by a great sorrow that they have been experiencing. So I can give them pills for headache but in reality I have not treated the root cause of the headache. Pr8
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30. You can advocate for them thanks to the conversation that you have had [omission] You can give them advice, and as the health care provider you have the opportunity to help them definitively. Pr7
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| What surrounds the interaction |
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PPC knowledge and practice |
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31. The course was taught a few hours and people did not attach any big importance to it […] they do not teach you how you will talk to patients. Pr 4
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32. So many people don’t grasp the importance of it to the extent that conversations between patients and health care providers are too short. Pr 4
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33. You can tell them something and ask them to repeat it after a while. In that case, you can evaluate and see if they have understood what you agreed on. Pr 7
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34. If I know how to do it, I will be able to have a quality conversation with a patient, and s/he will have a hope. Pr 2
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35. They tell you what goes well and what does not go well in your services and therefore you know whether or not there are things that you have to amend. Pr5
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36. If an angry patient comes in, I will remain so kind that they will talk to me in a friendly way once they see that I am also friendly to them. Pr8
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Time and workload |
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37. I think the only obstacle to the conversation is time. Pr 6
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38. There is also a time you don’t explain much because you don’t have enough time and make you not do it the way it should be done. Pr 9
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39. We really have very short time, but if we use it properly we can have good outcomes Pr 8
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40. A heath care provider may be tired having a lot of work and feeling tired can cause that they do not talk to the patient effectively Pr 1
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41. It would be good if the healthcare provider would receive only as few patients as he will be able to have enough conversation with. Pr 7
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42. They should also increase the number of staff at health centers. Pr 2
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Patients’ rights |
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43. It is the patient’s right to participate in the health care which they are given. Pr 7
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44. Sometimes they go home knowing that you have treated them but without knowing what you have treated them for. Pr 5
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45. If you do not explain to them their illness, they cannot know how to change their behaviour in order to be able to live with their illness. Pr 8
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46. Those who get those explanations are those who are knowledgeable and who have the courage to ask the health care provider. Pr 4
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47. It is difficult to inform sad information but we have to do it. Pr 6
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48. You can tell a patient that you are going to do a test for HIV/AIDS and they have the right to refuse. If they refuse, you cannot do the test … when they insist that they need a transfer, you let them go because it is their right. Pr 7
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Culture |
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49. It requires that you try to be like them, you speak like them and you show them that you are equal to them, it is only then that they can feel free to talk with you. Pr 3
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50. It is very difficult to explain terms which do not have equivalents in Kinyarwanda. Pr 4
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51. In case you don’t know the […] metaphoric expressions of the language, you can treat the patients in a wrong way. Pr 8
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52. The Rwandan culture includes having the same language. [omission] sharing the same language helps to understand one another in a whatever way. Pr 2
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Power |
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53. It happens that health care providers make themselves very important people to the extent that patients feel afraid when they want to see them. In that case, you understand that the patient cannot be comfortable with the health care provider Pr 1
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54. You should be the patient’s parent Pr 3
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55. They feel that you are very highly important and therefore they cannot tell you anything. Pr7
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Categorising patients |
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56. It is very important that health care providers learn how to better engage different types of patients in conversation Pr 3
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57. Patients do not resemble, and each patient is unique. Pr 8
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58. The first thing that I do is to respect what they say and do not blame them or shout at them; I just listen to them and talk to them Pr 4
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59. You try to ask them questions that they are able to answer [omission] which are related to their level of knowledge. Pr 5
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