Skip to main content

The Role of Patient Activation on Patient–Provider Communication and Quality of Care for US and Foreign Born Latino Patients

Journal of General Internal Medicine volume 24, pages 534–541 (2009)Cite this article

ABSTRACT

BACKGROUND

Previous research has shown positive effects of patient activation on healthcare outcomes, but there is practically no information on the generalization of these findings for Latino patients. Little data are available on whether patient activation is associated with healthcare outcomes for Latino patients and whether activation varies by language proficiency and nativity status.

OBJECTIVE

We examined the levels of activation by characteristics of Latino patients (e.g. nativity, language, health status). We investigated whether patient activation relates to the quality of care received and enhanced doctor–patient communication for Latino patients.

DESIGN

We conducted analyses of 1,067 US born and foreign born Latinos who participated in the second wave of the PEW/RWJF Hispanic Healthcare Survey during 2008.

PARTICIPANTS

Participants were self-identified Latinos (18+) with a doctor visit, living in the contiguous United States who could be contacted by telephone.

RESULTS

US born Latinos had significantly (P < 0.001) greater patient activation scores than foreign born Latinos (75 versus 70). Latinos classified as bilingual and those reporting excellent health evidenced higher mean activation scores as compared to Spanish-speaking Latinos and those reporting fair or poor health. After adjusting for demographics, health status, other language and service use factors, patient activation was strongly associated with self-reported quality of care and better doctor–patient communication among both US and foreign born Latino respondents.

CONCLUSIONS

Interventions that augment patient activation could increase quality of care and improved patient–provider communication, potentially reducing health care disparities for Latinos.

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

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Hibbard J, Cunningham P. How Engaged are Consumers in Their Health and Health Care, and Why Does It Matter? Washington: Center for Studying Health System Change; 2008.

    Google Scholar 

  2. Clayton J, Butow P, Tattersall M, et al. Asking questions can help: Development and preliminary evaluation of a question prompt list for palliative care patients. Br J Cancer. 2003; 8911: 2069–77.

    Article  CAS  PubMed  Google Scholar 

  3. Miranda J, Cooper L. Disparities in care for depression among primary care patients. J Gen Intern Med. 2004; 192: 120–6.

    Article  PubMed  Google Scholar 

  4. Clever SL, Ford DE, Rubenstein LV, et al. Primary care patients’ involvement in decision-making is associated with improvement in depression. Med Care. 2006; 445: 398–405.

    Article  PubMed  Google Scholar 

  5. Post DM, Cegala DJ, Miser WF. The other half of the whole: teaching patients to communicate with physicians. Fam Med. 2002; 345: 344–52.

    PubMed  Google Scholar 

  6. Korsch BM, Gozzi EK, Francis V. Gaps in doctor-patient communication. 1. Doctor-patient interaction and patient satisfaction. Pediatrics. 1968; 425: 855–71.

    CAS  PubMed  Google Scholar 

  7. Roter D, Stewart M, Putnam S, Lipkin MJ, Stiles W, Inui T. Communication patterns of primary care physicians. JAMA. 1997; 277: 350–6.

    Article  CAS  PubMed  Google Scholar 

  8. Beisdecker AE, Beisdecker TD. Patient information-seeking behaviors when communicating with doctors. Med Care. 1990; 28: 19–28.

    Article  Google Scholar 

  9. Waitzkin H. Information giving in medical care. J Health Soc Behav. 1985; 262: 81–101.

    Article  CAS  PubMed  Google Scholar 

  10. Hall JA, Roter DL, Katz NR. Meta-analysis of correlates of provider behavior in medical encounters. Med Care. 1988; 26: 657–75.

    Article  CAS  PubMed  Google Scholar 

  11. Stewart AL, Sherbourne CD, Wells KB, et al. Do depressed patients in different treatment settings have different levels of well-being and functioning? J Consult Clin Psychol. 1993; 615: 849–57.

    Article  CAS  PubMed  Google Scholar 

  12. Blanchard CG, Labrecque MS, Ruckdeschel JC, Blanchard EB. Physician behaviors, patient perceptions, and patient characteristics as predictors of satisfaction of hospitalized adult cancer patients. Cancer. 1990; 651: 186–92.

    Article  CAS  PubMed  Google Scholar 

  13. Rosenberg EE, Lussier MT, Beaudoin C. Lessons for clinicians from physician-patient communication literature. Arch Fam Med. 1997; 63: 279–83.

