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.

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.