Purpose: Although the management of chronic disease over time is widely acknowledged to be a partnership between health care providers and patients, little information beyond a clinical history of the individual is often considered. Additionally, as communication-based behavior change models have been created in large part for mass interventions and media campaigns, most lack a construct that examines the impact of patients' immediate social and physical environments outside the formal care context, in which behavior change must occur. Patients who have significant barriers that are outside of their control may have more difficulty faithfully executing treatment plans, yet this information is not universally embedded in medical decision making. The objective was to identify variables to describe adult patients' immediate social and physical environments and determine those most important to discuss within the medical office visit to tailor conversations.
Method: A quantitative survey was conducted with existing adult patients of an academic ambulatory clinic specializing in asthma, allergy and immunology. Of the total 101 respondents aged 20 to 80, most were female (71%), Caucasian (54%) or Black (37%). Half completed college (50%) and one-third (29%) had completed some college or trade school, with one-quarter reporting total household incomes under $30,000. The questionnaire design was informed by reciprocal determinism, or the melding of the environment and individual behaviors at the core of Bandura’s Social Cognitive Theory. Existing and new measures were used to assess the state of the immediate social and physical environment at the time of the medical office visit, and were tested using multivariate analysis.
Result: Employment status, income, marital status and the number of adults living in the household and health status were indicators of the amount of social support available and patients' self efficacy. Anxiety at the time of the appointment was reduced by increased social support and self-efficacy. Social support appeared to mitigate the perceived difficulty of following the physician’s treatment recommendations.
Conclusion: The inclusion of information about patients' immediate social and physical environments outside the formal care context in the decision making and treatment planning process should improve their ability to adhere to the treatment plan after the visit, and thus merits continued study.
See more of: The 34th Annual Meeting of the Society for Medical Decision Making