    Article  CAS  PubMed  Google Scholar 

  14. Epstein R, Campbell T, Cohen-Cole S, McWhinney I, Smilkstein G. Perspectives on patient-doctor communication. J Fam Pract. 1993; 37: 377–88.

    CAS  PubMed  Google Scholar 

  15. Kaplan SH, Greenfield S, Ware JE. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989; 273 Supp: S110–127.

    Article  CAS  PubMed  Google Scholar 

  16. Brown B, Butow P, Dunn SM, Tattersall M. Promoting patient participation and shortening cancer consultations: a randomized trial. Br J Cancer. 2001; 859: 1273–9.

    Article  CAS  PubMed  Google Scholar 

  17. Pibernik-Okanovic M, Prasek M, Poljicanin-Filipovic T, Pavlic-Renar I, Metelko Z. Effects of an empowerment-based psychosocial intervention on quality of life and metabolic control in type 2 diabetic patients. Patient Educ Couns. 2004; 52: 193–9.

    Article  PubMed  Google Scholar 

  18. Roter DL. Patient participation in the patient-provider interaction: the effects of patient question asking on the quality of interaction, satisfaction, and compliance. Health Educ Monogr. 1977; 54: 281–315.

    CAS  PubMed  Google Scholar 

  19. Thompson SC, Nanni C, Schwankovsky L. Patient-oriented interventions to improve communication in a medical office visit. Health Psychol. 1990; 94: 390–404.

    Article  CAS  PubMed  Google Scholar 

  20. Tsay S, Hung L. Empowerment of patients with end-stage renal disease–a randomized controlled trial. Int J Nurs Stud. 2004; 411: 59–65.

    Article  PubMed  Google Scholar 

  21. Eisenthal S, Lazare A. Evaluation of the initial interview in a walk-in clinic. The patient’s perspective on a "customer approach". J Nerv Ment Dis. 1976; 1623: 169–76.

    CAS  PubMed  Article  Google Scholar 

  22. Flores G. Culture and the patient-physician relationship: achieving cultural competency in health care. J Pediatr. 2000; 1361: 14–23.

    Article  CAS  PubMed  Google Scholar 

  23. American Medical Association. Culturally Competent Healthcare for Adolescents: a Guide for Primary Care Proiders. Chicago: American Medical Association; 1994.

    Google Scholar 

  24. Levinson W, Kao A, Kuby A, Thisted R. Not all patients want to participate in decision making. J Gen Intern Med. 2005; 206: 531–5.

    Article  PubMed  Google Scholar 

  25. Xu K, Borders T, Arif A. Ethnic differences in parents’ perception of participatory decision-making style of their children’s physicians. Med Care. 2004; 424: 328–35.

    Article  PubMed  Google Scholar 

  26. Hibbard J, Stockard J, Mahoney E, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004; 394p1: 1005–26.

    Article  PubMed  Google Scholar 

  27. Cortés D, Mulvaney-Day N, Fortuna L, Reinfeld S, Alegría M. Patient–provider communication: understanding the role of patient activation for Latinos in mental health treatment. Health Educ Behav. 2008;EPub.

  28. Current Population Survey. Annual Social and Economic (ASEC) Supplement, Conducted by the Bureau of the Census for the Bureau of Labor Statistics. Washington: U.S. Census Bureau; 2007.

    Google Scholar 

  29. Livingston G, Minushkin S, Cohn D. Hispanics and Health Care in the United States: Access, Information and Knowledge: PEW Hispanic Center and Robert Wood Johnson Foundation; 2008.

  30. Stewart A, Nápoles-Springer A, Gregorich S, Santoyo-Olsson J. Interpersonal processes of care survey: patient-reported measures for diverse groups. Health Serv Res. 2007; 423p1: 1235–56.

    Article  PubMed  Google Scholar 

  31. Stata Statistical Software Version 10.1. [computer program]. Version. College Station, TX; 2008.

  32. Alegría M, Polo A, Gao S, et al. Evaluation of a patient activation and empowerment intervention in mental health care. Med Care. 2008; 463: 247.

    Article  PubMed  Google Scholar 

  33. Schaafsma ES, Raynor TD, de Jong-van den Berg LT. Accessing medication information by ethnic minorities: barriers and possible solutions. Pharm World Sci. 2003; 255: 185–90.

