Adult literature has shown that quality of patient-physician relationships is associated with better patient adherence to treatment recommendations across chronic illnesses. However, few studies have examined this in youth with type 1 diabetes, particularly those of Hispanic origin. Evidence indicates that minority youth with type 1 diabetes are at higher risk for poorer metabolic control and experience less satisfaction in patient-provider relationships compared to their white, non-Hispanic counterparts. This study examined the association between satisfaction with the physician-patient relationship and regimen adherence and glycemic control in 120 Hispanic youth with type 1 diabetes. Most caregivers who participated were mothers (82.5%) and youths were primarily female (51.7%). Children ranged in age from 10 to 17 (M age = 13.63 ± 2.18 years). Mean duration of diabetes was 6.26 ± 3.72 years. Most caregivers were married (64.7%). Mothers? highest level of education included 35.3% who had a high school education or less, 34.5% who had some college, and 30.2% who completed college. Mean HbA1c level on recruitment date was 7.68 ± 3.56. Adolescents and their parents independently completed an adapted version of the Medical Interview Satisfaction Scale (MISS-21) (Meakin & Weinman, 2002), which assessed their personal satisfaction with their endocrinologist?s consultation, and the Diabetes Self Management Profile (DSMP) (Harris et al., 2000), which measures adherence over the past 3 months across multiple self-care domains. Spanish translations of both forms were used when appropriate in obtaining caregiver report. Also, physicians rated their patients? regimen adherence using an average of eight items concerning patient adherence. Youth and parents shared similar perceptions concerning youth regimen adherence, as measured by the DSMP (r=.68, p<.001). Youth and parent report of their relationship with their endocrinologist was modestly correlated (r=.27, p<.01). Due to high concordance between parent and child adherence scores, further analyses used a combined DSMP score, while separate scores were used for parent and child reports of satisfaction. Age, mother?s education, and single parent status were used as control variables and were correlated with parent and child satisfaction and a combined DSMP score. Including control variables, parent and child satisfaction did not significantly predict glycemic control (R2∆=.02, p<.10). Parent and child satisfaction also did not significantly predict adherence (R2∆=.02, p=.06). Due to these unexpected findings, further exploratory analyses were conducted. Parent and child satisfaction did not predict physician report of adherence. Interestingly, parent and child report of satisfaction with communication comfort with the physician predicted physician report of adherence (R2∆=.05, p<.01). More specifically, child report of communication comfort predicted physician report of adherence (ß=.26, p<.01), while parent report did not. No subscales of the satisfaction measure (MISS) or the adherence measure (DSMP) predicted glycemic control. Findings suggested that more positive patient-physician relationships are associated with better physician-reported regimen adherence, but not with family report of adherence. However, it is unclear whether better patient-physician relationships enhance adherence or whether more adherent patients are likely to be satisfied with their provider. Further studies are needed to prospectively examine the directionality of these relationships, as well as examine methods to improve the quality of physician-patient relationships in order to increase positive health outcomes.

