Intensity of exposure to a patient activation intervention and patient engagement in medical visit communication.
OBJECTIVE
We examined associations between intensity of exposure to a community health worker (CHW) delivered communication activation intervention targeting low-income patients with hypertension.


METHODS
We analyzed question-asking behaviors of patients assigned to the intervention arms (n=140) in a randomized controlled trial. Intensity of exposure to the intervention was operationalized as the duration of face-to-face coaching and number of protocol-specified topics discussed. Mixed effects models characterized the relationship between intensity of exposure and patients' communication in a subsequent medical visit.


RESULTS
The number of topics discussed during the coaching session was positively associated with patients' asking psychosocial-related questions during their visit. The duration of the coaching session was positively associated with patients' use of communication engagement strategies to facilitate their participation in the visit dialogue. Exposure to a physician trained in patient-centered communication did not influence these relationships.


CONCLUSIONS
A dose-response relationship was observed between exposure to a CHW- delivered communication activation intervention and patient-provider communication.


CONCLUSIONS
This study supports the use of CHWs in activating patients toward greater communication in the therapeutic exchange.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. Electronic address: cibe2@jhu.edu.
Chidinma
C
Ibe
Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Janice
J
Bowie
Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Debra
D
Roter
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Kathryn A
KA
Carson
Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Bone
B
Lee
Institute for Public Health Innovation, Washington, D.C., USA.
Dwyan
D
Monroe
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Lisa A
LA
Cooper
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003142:Communication; D003150:Community Health Workers / Q000193:education*; D003695:Delivery of Health Care / Q000458:organization & administration; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D018802:Patient-Centered Care / Q000379:methods*; D010817:Physician-Patient Relations; D011320:Primary Health Care
D000959:Antihypertensive Agents
Community health workers; Hypertension; Patient activation; Patient-centered communication; Patient-physician communication