title: A conceptual model of patient-professional communication as a self-management skill: A latent growth change modeling.
abstract: BACKGROUND
  Patient Communication with healthcare professionals is an integral self-management skill. Yet the underlying mechanisms explaining how such communication might be enhanced across time have not been well studied.
  
  
  OBJECTIVE
  Based on the transtheoretical model, the study aimed to develop an across-time Attitude-Social Influence-Efficacy model in order to explain changes in participants' patient-professional communication behaviors in the Chronic Disease Self-management Program (CDSMP). Readiness-to-change construct was hypothesized to be the overall predictors of psychological and behavioral parameters. It was hypothesized that social norm and attitude toward behaviors would be the indirect predictors of communication behavior.
  
  
  METHODS
  One hundred and thirty-six Chinese participants with chronic diseases underwent a 6-week CDSMP. Their attitude toward behavior, self-efficacy, social norm, readiness to change and communication behavior were obtained at 1st, 4th and 6th week of the structured program.
  
  
  RESULTS
  A modified latent growth change curve model yielded satisfactory model fit (χ(2)/df = 1.32; RMSEA = 0.063 (90% CI = 0.018-0.96)). The results showed that readiness to change had a positive influence on attitude and self-efficacy. Both attitude and social norm positively affected self-efficacy. Attitude and self-efficacy in turn positively influenced communication behavior at the beginning of the program. Across 6 weeks, self-efficacy imposed a negative influence on communication behavior while social norm exerted a positive influence on the behavior.
  
  
  CONCLUSIONS
  This study revealed possible underlying mechanisms influencing CDSMP participants' communication with professionals. The results could shed light on further improvement of the structured program.
authors.affiliation: Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China. Electronic address: samcc.chan@polyu.edu.hk.
authors.forename: Sam C C
authors.initials: SC
authors.lastname: Chan
authors.affiliation: Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China.
authors.forename: Chetwyn C H
authors.initials: CC
authors.lastname: Chan
authors.affiliation: Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China.
authors.forename: Andrew M H
authors.initials: AM
authors.lastname: Siu
authors.affiliation: The Hong Kong Society for Rehabilitation, Hong Kong, China.
authors.forename: Peter K K
authors.initials: PK
authors.lastname: Poon
mesh_terms: D000328:Adult; D001290:Attitude; D002681:China; D002908:Chronic Disease / Q000523:psychology; D003142:Communication; D006233:Persons with Disabilities / Q000523:psychology; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D012648:Self Care; D020377:Self Efficacy; D066262:Social Norms; D012944:Social Support; D011795:Surveys and Questionnaires
keywords: ASE model; Chronic disease; Health communication; Self-management; Transtheoretical model