Date of Award
Spring 6-16-2026
Document Type
Dissertation
Degree Name
D.S.W. Social work
Department
Social Work
First Advisor
Dr. Christopher Harris
Second Advisor
Dr. Yasoda Sharma
Third Advisor
Nafisah Houston, MS, MBA
Abstract
Medical case management (MCM) plays a critical role in supporting engagement in HIV care; however, differences in implementation across agencies may influence service delivery and outcomes. Existing research has focused primarily on outcomes such as retention in care and viral suppression, while less is known about how the MCM intervention is implemented in practice. The purpose of this grounded theory study was to explore how medical case management is implemented within HIV care settings and to examine the structural, organizational, and relational factors that shape service delivery. Semi-structured interviews were conducted with medical case managers working within Ryan White-funded agencies in the Philadelphia Eligible Metropolitan Area (EMA). Data were analyzed using grounded theory methods, including open, axial, and selective coding, with constant comparison used to identify patterns across interviews. Findings revealed that MCM implementation is influenced by structural barriers, organizational context, workforce capacity, policy requirements, and relational engagement strategies. These factors interacted to shape how case managers deliver services and support client engagement in care. The findings resulted in the development of a substantive grounded theory conceptualized as the Adaptive Implementation Theory of Medical Case Management. This theory explains how case managers adapt their approaches based on client needs, organizational capacity, and structural conditions to maintain engagement in HIV care. Overall, the findings underscore the critical role of organizational context, workforce support, and relational processes in the evaluation and enhancement of medical case management services. Implications for social work practice, policy, and future research are discussed.
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
Recommended Citation
Wynne, Shakeera, "Link, Retain, Suppress: A Grounded Theory Study of Medical Case Management in the Philadelphia HIV Service Agencies" (2026). Social Work Doctoral Dissertations. 51.
https://research.library.kutztown.edu/socialworkdissertations/51
