11
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Patient–provider relationship and perceived provider weight bias among American Indians and Alaska Natives

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Summary

          Objective

          The objective of this study was to examine patient–provider relationships among American Indians and Alaska Native (AI/AN) patients by examining associations between patient activation, perceived provider weight bias and working alliance. Patient activation is generally defined as having the knowledge, skills and confidence to manage one's health.

          Methods

          Among a sample of 87 AI/AN adults presenting for general medical care at an urban clinic in the north‐west region of the USA, ordinary least squares regression analysis was completed to examine associations.

          Results

          Better working alliance scores were associated with increased patient activation, while perceived provider weight bias was associated with reduced patient activation. In addition, those with class II obesity had decreased patient activation.

          Conclusion

          These findings point to the importance of a positive patient–provider relationship in AI/ANs. Optimal patient engagement and subsequent health outcomes warrant additional consideration of patients' perceptions of provider weight bias within the context of health promotion and interventions.

          Related collections

          Most cited references39

          • Record: found
          • Abstract: found
          • Article: not found

          Development and testing of a short form of the patient activation measure.

          The Patient Activation Measure (PAM) is a 22-item measure that assesses patient knowledge, skill, and confidence for self-management. The measure was developed using Rasch analyses and is an interval level, unidimensional, Guttman-like measure. The current analysis is aimed at reducing the number of items in the measure while maintaining adequate precision. We relied on an iterative use of Rasch analysis to identify items that could be eliminated without loss of significant precision and reliability. With each item deletion, the item scale locations were recalibrated and the person reliability evaluated to check if and how much of a decline in precision of measurement resulted from the deletion of the item. The data used in the analysis were the same data used in the development of the original 22-item measure. These data were collected in 2003 via a telephone survey of 1,515 randomly selected adults. Principal Findings. The analysis yielded a 13-item measure that has psychometric properties similar to the original 22-item version. The scores for the 13-item measure range in value from 38.6 to 53.0 (on a theoretical 0-100 point scale). The range of values is essentially unchanged from the original 22-item version. Subgroup analysis suggests that there is a slight loss of precision with some subgroups. The results of the analysis indicate that the shortened 13-item version is both reliable and valid.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Do increases in patient activation result in improved self-management behaviors?

            The purpose of this study is to determine whether patient activation is a changing or changeable characteristic and to assess whether changes in activation also are accompanied by changes in health behavior. To obtain variability in activation and self-management behavior, a controlled trial with chronic disease patients randomized into either intervention or control conditions was employed. In addition, changes in activation that occurred in the total sample were also examined for the study period. Using Mplus growth models, activation latent growth classes were identified and used in the analysis to predict changes in health behaviors and health outcomes. Survey data from the 479 participants were collected at baseline, 6 weeks, and 6 months. Positive change in activation is related to positive change in a variety of self-management behaviors. This is true even when the behavior in question is not being performed at baseline. When the behavior is already being performed at baseline, an increase in activation is related to maintaining a relatively high level of the behavior over time. The impact of the intervention, however, was less clear, as the increase in activation in the intervention group was matched by nearly equal increases in the control group. Results suggest that if activation is increased, a variety of improved behaviors will follow. The question still remains, however, as to what interventions will improve activation.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              When patient activation levels change, health outcomes and costs change, too.

              Patient engagement has become a major focus of health reform. However, there is limited evidence showing that increases in patient engagement are associated with improved health outcomes or lower costs. We examined the extent to which a single assessment of engagement, the Patient Activation Measure, was associated with health outcomes and costs over time, and whether changes in assessed activation were related to expected changes in outcomes and costs. We used data on adult primary care patients from a single large health care system where the Patient Activation Measure is routinely used. We found that results indicating higher activation in 2010 were associated with nine out of thirteen better health outcomes-including better clinical indicators, more healthy behaviors, and greater use of women's preventive screening tests-as well as with lower costs two years later. Changes in activation level were associated with changes in over half of the health outcomes examined, as well as costs, in the expected directions. These findings suggest that efforts to increase patient activation may help achieve key goals of health reform and that further research is warranted to examine whether the observed associations are causal.
                Bookmark

                Author and article information

                Contributors
                kelly.gonzales@pdx.edu
                Journal
                Obes Sci Pract
                Obes Sci Pract
                10.1002/(ISSN)2055-2238
                OSP4
                Obesity Science & Practice
                John Wiley and Sons Inc. (Hoboken )
                2055-2238
                13 December 2017
                February 2018
                : 4
                : 1 ( doiID: 10.1002/osp4.v4.1 )
                : 76-84
                Affiliations
                [ 1 ] Oregon Health Sciences University‐Portland State University School of Public Health Portland State University Portland OR USA
                [ 2 ] Department of Sociology Portland State University Portland OR USA
                [ 3 ] Department of Education Studies, College of Education University of Oregon Eugene OR USA
                [ 4 ] Initiative for Research and Education to Advance Community Health Washington State University Seattle WA USA
                [ 5 ] Centers for American Indian and Alaska Native Health University of Colorado Denver Aurora CO USA
                Author notes
                [*] [* ]Address for correspondence: KL Gonzales, Oregon Health Sciences University‐Portland State University School of Public Health, Portland State University, 506 SW Mill Street, Suite 450, Portland, OR 97201, USA. E‐mail: kelly.gonzales@ 123456pdx.edu
                Article
                OSP4135 OSP4-2016-12-0073.R2
                10.1002/osp4.135
                5818742
                29479467
                0b80eef5-43ee-41a1-a8ea-b7380775b00a
                © 2017 The Authors. Obesity Science & Practice published by John Wiley & Sons Ltd, World Obesity and The Obesity Society.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 03 December 2016
                : 21 August 2017
                : 29 August 2017
                Page count
                Figures: 0, Tables: 3, Pages: 9, Words: 4462
                Funding
                Funded by: National Institute on Aging
                Award ID: P30 AG15297
                Funded by: Portland State University Library's Open Access Fund
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                osp4135
                February 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.3.2.2 mode:remove_FC converted:20.02.2018

                american indian,patient activation,therapeutic alliance,weight bias

                Comments

                Comment on this article