The AIMS of this study are to: (1) Explore the perceptions and experiences of diabetes consultations from the perspectives of Pakistani patients, health professionals and interpreters (when one was involved). (2) Identify the processes and mechanisms which hinder or foster effective communication between healthcare professionals and their patients. (3) Provide recommendations for ways in which communication can be improved between healthcare professionals and their Pakistani patients STUDY DESIGN: A prospective qualitative study was developed, comprising three sequential components; namely: In-depth interviews with patients prior to a diabetes consultation; observation of the consultation; and, in-depth interviews with patients, health professionals and interpreters (when one was involved) following the consultation. Data were collected in the form of 10 detailed case studies. Each case study involved a Pakistani patient with type 2 diabetes mellitus (T2DM), their practitioner (s) involved in the consultation and an interpreter (if one was used). SAMPLE: Five male and five female Pakistani with T2DM (aged 41-80 years), 12 practitioners (some patients consulted with two people) and three interpreters (two professional and one lay) were recruited through health services and personal contacts within Edinburgh’s Pakistani community. Individual case studies were thematically analysed before all the case studies were compared/contrasted to identify cross-cutting themes. FINDINGS: Alongside language, a range of barriers and issues were identified which impacted upon communication between patients and health professionals in the consultations observed. Because of previous experiences of attending consultations in the UK and also in Pakistan, patients tended to come to their diabetes consultations with limited expectations; namely, to have their medication reviewed and receive test results. Consequently, patients tended not to raise health concerns and other issues unless they perceived these to be directly relevant to the consultation. In some cases, this resulted in patients not disclosing important information relating to their diabetes management and led to health professionals making inappropriate treatment recommendations. The routine and predictable nature of these diabetes review consultations meant that patients could be passive, offer very little information and ‘get by’ in their consultations; for instance, by offering responses after guessing what the professional was asking. As a result, some health professionals were unaware of patients’ poor English and of how little they had understood during the consultation. Health professionals found it difficult to establish understanding and rapport with patients who adopted a passive role in their consultations. This hindered them from identifying, and appropriately addressing, gaps in patients’ diabetes knowledge and any concerns they may have had. Interpreters did not always address the language barrier and edited and misinterpreted information. This is partly because they struggled to interpret medical terminology. However, this research also revealed how interpreters can experience dilemmas and role conflicts by virtue of being members of the same closely-knit Pakistani community as the patients they interpret for. Some of the barriers identified during this study also arose because patients tended to see different professionals at every visit which discouraged patient-provider relationships from being established. CONCLUSION: Patients would benefit from receiving ‘continuity in care’ and education and training on how to use their consultations more effectively. Providers would also benefit from education and training on more effective ways to communicate with these patients.

BACKGROUND: Now considered a cornerstone of healthcare, patient-provider communication has long been studied and analyzed. Medical associations such as the Joint Commission and the American Association of Orthopaedic Surgeons (AAOS) have strongly endorsed for physicians to exercise patient-focused communication, a practice that involves showing empathy, involving patients in medical care decisions, eliciting concerns, and educating patients on treatment options (Joint Commission, 2016; AAOS, 2017). A lack of patient-provider communication has previously been identified as a significant factor in adverse medical outcomes occurring within hospitals (Khan et al., 2017). Bridging the communication disparity between patients and providers is crucial to improving overall patient outcome. Primary care providers are especially essential to improving overall patient outcome because they serve as the first point of contact for many patients accessing the healthcare system. While there is much literature on the importance of effective patient-provider communication, few studies provide technology-based tools that can enhance this establishment of communication. Human Papillomavirus is presently the most common sexually transmitted infection (STI) nationwide with 79 million Americans currently infected (CDC, 2017). Approximately 42,700 HPV-attributable cancers are diagnosed in the United States annually, and HPV is believed to be responsible for over 90% of cervical cancer cases (CDC, 2018). The Advisory Committee on Immunization Practices (ACIP) currently recommends three preventative HPV vaccines. Despite high rates of infection, HPV vaccination rates nationwide remain low as coverage of the HPV vaccine falls behind that of coverage for required vaccines like the tetanus, diphtheria, and acellular pertussis vaccine (Tdap) (Reagan-Steiner, 2016). Previous studies have sought to address factors that affect decisions to vaccinate children. An analyzation of the National Immunization Survey of Teens has identified that parents’ belief that the HPV was not necessary as a main factor (Darden et al., 2013). As a result, there is a gap needed to be filled by providers to educate parents on the importance of the HPV vaccine. PURPOSE: The current study sought to determine the effectiveness of a