To maintain their own health and the health of their families and communities, consumers rely heavily on the health information that is available to them. This information is at the core of the partnerships that patients and their families forge with today?s complex modern health systems. This information may be provided in a variety of forms ? ranging from a discussion between a patient and a health care provider to a health promotion advertisement, a consent form, or one of many other forms of health communication common in our society. Yet millions of Americans cannot understand or act upon this information. To address this problem, the field of health literacy brings together research and practice from diverse fields including education, health services, and social and cultural sciences, and the many organizations whose actions can improve or impede health literacy. Health Literacy: Prescription to End Confusion examines the body of knowledge that applies to the field of health literacy, and recommends actions to promote a health literate society. By examining the extent of limited health literacy and the ways to improve it, we can improve the health of individuals and populations.

Health literacy : a prescription to end confusion

The stereotype content model (SCM) defines two fundamental dimensions of social perception, warmth and competence, predicted respectively by perceived competition and status. Combinations of warmth and competence generate distinct emotions of admiration, contempt, envy, and pity. From these intergroup emotions and stereotypes, the behavior from intergroup affect and stereotypes (BIAS) map predicts distinct behaviors: active and passive, facilitative and harmful. After defining warmth/communion and competence/agency, the chapter integrates converging work documenting the centrality of these dimensions in interpersonal as well as intergroup perception. Structural origins of warmth and competence perceptions result from competitors judged as not warm, and allies judged as warm; high status confers competence and low status incompetence. Warmth and competence judgments support systematic patterns of cognitive, emotional, and behavioral reactions, including ambivalent prejudices. Past views of prejudice as a univalent antipathy have obscured the unique responses toward groups stereotyped as competent but not warm or warm but not competent. Finally, the chapter addresses unresolved issues and future research directions.

Warmth and Competence As Universal Dimensions of Social Perception: The Stereotype Content Model and the BIAS Map

Background The context in which patients consume health information has changed dramatically with diffusion of the Internet, advances in telemedicine, and changes in media health coverage. The objective of this study was to provide nationally representative estimates for health-related uses of the Internet, level of trust in health information sources, and preferences for cancer information sources. Methods Data from the Health Information National Trends Survey were used. A total of 6369 persons 18 years or older were studied. The main outcome measures were online health activities, levels of trust, and source preference. Results Analyses indicated that 63.0% (95% confidence interval [CI], 61.7%-64.3%) of the US adult population in 2003 reported ever going online, with 63.7% (95% CI, 61.7%-65.8%) of the online population having looked for health information for themselves or others at least once in the previous 12 months. Despite newly available communication channels, physicians remained the most highly trusted information source to patients, with 62.4% (95% CI, 60.8%-64.0%) of adults expressing a lot of trust in their physicians. When asked where they preferred going for specific health information, 49.5% (95% CI, 48.1%-50.8%) reported wanting to go to their physicians first. When asked where they actually went, 48.6% (95% CI, 46.1%-51.0%) reported going online first, with only 10.9% (95% CI, 9.5%-12.3%) going to their physicians first. Conclusion The Health Information National Trends Survey data portray a tectonic shift in the ways in which patients consume health and medical information, with more patients looking for information online before talking with their physicians.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/766849/ioi50160.pdf

Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey.

This paper reviews the literature on mentorship and presents an intitial framework for research on mentor-protege relationships for both men and women. Critical dimensions of this framework include the context within which a mentor-protege relationship exists, the gender of these role partners, the characteristics each partner seeks in the other, the stages of the relationship, and the positive and negative outcomes accruing to the mentor, to the protege, and to their organization.

Mentorship: A Career Training and Development Tool

Patient preferences for shared decisions: A systematic review

Background Use of the Internet for health information continues to grow rapidly, but its impact on health care is unclear. Concerns include whether patients' access to large volumes of information will improve their health; whether the variable quality of the information will have a deleterious effect; the effect on health disparities; and whether the physician-patient relationship will be improved as patients become more equal partners, or be damaged if physicians have difficulty adjusting to a new role.

