Associations of patient health-related problem solving with disease control, emergency department visits, and hospitalizations in HIV and diabetes clinic samples.
BACKGROUND
Patient problem solving and decision making are recognized as essential to effective self-management across multiple chronic diseases. However, a health-related problem-solving instrument that demonstrates sensitivity to disease control parameters in multiple diseases has not been established.


OBJECTIVE
To determine, in two disease samples, internal consistency and associations with disease control of the Health Problem-Solving Scale (HPSS), a 50-item measure with 7 subscales assessing effective and ineffective problem-solving approaches, learning from past experiences, and motivation/orientation.


METHODS
Cross-sectional study.


METHODS
Outpatients from university-affiliated medical center HIV (N = 111) and diabetes mellitus (DM, N = 78) clinics.


METHODS
HPSS, CD4, hemoglobin A1c (HbA1c), and number of hospitalizations in the previous year and Emergency Department (ED) visits in the previous 6 months.


RESULTS
Administration time for the HPSS ranged from 5 to 10 minutes. Cronbach's alpha for the total HPSS was 0.86 and 0.89 for HIV and DM, respectively. Higher total scores (better problem solving) were associated with higher CD4 and fewer hospitalizations in HIV and lower HbA1c and fewer ED visits in DM. Health Problem-Solving Scale subscales representing negative problem-solving approaches were consistently associated with more hospitalizations (HIV, DM) and ED visits (DM).


CONCLUSIONS
The HPSS may identify problem-solving difficulties with disease self-management and assess effectiveness of interventions targeting patient decision making in self-care.
Hill-Briggs
Felicia
F
Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA. fbriggs3@jhmi.edu
Gemmell
Leigh
L
Kulkarni
Babul
B
Klick
Brendan
B
Brancati
Frederick L
FL
D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000517:prevention & control; D004632:Emergency Medical Services; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D011340:Problem Solving