web-based mobile health education program called Wheel of Wellness (WoW) on patient-provider communication, to assess the viability and impact of WoW to increase HPV vaccination rates in age eligible children (boys and girls aged 9-17) and to augment awareness about the benefits of HPV vaccination in both these children and their guardians. RESEARCH METHOD AND DESIGN: As of August 2018, twenty-seven parents of children between the ages of 9 and 17 years of age within the Pediatrics and Adolescent departments of Boston Medical Center (BMC) have been recruited. Parents enrolled in the WoW program to compile a list of concerns to be shown to a provider during their child’s appointment. Participants were asked questions to determine initial knowledge on the HPV vaccine, and their opinions on the HPV vaccine. Following their appointment, participants completed a questionnaire to assess opinions on the WoW program in facilitating communication with their provider on the HPV vaccine and related cancers. Seven physicians were interviewed to assess their views on the WoW program in facilitating communication with their patients on the HPV vaccine and related cancers. RESULTS: Initial stages of this study found that views on the effectiveness of the WoW program in facilitating patient and provider communication on the different aspects of HPV vaccination and affecting parents’ decisions to vaccinate their children were mixed by both patients and their providers. Based on the WoW feedback collected from parents, the system was widely acceptable in terms of ease in usage and with the majority of parents (92%) reporting that the WoW website is helpful for communicating their health concerns with their provider. However, the majority of providers reported having never been presented the WoW system and expressed views that WoW was inefficient as it was a parallel system to existing workflow. This study determined that of the 12 participants who had one dose of the vaccine prior to enrollment, 75% of these participants completed the HPV vaccine series during the study. CONCLUSION: Based on the initiation and completion statistics reported, this shows great potential for the use of the BNI coupled with the WoW system to help improve rates of initiation and completion of HPV vaccination going forward as the intervention may have helped encourage parents to either initiate vaccination or complete their child’s previously started series. Further studies should explore ways of empowering patients to facilitate more communication with their providers and improvements to technology to enhance provider recommendation in order to promote an increase in HPV vaccine completion. / 2021-06-17T00:00:00Z

<p>  </p> <p>Pregnancy poses unjust dangers to Black women in the United States, who are currently faced with higher rates of maternal mortality and pregnancy-related adverse events than women of other races. The maternal mortality ratio for non-Hispanic Black women is 41.4/100,000 compared with 13.7/100,000 for White women (Hill et al., 2022). Although there are available statistics and other forms on expert knowledge on these dangers, risk perceptions and related behaviors are derived from subjective individual interpretations within a dynamic communicative context. While there is extensive evidence on the dangers pregnancy and childbirth pose to Black women, less is known about Black women’s conceptualizations of their own risks, the role of communication (with their healthcare providers and other sources), and the ways in which they enact agency in response to these risks. Using a multi-methodological approach that draws on in-depth interviews, qualitative network analysis and an environmental scan, this dissertation foregrounds Black women’s own narratives to explore the social construction of pregnancy risk, the role of communication with healthcare providers in the amplification or attenuation of these risks, and the broader communicative context that shapes Black women’s pregnancy experiences. In doing so, this study found that Black women’s pregnancy risk perceptions are socially constructed through communication in a socio-political context shaped by gendered racism, and Black women enacted agency in response to these risks in a variety of ways constrained by gendered racism, including intentional decision-making, extensive research, and self-advocacy. Insights from in-depth interviews and the qualitative network analysis were contextualized in an environmental scan that included a review of relevant policies, interviews with community leaders, and a review of community organizations efforts to support Black women. This dissertation concludes with a discussion of contributions to theory and insights for Black women, healthcare providers, community organizations, media and policy makers. </p>

The United States healthcare system cares for and supports a diverse patient population. Patients come from various ethnic backgrounds, speak different languages, hold distinct religious affiliations, and more. These differences can create a chasm in the patient-provider relationship, impacting the quality of care or health outcomes. Specifically, language-discordance can affect patient-provider communication; however, technological interventions, such as access to electronic medical record tools and digital translators, can facilitate this dyadic communication. This scoping review examines the literature present on the use of digital tools to facilitate multilingual patient-provider communication. The initial search in PubMed with MeSH terms resulted in 531 studies. After studies were screened for the inclusion criteria in abstract and full-text screening, seven studies remained for data extraction. Results revealed no strong patterns regarding either type of digital technology studied, medical specialization, or clinical setting. Only one randomized controlled trial was identified. Findings highlight the need for more research in this field to determine more specific impact of the usage of technology in healthcare communication.

