Relationship of Interpersonal Behaviors and Health-Related Control Appraisals to Patient Satisfaction and Compliance in a University Health Center

Objective: The authors' aim was to evaluate patient-provider relationships in a college health center. Participants: Eighty student patients and their health-care providers. Methods: Patients completed a measure of perceived health competence before a consultation and measures of provider participatory behavior and interpersonal behavior before and after the consultation. They evaluated their satisfaction with care and compliance after the consultation and again 2 weeks later. Providers completed measures of their participatory behavior and patients' interpersonal behavior after the consultation. Results: Patients preferred to be well informed and to have their preferences taken into account, and generally felt competent at managing their own health affairs. They indicated they obtained the high level of participation they desired. Patients desired and actually experienced friendly and submissive providers. Degree of match between patients' desired and actual level of involvement in their care was associated with greater satisfaction. A greater match between the extent to which they desired the provider to be affiliative and the provider's actual affiliative behavior was associated with more satisfaction. No variables were predictive of patient compliance. Conclusion: The authors discuss results in terms of the influence of situational factors characteristic of a college health center.     

Can healthcare providers at a university health clinic predict patient satisfaction?

Patient satisfaction in university health settings has received little research attention, and it is unclear whether the issue is being addressed in college health clinics. Because providers may make their own evaluations of patient satisfaction in the absence of other information, the authors conducted a study to determine whether healthcare providers at a university health clinic could accurately assess patient satisfaction. Ten providers completed a 10-item questionnaire immediately following the medical encounter to rate their perceptions of selected patients' levels of satisfaction. After seeing a healthcare provider, 201 patients completed a comparable questionnaire indicating how satisfied they were with the experience. Responses of providers and patients were compared, using a paired-sample t test. The results showed that providers' ratings were significantly lower than patients' ratings, indicating that providers were unable to judge patient satisfaction accurately. The results suggest that formal evaluations of patient satisfaction should be included in college health services.     

Financing Rural New England University Health Services: A Pilot Study

Abstract

Patient satisfaction in university health settings has received little research attention, and it is unclear whether the issue is being addressed in college health clinics. Because providers may make their own evaluations of patient satisfaction in the absence of other information, the authors conducted a study to determine whether healthcare providers at a university health clinic could accurately assess patient satisfaction. Ten providers completed a 10-item questionnaire immediately following the medical encounter to rate their perceptions of selected patients' levels of satisfaction. After seeing a healthcare provider, 201 patients completed a comparable questionnaire indicating how satisfied they were with the experience. Responses of providers and patients were compared, using a paired-sample t test. The results showed that providers' ratings were significantly lower than patients' ratings, indicating that providers were unable to judge patient satisfaction accurately. The results suggest that formal evaluations of patient satisfaction should be included in college health services.     

College Health as a Partner in the Care of Pediatric Cancer Survivors

Abstract

Objective: This study reviews an initiative to educate providers on pediatric cancer survivor care and to establish a cancer survivor registry in a college health center. Participants: Participants were University of Georgia (UGA) college health providers. Methods: Providers attended lectures on survivor care and were encouraged to register on Cancer SurvivorLink. Changes in provider familiarity and practice were measured using baseline and follow-up surveys. A survivor registry was created using health entrance forms and medical records abstraction. Results: Twenty-four providers registered on SurvivorLink, and 16 completed both surveys. Familiarity with survivor care (p = .003) and a survivor health care plan (p = .016) increased. Likelihood to deliver survivor care increased (p = .01). UGA follows 95 survivors; 71 diagnosed at < 21 years. Among survivors diagnosed at < 21 years, 91% reported their diagnosis on entrance forms. Conclusions: Through education and optimization of health informatics, college health centers can identify and provide survivor care to this medically vulnerable population.     

Very Brief Interventions in College Mental Health

Abstract

Although short encounters account for one-half of college mental health practice, they're often viewed as an unavoidable evil rather than a desired outcome. In order to evaluate client satisfaction with very brief interventions the authors mailed questionaires to 215 clients who had mental health encounters lasting no more than three sessions. Seventy-two percent of respondents were satisfied with their treatment. Thirty-six percent reported that they terminated because they felt they satisfied the conditions of the consultation, as opposed to 16% who left dissatisfied and 29% who left because they were referred elsewhere. A chart review revealed that in 45% of cases the decision to terminate was made unilaterally by the client. These findings suggest that very brief interventions are more often associated with rapid goal achievement than with client dissatisfaction.     

Perspectives of college students and their primary health care providers on substance abuse screening and intervention

The authors conducted a needs assessment among students and health-care providers of a southwestern university health center with the goal of developing health-care-provider training addressing substance-abuse screening and intervention. They collected data from focus groups of undergraduate students and structured interviews and questionnaires with health-care providers. They identified gaps in provider and student perspectives on the extent of substance abuse on campus and the perceived roles of health-care providers and patients in screening and conducting interventions for substance abuse. These findings suggest that training for college health-care providers regarding substance-abuse brief screening and intervention should emphasize confidentiality of student medical records, the importance of nonjudgmental attitudes toward students, and the role of the provider as one who is competent and appropriate to address substance abuse. Such training should also educate providers about the types of substances students are using.     

