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

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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.

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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

Authors and 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
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  2. William Sribney MS
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  3. Debra Perez MPA, MA, PhD
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  4. Mara Laderman BA
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  5. Kristen Keefe BA
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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).

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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 (Suppl 3), 534–541 (2009). https://doi.org/10.1007/s11606-009-1074-x

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