Resident Physician Empathy and Health Literacy Communications Associated with Diabetes Control

Document Type : Original Article

Authors

1 Psychology, Family Medicine, Loma Linda University

2 Department of Psychology, Department of Preventive Medicine, Loma Linda University

3 Department of Family Medicine, Loma Linda University

Abstract

Background and Objective: One third of U.S. adults struggle to understand health related information. To enhance patient understanding and outcomes, resident physicians must adapt communications to the patient’s health literacy level. These communications are particularly important when treating the patient for diabetes that requires intensive self-management.  The present study examined diverse patients’ perceptions of resident physicians’ communications after resident health literacy communication training. 

Materials and methods: We examined the association between patient perceptions of resident physician’s communications and diabetes control in a cross-sectional, correlational study in a convenience sample or patients with diabetes who consented to the survey within a month of clinic visits. After resident physician training, 160 Medicaid managed care adults seen at a Federally Qualified Health Center for type 2 diabetes were invited to complete a one-page survey on patient-provider communications (i.e., empathy, health literacy from Consumer Assessment of Healthcare Providers and Systems), treatment understanding, and diabetes control in 2018. Clinic staff recorded HbA1c upon survey completion with no patient identifiers and data were analyzed with logistic regression.  

Results: Non-Latino White and English-speaking Latino American patients rated resident physicians higher in empathy and health literate communications than Spanish-speaking Latino Americans. Patient perceptions of resident physician empathy and health literate communications were associated with diabetes treatment plan confidence. Patient perceptions of resident physician empathy were associated with diabetes control.  

Conclusions: Empathetic resident physician communications consistent with health literacy levels may improve patients’ understanding of the self-management required for diabetes control. Investing in training programs that target physician communication skills that are empathic and consistent with the patient’s health literacy may improve diabetes control by encouraging dialogue and shared decision making about the treatment plan. 

Keywords


Acknowledgements: We would like to thank all participants who assisted the authors to run this study.

 

Availability of data and materials: Data will be provided by the corresponding author upon request

 

Conflicts of interest: The authors declare that they have no competing interests.

 

Consent for publication: Not applicable

 

Ethical considerations: this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable.

 

Funding: No financial support was received for this study.

 

Author ‘s contributions: All researchers have participated equally in this research 

