Knocking down barriers: Changing the conversation between health providers and patients

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Mass Communications


Dennis F. Kinsey


Doctor patient communication, Health communication, Health promotion, Communication, Health literacy, Healthcare reform

Subject Categories

Communication | Mass Communication | Social and Behavioral Sciences


As the rate of chronic illness in the U.S. continues to increase and medical costs continue to rise, policy makers, health insurers, medical providers and employers will continue to look for ways to encourage patients to engage in proactive health maintenance. The management and maintenance of health and disease is widely acknowledged to be a partnership between health care providers and patients. Current theories of communication and psychology created to understand health behavior change include key constructs measuring the perceptions of the patient, perceived benefits and barriers, self-efficacy, and behavioral intent. Because these models have been created in large part for mass interventions and media campaigns, they are lacking a construct that examines the impact of the patient's environment, or context, in which behavior change must occur. Patients with chronic illness must manage their disease and treatment over time. Low SES patients may have significant barriers outside of their control that complicate their ability to faithfully execute the treatment plans.

This study investigated the gap between education and behavior change by bringing together well-established indices of communication, satisfaction, anxiety and self-efficacy. Using the idea of reciprocal determinism, or the melding of the environment and individual behaviors at the core of Bandura's Social Cognitive Theory, a new series of measures was created. These measures assessed the environmental barriers outside of the patient's immediate control at the time of the office visit.

In the Spring of 2009, a quantitative survey was conducted with patients of an academic ambulatory clinic specializing in asthma, allergy and immunology. Ethnicity, education, income, marital status, the number of adults living in the household, and the type of transportation used to travel to office visits were indicators of the amount of social support available, anxiety at the time of the appointment and the perceived difficulty of following the physician's recommendations. Anxiety at the time of the appointment had a negative impact on self-efficacy of health behaviors. Social support appeared to mitigate the perceived difficulty of following the physician's treatment recommendations. The result was a compact questionnaire, ready for further validation in an outpatient ambulatory setting, to customize communication.