    Article  PubMed  Google Scholar 

  34. Charles C, Whelan T, Gafni A, Willan A, Farrell S. Shared treatment decision making: what does it mean to physicians? J General Clinical Oncology. 2003; 21: 932–6.

    Article  Google Scholar 

Download references

Acknowledgements

This publication was made possible by the Robert Wood Johnson MD002261-02 and also supported by NIH Research Grant # 1P50 MHO 73469 funded by the National Institute of Mental Health and #P60 MD0 02261 (NCMHD) funded by the National Center for Minority Health and Health Disparities.

Conflict of Interest

Drs. Alegria and Perez, Mr. Sribney, Ms. Laderman, and Ms. Keefe report no conflicts of interest.

Author information

Affiliations

  1. Center for Multicultural Mental Health Research, Cambridge Health Alliance and Harvard Medical School, 120 Beacon Street, 4th Floor, Somerville, MA, 02143, USA

    Margarita Alegría PhD & Mara Laderman BA

  2. Third Way Statistics, Columbia, SC, USA

    William Sribney MS

  3. Robert Wood Johnson Foundation, Princeton, NJ, USA

    Debra Perez MPA, MA, PhD

  4. Boston College, Chestnut Hill, MA, USA

    Kristen Keefe BA

Authors
  1. Margarita Alegría PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. William Sribney MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Debra Perez MPA, MA, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mara Laderman BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kristen Keefe BA
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Margarita Alegría PhD.

Appendix

Appendix

Patient Activation Measure (PAM)

The 13-Item PAM (Hibbard et al.26) consists of the following items:

Please let me know how much you agree or disagree with the following statements.

  1. 1.

    When all is said and done, I am the person who is responsible for managing my health condition.

  2. 2.

    Taking an active role in my own health care is the most important factor in determining my health and ability to function.

  3. 3.

    I am confident that I can take actions that will help prevent or minimize some symptoms or problems associated with my health condition.

  4. 4.

    I know what each of my prescribed medications does.

  5. 5.

    I am confident that I can tell when I need to go get medical care and when I can handle a health problem myself.

  6. 6.

    I am confident I can tell my health care provider concerns I have even when he or she does not ask.

  7. 7.

    I am confident that I can follow through on medical treatments I need to do at home.

  8. 8.

    I understand the nature and causes of my health condition(s).

  9. 9.

    I know the different medical treatment options available for my health condition.

  10. 10.

    I have been able to maintain the lifestyle changes for my health that I have made.

  11. 11.

    I know how to prevent further problems with my health condition.

  12. 12.

    I am confident I can figure out solutions when new situations or problems arise with my health condition.

  13. 13.

    I am confident that I can maintain lifestyle changes like diet and exercise even during times of stress.

Would you say you...?

(4) Strongly agree

(3) Moderately agree

(2) Moderately disagree, or

(1) Strongly disagree

Item responses were summed to produce a raw score using the numerical values given above. Raw score statistics: minimum observed value 19; maximum observed value 52; median 46; mean 45.7; standard deviation 5.3; Cronbach’s α = 0.88 (overall), 0.83 (English version), and 0.88 (Spanish version).

Doctor–Patient Communication Scale

This scale was based on the following four items from the Interpersonal Processes of Care Survey Short Form (IPC-18; UCSF, 2006):

How often did doctors or health professionals ...

a. Really find out what your concerns were

b. Clearly explain their advice and recommendations

c. Clearly explain the side effects of the medication(s)

d. Ask if you were having problems following their advice and recommendations

Would you say...?

(0) Never

(1) Rarely

(2) Sometimes

(3) Usually, or

(4) Always

The items were summed to produce the scale using the numerical values given above. Scale statistics: minimum observed value 0; maximum observed value 16; median 10; mean 10.1; standard deviation 4.4; Cronbach’s α = 0.75 (overall), 0.74 (English version), 0.76 (Spanish version).

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Alegría, M., Sribney, W., Perez, D. et al. The Role of Patient Activation on Patient–Provider Communication and Quality of Care for US and Foreign Born Latino Patients. J GEN INTERN MED 24, 534–541 (2009). https://doi.org/10.1007/s11606-009-1074-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-009-1074-x

KEY WORDS

  • patient–provider communication
  • Latinos
  • activation
  • quality of care