Factors and priorities influencing satisfaction with care among women living with HIV in Canada: a Fuzzy Cognitive Mapping study


BACKGROUND: Engagement along the HIV care cascade in Canada is lower among women compared to men. Women living with HIV describe a lack of healthcare services that address their comprehensive care needs and priorities. This study aimed to identify factors influencing satisfaction with HIV care, their causal pathways and relative importance to satisfaction with care from the perspective of women living with HIV.
METHODS: We used Fuzzy Cognitive Mapping (FCM), a participatory research method to integrate existing literature and the experiential expertise of women living with HIV. A map of factors influencing satisfaction with HIV care was derived from a mixed-studies literature review. Between December 2020 and March 2021, Peer Research Associates conducted individual FCM interviews virtually with 23 women living with HIV in Canada. Participants adjusted the literature-based map, adding and removing factors, specifying causal relationships, and assigning weights between -5 and +5 to indicate the strength and direction of influence on satisfaction. Using content analysis and transitive closure, we synthesized individual maps into an aggregate map categorizing the factors influencing satisfaction with HIV care. The aggregate map was analyzed using network analysis to determine the most central considerations in women's satisfaction with HIV care.
RESULTS: Ten categories influencing satisfaction with HIV care were identified. The most central and influential category was 'feeling safe and supported by clinics and healthcare providers,' followed by 'accessible and coordinated services' and 'healthcare provider expertise.' The latter two of the top three categories closely reflected themes from the literature-based map, with factors expanded and redefined by participants. Additional categories captured gendered social and health considerations not previously specified in the literature. These categories included 'healthcare that considers women's unique care needs and social contexts,' 'gynecologic and pregnancy care,' and 'family and partners included in care.'
CONCLUSIONS: Women living with HIV emphasized the importance of care approaches that increase their feelings of safety and support. The maps enabled us to capture stakeholder perspectives not reflected in the literature. The findings also contribute to our understanding of how gender shapes care needs and priorities among women living with HIV.

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