The Impact of Health Information on the Internet on the Physician-Patient Relationship

Background Use of the Internet for health information continues to grow rapidly, but its impact on health care is unclear. Concerns include whether patients' access to large volumes of information will improve their health; whether the variable quality of the information will have a deleterious effect; the effect on health disparities; and whether the physician-patient relationship will be improved as patients become more equal partners, or be damaged if physicians have difficulty adjusting to a new role. Methods Telephone survey of nationally representative sample of the American public, with oversample of people in poor health. Results Of the 3209 respondents, 31% had looked for health information on the Internet in the past 12 months, 16% had found health information relevant to themselves and 8% had taken information from the Internet to their physician. Looking for information on the Internet showed a strong digital divide; however, once information had been looked for, socioeconomic factors did not predict other outcomes. Most (71%) people who took information to the physician wanted the physician's opinion, rather than a specific intervention. The effect of taking information to the physician on the physician-patient relationship was likely to be positive as long as the physician had adequate communication skills, and did not appear challenged by the patient bringing in information. Conclusions For health information on the Internet to achieve its potential as a force for equity and patient well-being, actions are required to overcome the digital divide; assist the public in developing searching and appraisal skills; and ensure physicians have adequate communication skills.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/215906/ioi20651.pdf

The impact of health information on the internet on the physician-patient relationship: patient perceptions.

OBJECTIVE: To investigate patient preferences for a patient-centered or a biomedical communication style. DESIGN: Randomized study. SETTING: Urgent care and ambulatory medicine clinics in an academic medical center. PARTICIPANTS: We recruited 250 English-speaking adult patients, excluding patients whose medical illnesses prevented evaluation of the study intervention. INTERVENTION: Participants watched one of three videotaped scenarios of simulated patient-physician discussions of complementary and alternative medicine (CAM). Each participant watched two versions of the scenario (biomedical vs. patient-centered communication style) and completed written and oral questionnaires to assess outcome measurements. MEASUREMENTS AND MAIN RESULTS: Main outcome measures were 1) preferences for a patient-centered versus a biomedical communication style; and 2) predictors of communication style preference. Participants who preferred the patient-centered style (69%; 95% confidence interval [CI], 63 to 75) tended to be younger (82% [51/62] for age 59; P<.03), more educated (76% [54/71] for postcollege education; 73% [94/128] for some college; 49% [23/47] for high school only; P=.003), use CAM (75% [140/188] vs. 55% [33/60] for non-users; P=.006), and have a patient-centered physician (88% [74/84] vs. 30% [16/54] for those with a biomedical physician; P<.0001). On multivariate analysis, factors independently associated with preferring the patient-centered style included younger age, use of herbal CAM, having a patient-centered physician, and rating a “doctor’s interest in you as a person” as “very important.” CONCLUSIONS: Given that a significant proportion of patients prefer a biomedical communication style, practicing physicians and medical educators should strive for flexible approaches to physician-patient communication.

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Patient-centered communication: do patients really prefer it?

Clinical decision-making: Patients' preferences and experiences.

Shared decision-making has been advocated; however there are relatively few studies on physician preferences for, and experiences of, different styles of clinical decision-making as most research has focused on patient preferences and experiences. The objectives of this study were to determine 1) physician preferences for different styles of clinical decision-making; 2) styles of clinical decision-making physicians perceive themselves as practicing; and 3) the congruence between preferred and perceived style. In addition we sought to determine physician perceptions of the availability of time in visits, and their role in encouraging patients to look for health information. Cross-sectional survey of a nationally representative sample of U.S. physicians. 1,050 (53% response rate) physicians responded to the survey. Of these, 780 (75%) preferred to share decision-making with their patients, 142 (14%) preferred paternalism, and 118 (11%) preferred consumerism. 87% of physicians perceived themselves as practicing their preferred style. Physicians who preferred their patients to play an active role in decision-making were more likely to report encouraging patients to look for information, and to report having enough time in visits. Physicians tend to perceive themselves as practicing their preferred role in clinical decision-making. The direction of the association cannot be inferred from these data; however, we suggest that interventions aimed at promoting shared decision-making need to target physicians as well as patients.

/pdf/clinical-decision-making-physicians-preferences-and-1i2ogdzkmy.pdf

Martha White

Papers

The Impact of Health Information on the Internet on the Physician-Patient Relationship

The impact of health information on the internet on the physician-patient relationship: patient perceptions.

Patient-centered communication: do patients really prefer it?

Clinical decision-making: Patients' preferences and experiences.

Clinical decision-making: physicians' preferences and experiences