Urban college student self-report of hookah use with health care providers

Objective: This study's purpose was to describe urban college students’ communication about hookah with health care providers. Participants: Participants included a random sample of undergraduate urban college students and health care providers. Methods: Students surveyed determined the epidemiology of hookah use in this population, how many health care providers asked about hookah, and how many students admitted hookah use to a physician. Results: Of 375 students surveyed, 78 (20.8%) had never tried it, 284 (75.7%) had smoked hookah at least once, and 64 students (22.6%) were classified as frequent hookah smokers. Only 15 (4.7%) reported a health care provider asking about hookah during visits, whereas 36 (12.7%) admitted their hookah use to a health care provider. Conclusion: Hookah use was found to be highly prevalent among students in one urban university. This study supports the hypothesis that few health care providers broach the topic with patients. Additional research on health consequences of hookah use, education, and improved screening is warranted.     

Provider perceptions of the social work environment and the state of pediatric care in a downsized urban public academic medical center

The author's purpose through this study was to document and analyze health provider perceptions of their social work environment and the state of pediatric care at Los Angeles County King/Drew Hospital and Medical Center in 2000, after the restructuring and downsizing of the hospital and its community clinics. The research results showed nurses and physicians reporting that both the quality of pediatric care and the provider social work environment were poor. Negative factors in the social work environment included: low employee morale, poorly staffed clinical teams, lack of professional autonomy, perceptions of low quality of care for pediatric patients, and interpersonal issues of poor communication and collaboration among providers. Providers also perceived a non-supportive work environment, sense of powerlessness, poor quality of work, lack of goal clarity from leadership, lack of fairness in leadership behavior, and an organizational leadership that is abandoning its core mission and values, thereby making it difficult for providers to carry out their professional functions. The author's findings in this study suggest a relationship between intra-role conflict, social employment environment and quality of care at King/Drew Medical Center in 2000. Lessons for practice are presented.     

Preference for same-race health care providers and perceptions of interpersonal discrimination in health care

This article examines black Americans' preference for black health care providers. Using data from a national survey, we assess how blacks 'perceptions of discrimination are related to preference for same-race health care providers. Overall, the belief that discrimination is frequent in different-race doctor-patient dyads is associated with greater preference for a same-race provider However; the belief that discrimination occurs regardless of a doctor's race reduces preference for a same-race provider Finally, general perceptions of discrimination are distinct from concerns about personally being treated unfairly, and low personal concern about unfair treatment reduces preference for a same-race provider among those who believe that interpersonal discrimination occurs frequently. These results suggest a complex picture of how perceptions of discrimination influence preferred race of health care provider among blacks in the United States.     

Healthcare and Listening: A Relationship for Caring

The optimal relationship between healthcare provider and patient is one of trust. This therapeutic relationship is dependent on the ability of the healthcare provider to communicate effectively with the patient. Research indicates that when healthcare providers listen to patients, there is more compliance with medical regimens, patient satisfaction is increased, and physicians are less vulnerable to malpractice lawsuits. Within the last few decades, the relationship between physician and patient has been reconceptualized from a paternalistic relationship to a partnership between provider and patient. This change is demanding a shift in how healthcare providers communicate and, in particular, listen to patients. To address this need, medical organizations such as the Accreditation Council for Graduate Medical Education has emphasized improved training and competence in communication skills of physicians. Effective communication and listening also is critical to the ethical treatment of patients and their families. This paper will discuss the critical component of listening within the healthcare context.     

An Examination of Weight-Associated Memorable Messages,Sources, and Outcomes

As college students are particularly vulnerable to weight struggles, understanding how weight-related communication impacts behavior can have important implications for overall health. This study investigated memorable messages regarding weight using the theoretical lens of control theory. Control theory provides a guiding framework to predict how memorable messages impact subsequent behavior when an individual senses a discrepancy between their ideal and actual weight. Participants were asked to report whether they had experienced a weight-associated discrepancy and if they recalled a memorable message about this issue. For those with a memorable message, characteristics and outcomes of the message were solicited. The prevalence of weight-associated discrepancies, associated memorable messages, topics, sources, and perceived intentions of the memorable messages and the reported outcomes of message recall were identified. Findings address the relationship between interpersonal communication and weight and offer insight to the role of memorable messages in both construction and achievement of individuals’ ideal states.     

