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Associations of Patient Health-Related Problem Solving with Disease Control, Emergency Department Visits, and Hospitalizations in HIV and Diabetes Clinic Samples

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Journal of General Internal Medicine Aims and scope Submit manuscript

Background

Patient problem solving and decision making are recognized as essential to effective self-management across multiple chronic diseases. However, a health-related problem-solving instrument that demonstrates sensitivity to disease control parameters in multiple diseases has not been established.

Objectives

To determine, in two disease samples, internal consistency and associations with disease control of the Health Problem-Solving Scale (HPSS), a 50-item measure with 7 subscales assessing effective and ineffective problem-solving approaches, learning from past experiences, and motivation/orientation.

Design

Cross-sectional study.

Participants

Outpatients from university-affiliated medical center HIV (N = 111) and diabetes mellitus (DM, N = 78) clinics.

Measurements

HPSS, CD4, hemoglobin A1c (HbA1c), and number of hospitalizations in the previous year and Emergency Department (ED) visits in the previous 6 months.

Results

Administration time for the HPSS ranged from 5 to 10 minutes. Cronbach’s alpha for the total HPSS was 0.86 and 0.89 for HIV and DM, respectively. Higher total scores (better problem solving) were associated with higher CD4 and fewer hospitalizations in HIV and lower HbA1c and fewer ED visits in DM. Health Problem-Solving Scale subscales representing negative problem-solving approaches were consistently associated with more hospitalizations (HIV, DM) and ED visits (DM).

Conclusions

The HPSS may identify problem-solving difficulties with disease self-management and assess effectiveness of interventions targeting patient decision making in self-care.

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Acknowledgement

The authors wish to thank Bill Ruby, MD, Heather Campbell, MPH, Christopher Saudek, MD, and Sherita Hill Golden, MD, MHS for providing access to clinic patients recruited for participation in this study. This research was supported by a supplement to NIH grant R01 DK48117, grant NIH K01 HL076644, and the Johns Hopkins Center for Mind Body Research (R21 NS048593).

Potential Financial Conflicts of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, 2024 East Monument Street, Suite 2-600, Baltimore, MD, 21205, USA

    Felicia Hill-Briggs PhD & Frederick L. Brancati MD, MHS

  2. Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

    Felicia Hill-Briggs PhD

  3. Department of Psychology, University of Maryland, Baltimore County, Baltimore, USA

    Leigh Gemmell MA

  4. Department of Family Medicine, State University of New York, New York, USA

    Babul Kulkarni MD, MPH

  5. Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, USA

    Brendan Klick ScM

  6. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

    Frederick L. Brancati MD, MHS

Authors
  1. Felicia Hill-Briggs PhD
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  2. Leigh Gemmell MA
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  3. Babul Kulkarni MD, MPH
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  4. Brendan Klick ScM
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  5. Frederick L. Brancati MD, MHS
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Corresponding author

Correspondence to Felicia Hill-Briggs PhD.

Appendix

Appendix

Health Problem-Solving Scale

Please read the statements below. They are thoughts and feelings people sometimes have about taking care of their health condition(s) and problems that can come up with their health. Problems include trouble managing symptoms (like pain, fatigue, shortness of breath, or thirst) and difficulties sticking to your treatments (like taking medication, following a healthy diet, or doing exercise/physical activity). Problems with your health condition(s) can also include things like dealing with emotions, social relationships, or problems taking care of your health while trying to go about your everyday life.

Write down the number for how much these statements are true of how you think or feel. Please use these options:

  1. 1.

    I know that my choices about taking care of my health condition(s) make a difference in how things come out in the end.

  2. 2.

    I cannot find ways to stop problems with my health condition(s) from getting worse.

  3. 3.

    I find myself dealing with the same problems with my health over and over again.

  4. 4.

    I put off trying to deal with problems with my health condition(s) as long as I can.

  5. 5.

    I know exactly what types of problems I could have with my health condition(s) and my body each day.

  6. 6.

    I can find ways to manage how much my health condition(s) interfere with my life.

  7. 7.

    I always take time to consider how the things I choose to do can help or hurt my health condition(s).

  8. 8.

    Sometimes I decide that I am going to stop taking care of my health condition(s) and do the things I want to do.

  9. 9.

    I avoid the things that I figure out make my health condition(s) worse (such as certain foods, types of activity, places, or environments).

  10. 10.

    I try to solve problems with my health condition(s), but it seems like nothing works.

  11. 11.

    I try to conquer my health condition(s), but problems with my health are conquering me.

  12. 12.

    If I do not like the way treatments for my health condition(s) make me feel (for example, medications or doing exercise), then I stop taking those treatments.

  13. 13.

    When a problem with my health condition(s) happens, I am able to figure out what caused the problem.

  14. 14.

