Carly Wolfer, Maria Sobrino, Elijah R Castle, Lila Starbuck, Chi-Chi N Udeagu, Sarit A Golub
Staff underutilized client engagement approaches with strong empirical support (e.g., motivational interviewing), while overutilizing emotionally demanding strategies often linked to provider burnout. Although empathy-based communication is foundational to public health care, overreliance may compromise staff wellbeing and miss opportunities to optimize client behavior change. Systematically training DIS in evidence-based communication strategies represents a promising path to improve both client engagement and provider sustainability.
BACKGROUND: Disease Intervention Specialists (DIS), essential implementers of HIV prevention efforts, have increasingly relied on learned empathy, rather than evidence-based strategies for client engagement. Given the mismatch between DIS demands and training, as well as demonstrated reductions in both client engagement and front-line implementer wellbeing, research is needed to identify and evaluate the communication strategies and skills that DIS currently employ, those they overlook, and those they would need additional support to utilize effectively.
METHODS: With 18 semi-structured interviews, we identified the range of strategies currently used by DIS to engage clients in HIV prevention at a city health department. We also considered how strategies correspond to established behavioral science theory and research.
RESULTS: We identified 26 distinct strategies within four clusters: Empathy, Emotion Regulation, Persuasion, and Partnership. The most commonly reported strategies were Cognitive and Compassionate Empathy and Logistical Support/Help, while the least utilized were Change Talk and Seeking Collaboration. Overall, we observed a disproportionate reliance on empathy and emotion-based strategies, but a relative underutilization of persuasion and partnership-based communication strategies with evidence-based impacts on client engagement and motivation for health behavior change.
CONCLUSIONS: Staff underutilized client engagement approaches with strong empirical support (e.g., motivational interviewing), while overutilizing emotionally demanding strategies often linked to provider burnout. Although empathy-based communication is foundational to public health care, overreliance may compromise staff wellbeing and miss opportunities to optimize client behavior change. Systematically training DIS in evidence-based communication strategies represents a promising path to improve both client engagement and provider sustainability.