A test of equilibrium theory: Effects of topic intimacy and proximity on verbal and nonverbal behavior in pairs of friends and strangers

This experiment examined verbal and nonverbal behavior by pairs of female friends and strangers as they discussed either intimate or nonintimate topics at face-to-face distances of approximately 2.5 or 4.5 feet. On the basis of equilibrium theory and Altman and Taylor's (1973) theory about interpersonal exchange, strangers were expected to react to intimate topics or close proximity or both with discomfort and decreased affiliative behavior (facial regard, gesturing, speech). Friends were expected to show increased affiliative behavior. Results indicated that both strangers and friends showed signs of discomfort and low levels of affiliative behavior while discussing intimate topics, i.e.compensation. Discomfort with intimate topics and compensation decreased over time, indicatingadaptation. This finding suggests that compensation for intimate topics may occur only during the initial phases of an encounter.     

Rapid Assessment for Psychopathology in a College Health Clinic: Utility of College Student Specific Questions

Abstract

Objective: The purpose of this study was to determine the utility and unique benefits of employing the College Health Questionnaire (CHQ) in a college health care setting. The CHQ is a newly designed measure to assess psychosocial issues commonly problematic among college students. Participants: One hundred nine patients participated in the study during their medical appointments. Methods: Participants completed the study questionnaires (CHQ and Patient Health Questionnaire) in the waiting room. Their provider had the opportunity to use the responses in treatment decision making. Results: A majority (66.1%) endorsed at least one CHQ item. Patients who indicated traditional mental health problems were more likely to be prescribed psychotropic medications, whereas patients who endorsed psychosocial issues commonly problematic among college students were more likely to be referred for behavioral treatment. Conclusions: Screening for behavioral problems in college primary care settings without the use of college-related questions would result in missing numerous important psychosocial problems.     

Nonverbal response patterns in physician-patient interactions: A functional analysis

In this paper, we examined physician-patient interactions in terms of the communicative functions accomplished during these encounters. Specifically, the nonverbal communicative exchanges of 38 physician-patient interactions in a family practice clinic were investigated. Two distinctive communicative patterns characterized these interactions. First, physicians nonverbally exerted greater dominance and control by employing longer speaking turns, more social touch, and more pauses while speaking than did the patients. Secondly, physicians and patients tended to reciprocate nonverbal behaviors signalling affiliation including gaze, response latencies, body orientations, and gestures. Consistent with previous research, there was a strong positive relationship between patients' satisfaction with health care and perceptions of the physicians' affiliativeness. Although there were few significant effects, physicians perceived less affiliative tended to be more vocally and gesturally active relative to the patients' nonverbal behavior styles. Finally, there were positive relationships between patients' perceptions of physicians' dominance and the physicians' use of task touch, and the extent to which physicians produced more interruptions and maintained more indirect body orientations relative to the patients' performances of these behaviors. The results are discussed in terms of the communicative functions of nonverbal behavior in physician-patient interactions and of patients' preferences for physicians' nonverbal expressiveness.The authors wish to thank Joe Cappella, Howard Waitzkin, Martha Davis, and William B. Stiles for their helpful comments on previous drafts of this paper.     

Screening and Brief Intervention for Tobacco Use by Student Health Providers on College Campuses

Abstract

Objective: This study assessed college students’ reports of tobacco screening and brief intervention by student health center providers. Participants: Participants were 3,800 students from 8 universities in North Carolina. Methods: Web-based survey of a stratified random sample of undergraduates. Results: Fifty-three percent reported ever visiting their student health center. Of those, 62% reported being screened for tobacco use. Logistic regression revealed screening was higher among females and smokers, compared to nonsmokers. Among students who were screened and who reported tobacco use, 50% reported being advised to quit or reduce use. Brief intervention was more likely among current daily smokers compared to current nondaily smokers, as well as at schools with higher smoking rates. Screening and brief intervention were more likely at schools with lower clinic caseloads. Conclusions: Results highlight the need to encourage college health providers to screen every patient at every visit and to provide brief intervention for tobacco users.     

US college and university student health screening requirements for tuberculosis and vaccine-preventable diseases, 2012

ABSTRACT

Objective: Colleges are at risk for communicable disease outbreaks because of the high degree of person-to-person interactions and relatively crowded dormitory settings. This report describes the US college student health screening requirements among US resident and international students for tuberculosis (TB) and vaccine-preventable diseases (VPDs) as they relate to the American College Health Association (ACHA) guidelines. Methods/Participants: In April 2012, US college health administrators (N = 2,858) were sent online surveys to assess their respective school's TB screening and immunization requirements. Results: Surveys were completed by 308 (11%) schools. Most schools were aware of the ACHA immunization (78%) and TB screening (76%) guidelines. Schools reported having policies related to immunization screening (80.4%), immunization compliance (93%), TB screening (55%), and TB compliance (87%). Conclusion: Most colleges were following ACHA guidelines. However, there are opportunities for improvement to fully utilize the recommendations and prevent outbreaks of communicable diseases among students in colleges.