    Bad experiences with my health condition(s) discourage me from trying to solve new problems that come up with my health.

  15. 15.

    Dealing with my health problems makes me want to give up.

  16. 16.

    I use things that have worked before to solve new problems that come up with my health.

  17. 17.

    I get stuck doing the same things I have always done, even if those things do not help.

  18. 18.

    I am able to solve problems that come up with my health.

  19. 19.

    When I find something that makes my health condition(s) better, then I make sure I remember what it was and how I did it.

  20. 20.

    I can think of many different things to do to solve the problems I experience with my health condition(s).

  21. 21.

    When I have a problem with my health condition(s) that I do not know how to deal with, I find a way to get the answers.

  22. 22.

    I get so upset when a problem comes up with my health that it is hard for me to think straight.

  23. 23.

    I forget to do the things that I know work to make my health condition(s) better.

  24. 24.

    Before I do something that will affect my health, I think about all the options.

  25. 25.

    When I am having problems with my health, I avoid dealing with them.

  26. 26.

    Over time, it gets harder and harder for me to handle problems with my health.

  27. 27.

    Sometimes, I know I am doing the wrong thing for my health problem(s), but I just cannot stop myself.

  28. 28.

    I have no trouble putting plans for dealing with my health problems into actions.

  29. 29.

    Bad experiences with my health condition(s) have taught me that I cannot stop those problems from happening again.

  30. 30.

    I do the things I want to do, without paying much attention to how it affects my health condition(s).

  31. 31.

    When I am having problems managing my health condition(s), I keep it to myself (for example, do not tell my doctor, I miss appointments, or do not tell family or friends).

  32. 32.

    When I think about the problems that can happen because of poor health, then I want to do even more to take care of my health.

  33. 33.

    I would rather stay in bed than deal with problems that come up with my health.

  34. 34.

    I feel there is nothing I can do about problems that come up with my health.

  35. 35.

    Although I have had some problems with my health, I find myself still doing things that caused them (for example, unhealthy diet, unhealthy amount of exercise, smoking, or stress).

  36. 36.

    I know that what I do to take care of my health will make a difference.

  37. 37.

    If I see family or friends who have health problems do whatever they want, then it makes me go ahead and do what I want too.

  38. 38.

    If I really do not feel like doing things to control my health condition(s), then I choose not to do them.

  39. 39.

    When I am having a problem with my health, I try to forget all about it and go on like nothing is wrong.

  40. 40.

    If my family or friends have problems with their health, then I know that what happened to them is going to happen to me.

  41. 41.

    If it is too hard to stick with the treatment recommendations for controlling my health condition(s), then I do not dwell on finding ways to do it.

  42. 42.

    When I am having a problem with my health condition(s), I do the first thing that comes to mind rather than thinking through the options.

  43. 43.

    When I feel like there is nothing I can do about a problem with my health, I want to just lie down and go to sleep.

  44. 44.

    I decide how to handle everyday problems with my health based on what will be best for me in the long run—not what I might want today.

  45. 45.

    After I have a bad experience with my health condition(s), I come away knowing what to do and what not to do so the problem does not happen again.

  46. 46.

    I have used alcohol/drinking to try to escape dealing with my health problems.

  47. 47.

    Sometimes dealing with my health problems has felt so tough that I felt like I just wanted to die.

  48. 48.

    I tune out problems that come up with my health, like I am daydreaming.

  49. 49.

    I am able to figure out when problems are making my health condition(s) worse.

  50. 50.

    I get better and better at choosing the best way to solve problems with my health condition(s).

Scoring of HPSS subscales and total Scale:

Effective Problem Solving (EPS) = Item nos. 7, 9, 13, 20, 21, 24, 28, 44, and 49

Impulsive/Careless Problem Solving (IPS) = Item nos. 8, 12, 27, 30, 38, 39, 41, and 42

Avoidant Problem Solving (APS) = Item nos. 4, 25, 31, 33, 43, 46, and 48

Positive Transfer/Learning (PTR) = Item nos. 5, 16, 19, 45, and 50

Negative Transfer/Learning (NTR) = Item nos. 2, 3, 10, 14, 17, 23, 26, 29, 35, 37, and 40

Positive Motivation/Orientation (PMO) = Item nos. 1, 6, 18, 32, and 36

Negative Motivation/Orientation (NMO) = Item nos.11, 15, 22, 34, and 47

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Hill-Briggs, F., Gemmell, L., Kulkarni, B. et al. Associations of Patient Health-Related Problem Solving with Disease Control, Emergency Department Visits, and Hospitalizations in HIV and Diabetes Clinic Samples. J GEN INTERN MED 22, 649–654 (2007). https://doi.org/10.1007/s11606-006-0091-2

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  • DOI: https://doi.org/10.1007/s11606-006-0091-2

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