Skip to main content

Congruence research in behavioral medicine: methodological review and demonstration of alternative methodology

Abstract

Researchers in behavioral medicine are using methods to study the effect of congruence between two predictors (e.g., patient and provider preferences for patient-decision making) on outcomes (e.g., patient satisfaction and adherence) that may compromise the validity of their results and conclusions. The current paper reviews the methods used in behavioral medicine for the study of congruence effects and the problems associated with those methods—namely, that difference-score-based and artificial-group-based methods increase the risk of both Types I and II error and constrain the theoretical hypotheses that researchers are able to assess. The current paper explains and demonstrates a possible alternative method, polynomial regression, that may be used in some instances of congruence research and that avoids many of the problems of currently used methods; the current paper provides the first analysis of behavioral-medicine data using this method. Methodological advancement in health-related congruence research can help advance theory and optimize intervention-design.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  • Bosworth, H. B., Olsen, M. K., Dudley, T., Orr, M., Goldstein, M. K., Datta, S. K., et al. (2009). Patient education and provider decision-support to control blood pressure in primary care: A cluster randomized trial. American Heart Journal, 157, 450–456.

    PubMed  Article  Google Scholar 

  • Christensen, A. J., Howren, M. B., Hillis, S. L., Kaboli, P., Carter, B. L., Cvengros, J. A., et al. (2010). Patient and physician beliefs about control over health: Association of symmetrical beliefs with medication regimen adherence. JGIM, 25, 397–402.

    PubMed  Article  Google Scholar 

  • Cronbach, L. J. (1958). Proposals leading to analytic treatment of social perception scores. In R. Tagiuri & L. Petrullo (Eds.), Person perception and interpersonal behavior (pp. 353–379). Stanford, CA: Stanford University Press.

    Google Scholar 

  • Cvengros, J. A., Christensen, A. J., Cunningham, C., Hills, S. L., & Kaboli, P. J. (2009). Patient preferences for and reports of provider behavior: Impact of symmetry on patient outcomes. Health Psychology, 28, 660–667.

    PubMed  Article  Google Scholar 

  • Cvengros, J. A., Christensen, A. J., Hillis, S. L., & Rosenthal, G. E. (2007). Patient and physician attitudes in the health care context: Attitudinal symmetry predicts patient satisfaction and adherence. Annals of Behavioral Medicine, 33, 262–268.

    PubMed  Article  Google Scholar 

  • Edwards, J. R. (1993). Problems with the use of profile similarity indices in the study of congruence in organizational research. Personnel Psychology, 46, 641–665.

    Article  Google Scholar 

  • Edwards, J. R. (1994). The study of congruence in organizational behavior research: Critique and proposed alternative. Organizational Behavior &Human Decision Processes, 58, 51–100.

    Article  Google Scholar 

  • Edwards, J. R. (1995). Alternatives to difference scores as dependent variables in the study of congruence in organizational research. Organizational Behavior and Human Decision, 64, 307–324.

    Article  Google Scholar 

  • Edwards, J. R. (2001). Ten difference score myths. Organizational Research Methods, 4, 265–287.

    Article  Google Scholar 

  • Edwards, J. R. (2002). Alternatives to difference scores: Polynomial regression analysis and response surface methodology. In F. Drasgow & N. W. Schmitt (Eds.), Advances in measurement and data analysis (pp. 350–400). San Francisco, CA: Jossey-Bass.

    Google Scholar 

  • Edwards, J. R., & Harrison, R. V. (1993). Job demands and worker health: Three-dimensional reexamination of the relationship between person-environment fit and strain. Journal of Applied Psychology, 78, 628–648.

    PubMed  Article  CAS  Google Scholar 

  • Edwards, J. R., & Parry, M. E. (1993). On the use of polynomial regression equations as an alternative to difference scores in organizational research. Academy of Management Journal, 36, 1577–1613.

    Article  Google Scholar 

  • Efron, B. (1981). Nonparametric estimates of standard error: The jackknife, the bootstrap and other methods. Biometrika, 68, 589–599.

    Article  Google Scholar 

  • Greer, J., & Halgin, R. (2006). Predictors of physician-patient agreement on symptom etiology in primary care. Psychosomatic Medicine, 68, 277–282.

    PubMed  Article  Google Scholar 

  • Hedeker, D., Gibbons, R. D., & Flay, B. R. (1994). Random-effects regression models for clustered data with an example from smoking prevention research. Journal of Consulting and Clinical Psychology, 62, 757–765.

    PubMed  Article  CAS  Google Scholar 

  • Horne, R. (2004). The medication adherence report scale. Brighton, UK: University of Brighton.

  • Hunter, J. E., & Schmidt, F. L. (1990). Dichotomization of continuous variables: The implications for meta-analysis. Journal of Applied Psychology, 75, 334–349.

    Article  Google Scholar 

  • Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38, 21–37.

