Jae-ann Sumalo, RN

Authors: Bethany Holt, Jhaki Mendoza, Hoang Nguyen, Duong Doan, Thu Huyen Nguyen, Timothy Bill Mercado, Lam Dam Duy, Martin Fernandez, Manu Gaspar, Geohari Hamoy, Bao Ngoc Le, Boon-Leong Neo, Vy Nguyen, Thuy Pham, Janus Ong, Todd M Pollack, Jae-Ann Sumalo, Pham Thai, David B Duong

BACKGROUND: To ensure that health services are high-quality, trusted and used by the population, their design and improvement should start from the perspective of what matters to people. Patient journey mapping (PJM) is one research method that centers the experiences of individuals living with health conditions and follows their pathways through care and recovery. This paper describes a novel, qualitative PJM methodology used in Vietnam and the Philippines to inform the co-design of a people-centered viral hepatitis screening, care and treatment pathway for individuals living with chronic hepatitis, which is a significant public health concern in the Asia-Pacific region. METHODS: Data collection involved in-depth interviews with a purposive sample of 63 people living with hepatitis (demand-side) and focus group discussions with healthcare providers working in the same geographical areas (supply-side). Rapid deductive qualitative analysis was used to identify typical journeys, and related barriers and enablers. The methodology was implemented over 8 weeks, adapting the Consolidated Criteria for Reporting Qualitative Research (COREQ). RESULTS: This paper demonstrates how a PJM methodology that incorporates patient and HCP perspectives can be feasibly implemented in two LMIC contexts, while fulfilling many of the criteria identified by the COREQ guidelines. Sharing such methods and associated instruments may help to enable broader uptake and application in other LMIC settings, providing health systems practitioners with a critical tool to identify and overcome barriers in and promote the delivery of people-centered health services globally. CONCLUSION: Despite limited uptake, especially in resource-limited contexts and at the primary healthcare level, PJM is a novel research method with the potential to make promising contributions to people-centered health service design.

Authors: Naeema Hopkins-Kotb, Jhaki Mendoza, Manu Gaspar, Martin Fernandez, Jae-Ann Sumalo, Timothy Mercado, Jovein Alcantara, Joshua Bartolome, Diana Rose de Silva, Janus P Ong, Todd M Pollack, David B Duong, Bethany Holt

BACKGROUND: Stigma is a key barrier to compassionate primary health care delivery and people-centered care (PCC), but is understudied among primary care providers (PCPs). Hepatitis B and C have a significant burden of disease in the Philippines, where there is limited awareness of and access to screening and treatment. Patient-reported stigma has been identified as a significant barrier to hepatitis care in the Philippines, but PCP stigma-related attitudes and behaviors have not been explored in this context. METHODS: In this study, we assessed primary PCP-reported stigma-related attitudes and behaviors toward patients with hepatitis B and C. We surveyed primary PCPs in Tarlac, Philippines working within a network of healthcare facilities that have been part of an initiative to decentralize hepatitis care to the primary care level and prioritize PCC. RESULTS: We found that PCPs' self-reported attitudes toward patients with hepatitis B and C reflect a strong sense of responsibility to provide care, and comfort with sensitive history-taking, but also pervasive attitudes of pity and blame. PCPs' self-reported behaviors showed commitment to providing equal care, but variation in infection control practices suggesting misconceptions about transmission risk. CONCLUSIONS: Our results provide essential insight into PCPs' stigma-related attitudes and behaviors that will serve as a baseline for future comparison with patient-reported experiences. These findings underscore the critical role of primary care in addressing stigma and improving hepatitis care in the Philippines, highlighting the importance of training, resource allocation, and people-centered care strategies.