Activating Community Health Center Patients in Developing Question-Formulation Skills

The authors developed and delivered a brief patient activation intervention (PAI) that sought to facilitate physician–patient communication. The intervention was designed to assist low-income, racial/ethnic minority users of community health centers in building skills and confidence asking questions. The PAI takes 8 to 10 minutes to deliver and consists of five steps that can be carried out by individuals with minimal formal medical training. A total of 252 patients waiting to see their physician participated in the intervention and completed the follow-up semistructured interview after their health care visit. The authors describe the intervention and the results of their qualitative evaluation of patient’s responses. Overall, the PAI was valued by patients, appeared to add to patients’ satisfaction with the health care they received, and was feasible to implement in the primary care setting. Furthermore, findings from this study provide indirect insight regarding factors that influence minority patient’s question-asking behavior that include patient’s attitudes, social factors, and patient’s self-efficacy in question formulation.

[1]  W. Stewart,et al.  Patient Satisfaction and Physician Productivity: Complementary or Mutually Exclusive? , 2009, American journal of medical quality : the official journal of the American College of Medical Quality.

[2]  M. Alegría,et al.  Patient—Provider Communication , 2009, Health education & behavior : the official publication of the Society for Public Health Education.

[3]  Judith H Hibbard,et al.  How engaged are consumers in their health and health care, and why does it matter? , 2008, Research brief.

[4]  R. Epstein,et al.  So much to do, so little time: care for the socially disadvantaged and the 15-minute visit. , 2008, Archives of internal medicine.

[5]  S. Normand,et al.  Evaluation of a Patient Activation and Empowerment Intervention in Mental Health Care , 2008, Medical care.

[6]  S. Kripalani,et al.  Patient Literacy and Question-asking Behavior During the Medical Encounter: A Mixed-methods Analysis , 2007, Journal of General Internal Medicine.

[7]  M. Alexander.  To Err is Human. , 2006, Journal of infusion nursing : the official publication of the Infusion Nurses Society.

[8]  Judith H Hibbard,et al.  Development and testing of a short form of the patient activation measure. , 2005, Health services research.

[9]  R. Kravitz,et al.  Patient Participation in Medical Consultations: Why Some Patients are More Involved Than Others , 2005, Medical care.

[10]  W. Levinson,et al.  Not all patients want to participate in decision making , 2005, Journal of General Internal Medicine.

[11]  S. Saha,et al.  Racial and ethnic differences in patient perceptions of bias and cultural competence in health care , 2004, Journal of General Internal Medicine.

[12]  Laura A. Petersen,et al.  Racial and ethnic disparities in the use of health services , 2003, Journal of General Internal Medicine.

[13]  S. Flocke,et al.  Relationships between physician practice style, patient satisfaction, and attributes of primary care. , 2002, The Journal of family practice.

[14]  R. Adams,et al.  Impact of the physician's participatory style in asthma outcomes and patient satisfaction. , 2001, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[15]  American College of Clinical Pharmacology Response to the Institute of Medicine Report “To Err Is Human: Building a Safer Health System” , 2000, The Journal of Clinical Pharmacology.

[16]  D. Cegala,et al.  The effects of communication skills training on patients' participation during medical interviews. , 2000, Patient education and counseling.

[17]  A. Fleissig,et al.  Encouraging out-patients to make the most of their first hospital appointment: to what extent can a written prompt help patients get the information they want? , 1999, Patient education and counseling.

[18]  P. Butow,et al.  Promoting patient participation in the cancer consultation: evaluation of a prompt sheet and coaching in question-asking , 1999, British Journal of Cancer.

[19]  K C Stange,et al.  Patient satisfaction with time spent with their physician. , 1998, The Journal of family practice.

[20]  Judith A. Hall,et al.  Effectiveness of interventions to improve patient compliance: a meta-analysis. , 1998, Medical care.

[21]  M. Stewart.  Effective physician-patient communication and health outcomes: a review. , 1995, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[22]  Gerjo Kok,et al.  The impact of social influences in the context of attitude, self-efficacy, intention, and previous behavior as predictors of smoking onset , 1995 .

[23]  P. Butow,et al.  Patient participation in the cancer consultation: evaluation of a question prompt sheet. , 1994, Annals of oncology : official journal of the European Society for Medical Oncology.

[24]  B. Glaser.  Basics of Grounded Theory Analysis: Emergence Vs. Forcing , 1992 .

[25]  J. McGill,et al.  Change in Metabolic Control and Functional Status After Hospitalization: Impact of Patient Activation Intervention in Diabetic Patients , 1991, Diabetes Care.

[26]  S. Kaplan,et al.  Assessing the Effects of Physician-Patient Interactions on the Outcomes of Chronic Disease , 1989, Medical care.

[27]  Hein de Vries,et al.  Self-efficacy: the third factor besides attitude and subjective norm as a predictor of behavioural intentions , 1988 .

[28]  Linda S. Lotto.  Qualitative Data Analysis: A Sourcebook of New Methods , 1986 .

[29]  D. Roter.  Patient Participation in the Patient-Provider Interaction: The Effects of Patient Question Asking on the Quality of Interaction, Satisfaction and Compliance* , 1977, Health education monographs.

[30]  I. Ajzen,et al.  Belief, Attitude, Intention, and Behavior: An Introduction to Theory and Research , 1977 .

[31]  A. Bandura.  Self-efficacy: toward a unifying theory of behavioral change. , 1977, Psychological review.

[32]  Richard L Street,et al.  Empowering communication: a community-based intervention for patients. , 2004, Patient education and counseling.

[33]  Lorraine M Noble,et al.  Improving patients' communication with doctors: a systematic review of intervention studies. , 2004, Patient education and counseling.

[34]  P. Sloane,et al.  Physician-patient communication in the primary care office: a systematic review. , 2002, The Journal of the American Board of Family Practice.

[35]  D. Cegala,et al.  The effects of patient communication skills training on compliance. , 2000, Archives of family medicine.

[36]  Anselm L. Strauss,et al.  Basics of qualitative research : techniques and procedures for developing grounded theory , 1998 .

[37]  D. L. Rogers.  Are Questions the Answer , 1990 .

[38]  S. Thompson,et al.  Patient-oriented interventions to improve communication in a medical office visit. , 1990, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[39]  Michael Quinn Patton,et al.  How to use qualitative methods in evaluation , 1987 .

[40]  A. Bandura.  Social Foundations of Thought and Action , 1986 .