    PubMed  Article  CAS  Google Scholar 

  • Jahng, K. H., Martin, L. R., Golin, C. E., & DiMatteo, M. R. (2005). Preferences for medical collaboration: Patient-physician congruence and patient outcomes. Patient Education and Counseling, 57, 308–314.

    PubMed  Article  Google Scholar 

  • Johns, G. (1981). Difference score measures of organizational behavior variables: A critique. Organizational Behavior and Human Performance, 27, 443–463.

    Article  Google Scholar 

  • Joosten, E., DeFuentes, L., de Weert, G., Sensky, T., van der Staak, C., & de Jong, C. (2008). Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychotherapy and Psychosomatics, 77, 219–226.

    PubMed  Article  CAS  Google Scholar 

  • Kalliath, T. J., Bluedorn, A. C., & Strube, M. J. (1999). Person–organization value congruence: A test of value congruence effects. Journal of Organizational Behavior, 20, 1175–1198.

    Article  Google Scholar 

  • Krupat, E., Bell, R. A., Kravitz, R. L., Thom, D., & Azari, R. (2001). When physician and patients think alike: Patient-centered beliefs and their impact on satisfaction and trust. Journal of Family Practice, 50, 1057–1062.

    PubMed  CAS  Google Scholar 

  • Krupat, E., Rosenkranz, S. L., Yeager, C. M., Barnard, K., Putnam, S. M., & Inui, T. S. (2000a). The practice orientations of physicians and patients: The effect of doctor-patient congruence on satisfaction. Patient Education and Counseling, 39, 49–59.

    PubMed  Article  CAS  Google Scholar 

  • Krupat, E., Yeager, C. M., & Putnam, S. (2000b). Patient role orientations, doctor-patient fit, and visit satisfaction. Psychology & Health, 15, 707–719.

    Article  Google Scholar 

  • MacCallum, R. C., Zhang, S., Preacher, K. J., & Rucker, D. D. (2002). On the practice of dichotomization of quantitative variables. Psychological Methods, 7, 19–40.

    PubMed  Article  Google Scholar 

  • Maxwell, S. E., & Delaney, H. D. (1993). Bivariate median splits and spurious statistical significance. Psychological Bulletin, 113, 181–190.

    Article  Google Scholar 

  • Myers, R., Montgomery, D., & Anderson-Cook, C. (2009). Response surface methodology: Process and product optimization using designed experiments. Hoboken, NJ: Wiley.

    Google Scholar 

  • Ranby, K. W., Aiken, L. S., Gerend, M. A., & Erchull, M. J. (2010). Perceived susceptibility measures are not interchangeable: Absolute, direct comparative, and indirect comparative risk. Health Psychology, 29, 20–28.

    PubMed  Article  Google Scholar 

  • Roter, D. L., Frankel, R. M., Hall, J. A., & Sluyter, D. (2006). The expression of emotion through nonverbal behavior in medical visits. Journal of General Internal Medicine, 21, S28–S34.

    PubMed  Article  Google Scholar 

  • Sewitch, M. J., Abrahamowicz, M., Dobkin, P. L., & Tamblyn, R. (2003). Measuring differences between patients’ and physicians’ health perceptions: The Patient-Physician Discordance Scale. Journal of Behavioral Medicine, 26, 245–264.

    PubMed  Article  Google Scholar 

  • Shanock, L. R., Baran, B. E., Gentry, W. A., Pattinson, S. C., & Heggestad, E. D. (2010). Polynomial regression with response surface analysis: A powerful approach for examining moderation and overcoming limitations of difference scores. Journal of Business and Psychology, 25, 543–554.

    Article  Google Scholar 

  • Sterba, K. R., DeVellis, R. F., Lewis, M. A., DeVellis, B. M., Jordan, J. M., & Baucom, D. H. (2008). Effect of couple illness perception congruence on psychological adjustment in women with rheumatoid arthritis. Health Psychology, 27, 221–229.

    PubMed  Article  Google Scholar 

  • Stewart, M. A., McWhinney, I. R., & Buck, C. W. (1979). The doctor/patient relationship and its effect upon outcome. Journal of the Royal College of General Practitioners, 29, 77–82.

    PubMed  CAS  Google Scholar 

  • Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics. Boston: Allyn & Bacon.

    Google Scholar 

  • Wall, T. D., & Payne, R. (1973). Are deficiency scores deficient? JAP, 58, 322–326.

    Article  Google Scholar 

  • Yang, L., Levine, E. L., Smith, M. A., Ispas, D., & Rossi, M. E. (2008). Person-environment fit or person plus environment: A meta-analysis of studies using polynomial regression analysis. Human Resource Management Review, 18, 311–321.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to L. Alison Phillips.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 86 kb)

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Phillips, L.A. Congruence research in behavioral medicine: methodological review and demonstration of alternative methodology. J Behav Med 36, 61–74 (2013). https://doi.org/10.1007/s10865-012-9401-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-012-9401-9

Keywords

  • Methodology
  • Congruence/concordance
  • Polynomial regression
  • Difference scores
  • Doctor-patient interactions