Thesis advisor: Joyce Edmonds / Background: Systemic racism contributes to the persistent and large inequities in perinatal health outcomes for pregnant people of color, particularly Black pregnant people. Poor communication between pregnant people of color and their providers contributes to these health inequities and perpetuates systemic racism in perinatal health. Pregnant people of color report being dismissed, ignored, discriminated against, and disrespected within the perinatal care system. One of the ways that patients communicate with their providers is via the patient portal. According to the Health Information National Trends Survey, around 80% of U.S. adults utilized information technology, such as patient portals, to track health data or communicate with their provider. Researchers have identified lower usage of patient portals in pregnant people of color compared to their White counterparts. Lower levels of utilization may perpetuate the digital divide for the low-resourced communities of color. Aims: The dissertation has three aims. The first aim was to synthesize and critically analyze patient-provider communication in pregnant people of color. The second aim was to examine the relationship between the quality of patient-provider communication (PPC) and the extent of patient portal use in pregnant people of color and to determine if digital health literacy is a moderating factor in this relationship. The third aim was to explore pregnant people of color’s access, use and perceptions of the patient portal in order to identify barriers and facilitators to quality digital communication with their prenatal providers. Methods: An integrative review method was applied to the empirical literature to achieve aim one. A multi-method, cross-sectional survey study with a non-probability convenience sample of 130 pregnant people of color receiving prenatal care at a large safety net hospital in Boston was conducted for aims two and three. Logistic regression and moderation models were utilized to analyze the quantitative survey data to achieve the second aim. Content analysis was used to analyze the responses to four open-ended survey questions to achieve the third aim. Results: A three-manuscript dissertation was completed. In the first manuscript, 26 articles were identified and the factors, outcomes and recommendations from communication between pregnant people of color and their prenatal providers were evaluated. There were two overarching themes: Racism and Discrimination and Unmet Information Needs along with multiple factors, outcomes and recommendations. The second manuscript reported on the quantitative results responses from 130 pregnant people of color. Participants that did not use the patient portal and who had public insurance had lower odds of rating higher quality PPC. Digital health literacy was found to be a moderating factor in the association between PPC and portal use at the level of portal users. The third manuscript reported on the content analysis and found main facilitators to communication between pregnant people of color and their providers were Provider behaviors and functionality of myChart and barriers were quality of response, multiple providers and digital access and literacy. Conclusions: The findings from this dissertation may be translated into clinical practice by informing perinatal providers on the pregnant people of color’s ratings of respectful communication and facilitators and barriers to quality health communication. Policies and strategies may be developed to improve digital health communication in order to provide inclusive and person-centered care in pregnancy. / Thesis (PhD) — Boston College, 2024. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Background: Chronic kidney disease (CKD) affects approximately 26 million individuals in the United States and is a top priority in the objectives for Healthy People 2020. Despite efforts to improve awareness, discussion of CKD is often minimal or ineffective in the primary care setting. This leads to a lack of patient awareness and knowledge of self-care skills to prevent or slow progression of the disease. A lack of communication of has been attributed to the provider's lack of confidence and knowledge to discuss CKD and to avoid unnecessary stress. Purpose: The purpose of the DNP project is to provide a systematic review of patient-provider communication processes used to influence self-management or behavioral change in primary care and propose a tool to enhance communication and slow progression of CKD. Methods: A systematic review was conducted following the method guidelines of the Cochrane Collaboration. Six electronic databases were searched. Inclusion criteria were adult humans, primary research studies, systematic and literature reviews, focus on communication of self-management or behavioral change strategies, primary outcomes of improving self-management and/or patient outcomes and availability of full-text online or by request. Outcomes: Of the 5765 articles initially identified, 28 studies met inclusion criteria. The studies revealed a lack of evidence directed towards CKD and communication was not directly addressed in a majority of the studies. Interventions most successful in improving patient outcomes were individualized, elicited collaboration or interaction with the patient and provider, were motivational or encouraging and aided in barrier identification and problem solving. A communication tool was developed from the evidence in order to stimulate more meaningful conversation between the patient and provider.

