Clustering patients according to health perceptions: relationships to psychosocial characteristics and medication nonadherence.
BACKGROUND
Little is known about how patients rate their health perceptions. Our objectives were to identify systematic multivariate patterns of perceptions using cluster analysis, and to investigate associations among the clusters, psychosocial characteristics and medication nonadherence.


METHODS
Demographic, clinical and psychosocial data on 200 patients with inflammatory bowel disease (IBD) were collected prior to the index office visit and health perceptions were collected afterwards. Cluster analysis using a k-means method was used to identify subgroups of patients based on their responses to the Patient-Physician Discordance Scales (PPDS), an instrument that assesses perceptions of health status and of the clinical visit.


RESULTS
We identified five different patient groups: a "healthy, not distressed, good communication, low expectation for medication/testing" group; a "healthy, relatively distressed, good communication, high expectation for medication, low expectation for testing" group; a "symptomatic, distressed, good communication, high expectation for medication/testing" group; a "healthy, not distressed, good communication, high expectation for medication/testing" group; and a "relatively healthy, relatively distressed, poor communication, low expectation for medication/testing" group. After adjustment for age, sex, language, form of IBD, and disease activity, statistically significant between-clusters differences were found in psychological distress, social support satisfaction and medication nonadherence.


CONCLUSIONS
Distinct patterns of patients' health perceptions correlated with psychological health and adherence to treatment. This categorization may be used to help identify patients at higher risks for ineffective communication and nonadherence to medication.
Sewitch
Maida J
MJ
Groupe de recherche interdisciplinaire en santé, Faculté de médecine, Université de Montréal C.P. 6128, succ. Centre-ville, Montreal, Québec, Canada, H3C 3J7. maida.sewitch@umontreal.ca
Leffondré
Karen
K
Dobkin
Patricia L
PL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D016000:Cluster Analysis; D003142:Communication; D003710:Demography; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011446:Prospective Studies; D011584:Psychology; D011594:Psychometrics / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires