2015 Theses Doctoral

Health Communication & The Medical Encounter: Perspectives Of Urban African American Women

Otey, Dionne T.

Effective communication is essential for both a satisfying and productive patient-provider relationship. Ineffective communication can lead to many detrimental patient outcomes including a lack of access to care, an inability to navigate the healthcare environment, a decreased adherence to treatment recommendations, and a lack of patient understanding about disease risk factors, prevention, and management. The Healthy People 2010 initiative recognized the importance of communication by including several health communication-related goals in its objectives. A goal of one of these objectives included increasing the percentage of patients who reported that their care providers have satisfactory communication skills. Researchers can gain insight about those barriers that prevent providers from experiencing effective communication by examining the patients' perspectives about communication. The primary aim of this pilot study was to explore urban African American women's perspectives about the communication utilized during clinical encounters with providers via the use of semi-structured interviews. The semi-structured interviews collected data about a variety of topics including participants' breast cancer-related knowledge, attitudes, beliefs, and practices. Data was also collected about participants' clinical encounter experiences, including their comprehension of health information and their communication experiences with medical providers and other types of health care professionals. Any responses that discussed participants' communication experiences with providers, comprehension of health information, or perspectives about factors that could impede or facilitate communication were selected for analysis.

In addition to the semi-structured interviews, participants also completed two health literacy assessments in order to gauge their health literacy levels. Women were administered the Rapid Estimate of Adult Literacy in Medicine (REALM), a word recognition assessment, and the Short Test of Functional Health Literacy in Adults (STOFHLA), a comprehension assessment. Eligibility criteria included women who: (1) were aged 50 and older, (2) were English-speaking, (3) able to respond to interview questions without assistance, (4) of African descent, (5) were Harlem residents, and (6) had never received a diagnosis of breast cancer. One hundred women participated in the study. Data about the effectiveness of providers' communication skills, patients' abilities to comprehend health information, patients' communication experiences with various types of health care providers, and preferred sources of health information were collected from the interviews. Open-ended questions were utilized to gather information about factors that women deemed as either impediments or facilitators to effective communication with providers. Collected data from interviews were analyzed qualitatively. In addition to information about participants' health literacy scores from the literacy assessments, final results included demographic information, preferred sources of health information, and information about those factors that women viewed as either impediments or facilitators to effective communication with doctors and with other health care providers both in and outside of the medical appointment. Additionally, findings from the qualitative analysis results were utilized in order to inform the creation of health communication recommendations for providers who treat urban African American female patients.