This study examined the relationships between cultural characteristics, communication variables, and medical outcomes in HIV-positive racial/ethnic minority patients. Participants included 33 patients and 5 providers across two urban, community medical clinics. The patient sample was 61% African American, 24% Latino, and 15% Other/Mixed. The majority (73%) were male. Providers included one White female physician, one White male nurse practitioner, two White female nurse practitioners, and one White male physician assistant. In this descriptive study, patients completed self-report ratings of their desire for engagement in decision-making prior to their scheduled medical consultation. After their consultations, patients rated their provider regarding engagement in decision-making, interpersonal communication, and working alliance. Patients also completed measures of acculturation, fatalism, familism, and mistrust. Providers rated their engagement of patients in decision-making, the patients’ interpersonal style, and working alliance immediately after the consultation. Measures of CD4 count and viral load were obtained from patients’ medical records. Cultural characteristics were not related to patient desire for engagement in decision-making. Patient perceptions of being highly informed and involved in decision-making were not related to satisfaction or immune functioning. Patient perceptions of provider affiliation and control, and the complementarity between these two, were also not found to have any significant relation to satisfaction or immune functioning. Though working alliance was not found to have a significant relation to any outcome, the relation between patient perception of a stronger working alliance and higher satisfaction was marginally significant. A match between patient and provider on the bond subscale of working alliance was found to correspond to IMI affiliation complementarity. Though the hypotheses were not supported, certain demographic variables were significantly associated with outcomes. For example, use of antiretroviral medications was associated with lower viral load and gender (i.e., being male) was related to lower CD4. The limitations of this study and directions for future research are discussed.

This dissertation sought to identify correlates of perceived self-efficacy to disclose drug use to one’s HIV primary care provider (DISDR) among a sample of HIV-positive injection drug users (IDUs). Additionally the relationship between identified correlates and DISDR was evaluated to determine whether it persists longitudinally. Potential correlates consisted of individual characteristics (socio-demographic), health care service utilization, sex/drug use behaviors, and psychosocial characteristics. It was postulated that selected variables from these domains would be associated with DISDR. This study presents baseline and longitudinal data that suggest a positive association between self-efficacy to disclose injection drug use to one’s HIV primary care provider and the following variables: patient-provider relationship, attendance of a drug treatment program during the previous six months, “taking control of one’s healthcare,” and social support. However, current receipt of HIV medications and being recruited from the city of Miami were negatively associated with reporting a high DISDR. These findings will potentially inform interventions that can improve HIV treatment among drug users and inform policymakers and stakeholders regarding the importance of providing comprehensive HIV care in conjunction with substance abuse treatment options to achieve optimal health outcomes. A recommendation for further study is enclosed.

Depression can be a profoundly disabling and costly disorder and is a major public health concern. Despite the efficacy of treatment options, it is often unrecognized, under-diagnosed, and inadequately treated in primary care settings. Research on patient-provider communication supports the connection among the quality of the patient-provider interaction, patient behavior, and health outcomes. The purpose of this study was to systematically examine the impact of patients' depressive symptoms on the patient-provider relationship, patient-provider communication, and patient satisfaction with the primary care office visit. One hundred twenty three patient-provider encounters were audiotaped and coded using the Roter Interaction Analysis System (RIAS). A 2 x 2 x 2 within-subjects factorial model provided the analytic framework for examining eight verbal communication behaviors categorized by speaker (patient or provider), type of utterance (question or information giving), and content of utterance (medical or psychosocial talk). Hierarchical linear modeling was used to analyze the two-level nested structure of the data. Results indicated that depression is associated with, but does not predict, increased provider-perceived difficulty in the patient-provider relationship. There was no significant change in either patient or provider communication behavior in relation to the severity of patients' depressive symptoms. Significantly more provider medical information was given during encounters with "difficult" patients and this behavior had a consistent negative effect on patient satisfaction. Patient-provider communication, by itself, does not appear to be a source of depressed patients' oft-reported dissatisfaction with medical care. Additional research is needed to further understand the core processes and structures of primary care practice in relation to the diagnosis and management of depression, their effect on patient outcomes, and to uncover opportunities for enhancing the effectiveness of depression care in primary care.