1- Christie GP, Ratzan SC. Beyond the Bench and Bedside: Health Literacy Is Fundamental to Sustainable Health and Development. Stud Health Technol Inform. 2020;269:544-60
2- Njeru, J. W., Hagi-Salaad, M. F., Haji, H., Cha, S. S., & Wieland, M. L. (2016). Diabetes Health Literacy Among Somali Patients with Diabetes Mellitus in a US Primary Care Setting. Journal of racial and ethnic health disparities, 3(2), 210-216. https://doi.org/10.1007/s40615-015-0129-4 PMid:27271060 PMCid:PMC4901386
3- Parker RM, Ratzan S. Re-enforce, Not Re-Define Health Literacy-Moving Forward with Health Literacy 2.0. J Health Commun. 2019;24(12):923-5. https://doi.org/10.1080/10810730.2019.1691292 PMid:31752603
4- Lambrinou, E., Hansen, T. B., & Beulens, J. W. (2019). Lifestyle factors, self-management and patient empowerment in diabetes care. European journal of preventive cardiology,26(2_suppl), 55-63. https://doi.org/10.1177/2047487319885455 PMid:31766913
5- Sun, H., Saeedi, P., Karuranga, S., Pinkepank, M., Ogurtsova, K., Duncan, B. B., Stein, C., Basit, A., Chan, J. C. N., Mbanya, J. C., Pavkov, M. E., Ramachandaran, A., Wild, S. H., James, S., Herman, W. H., Zhang, P., Bommer, C., Kuo, S., Boyko, E. J., & Magliano, D. J. (2022). IDF Diabetes Atlas: Global, regional, and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes research and clinical practice, 183, 109119. https://doi.org/10.1016/j.diabres.2021.109119 PMid:34879977
6- Kim, S. H., & Lee, A. (2016). Health-Literacy-Sensitive Diabetes Self-Management Interventions: A Systematic Review and Meta-Analysis. Worldviews on evidence-based nursing, 13(4), 324-333. https://doi.org/10.1111/wvn.12157 PMid:27104337
7- Paiva, D., Abreu, L., Azevedo, A., & Silva, S. (2019). Patient-centered communication in type 2 diabetes: The facilitating and constraining factors in clinical encounters. Health services research, 54(3), 623-635. https://doi.org/10.1111/1475-6773.13126 PMid:30815858 PMCid:PMC6505418
8- Fina Lubaki, J. P., Omole, O. B., & Francis, J. M. (2022). Glycemic control among type 2 diabetes patients in sub-Saharan Africa from 2012 to 2022: A Systematic Review and Meta-Analysis. Diabetology & Metabolic Syndrome, 14(1), 134. https://doi.org/10.1186/s13098-022-00902-0 PMid:36127712 PMCid:PMC9487067
9-Abdullah, A., Liew, S. M., Salim, H., Ng, C. J., & Chinna, K. (2019). Prevalence of Limited Health Literacy among Patients with Type 2 Diabetes Mellitus: A Systematic Review. PloS One, 14(5), e0216402. https://doi.org/10.1371/journal.pone.0216402 PMid:31063470 PMCid:PMC6504081
10- Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. (2011). Low health literacy and health outcomes: an updated systematic review. Annals of Internal Medicine, 155(2):97-107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005 PMid:21768583
11-De Abreu, I.R., Baia, C., Silva, J.M., Santos, A.M., Oliveira, M., Castro, F., Mozes, M., Ferreira, R., Alves, L.A. (2022). LitKDM2 study: The impact of health literacy and knowledge about the disease on the metabolic control of type 2 diabetes mellitus. Acta Diabetologica, S9:819-825. https://doi.org/10.1007/s00592-022-01875-2 PMid:35305157
12-Macauda, M. M., Arent, M. A., Sakhuja, M., Yelton, B., Noblet, S., Fedrick, D., Zona, D., New, C., Isenhower, W. D., Wandersman, A., & Friedman, D. B. (2022). Elements for successful implementation of a clinic-based health literacy intervention. Frontiers in public health, 10, 977765. https://doi.org/10.3389/fpubh.2022.977765 PMid:36388330 PMCid:PMC9650509
13-Kumah E, Afriyie EK, Abuosi AA, Ankomah SE, Fusheini A, Otchere G. (2021). Influence of the Model of Care on the Outcomes of Diabetes Self-Management Education Program: A Scoping Review. Journal of Diabetes Research, 2969243. https://doi.org/10.1155/2021/2969243 PMid:33688505 PMCid:PMC7914106
14-Kim MT, Kim KB, Ko J, Murry N, Xie B, Radhakrishnan K, et al. (2020). Health Literacy and Outcomes of a Community-Based Self-Help Intervention: A Case of Korean Americans With Type 2 Diabetes. Nurs Res, 69(3):210-8. https://doi.org/10.1097/NNR.0000000000000409 PMid:31972848 PMCid:PMC7266039
15-Howard T, Jacobson KL, Kripalani S. (2013). Doctor talk: physicians' use of clear verbal communication. Journal of Health Communication, 18(8):991-1001. https://doi.org/10.1080/10810730.2012.757398 PMid:23577746
16-Ali NK, Ferguson RP, Mitha S, Hanlon A. (2014). Do medical trainees feel confident communicating with low health literacy patients? J community Hosp Intern Med Perspect, 4:1-5. https://doi.org/10.3402/jchimp.v4.22893 PMid:24765262 PMCid:PMC3992362
17-Neumann M, Edelhauser F, Tauschel D, Fischer MR, Wirtz M, Woopen C, et al. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med. 2011;86(8):996-1009. https://doi.org/10.1097/ACM.0b013e318221e615 PMid:21670661
18-Derksen F, Bensing J, Lagro-Janssen A. Effectiveness of empathy in general practice: a systematic review. Br J Gen Pract. 2013;63(606):e76-84. https://doi.org/10.3399/bjgp13X660814 PMid:23336477 PMCid:PMC3529296
19-Chu CI, Tseng CC. A survey of how patient-perceived empathy affects the relationship between health literacy and the understanding of information by orthopedic patients? BMC Public Health. 2013;13:155. https://doi.org/10.1186/1471-2458-13-155 PMid:23421348 PMCid:PMC3584842
20-Halpern J. From idealized clinical empathy to empathic communication in medical care. Med Health Care Philos. 2014;17(2):301-11. https://doi.org/10.1007/s11019-013-9510-4 PMid:24343367
21-Riess H. Empathy can be taught and learned with evidence-based education. Emerg Med J. 2022;39(6):418-9. https://doi.org/10.1136/emermed-2021-212078 PMid:34933918
22-Green JA, Gonzaga AM, Cohen ED, Spagnoletti CL. Addressing health literacy through clear health communication: a training program for internal medicine residents. Patient Educ Couns. 2014;95(1):76-82. https://doi.org/10.1016/j.pec.2014.01.004 PMid:24492156
23-Brega AG, Barnard J, Mabachi NM, et al. AHRQ Health Literacy Universal Precautions Toolkit, Second Edition.; 2014.
24-Weidmer BA, Brach C, Hays RD. Development and evaluation of CAHPS survey items assessing how well healthcare providers address health literacy. Med Care. 2012;50(9 Suppl 2):S3-11. https://doi.org/10.1097/MLR.0b013e3182652482 PMid:22895227 PMCid:PMC5102018
25-Amador JA, Flynn PM, Betancourt H. Cultural beliefs about health professionals and perceived empathy influence continuity of cancer screening following a negative encounter. J Behav Med. 2015;38(5):798-808. https://doi.org/10.1007/s10865-015-9646-1 PMid:26032574
26-National Institute for health and Care Excellence. Type 2 diabetes in adults: management. (NICE guideline 28.) 2015. www.nice.org.uk/guidance/ng28.
27-Rakel DP, Hoeft TJ, Barrett BP, Chewning BA, Craig BM, Niu M. Practitioner empathy and the duration of the common cold. Fam Med. 2009 41(7), 494.
28-Hojat M, Louis DZ, Maio V, Gonnella JS. Editorial: Empathy and Health Care Quality. Amer J of Med Quality. 2013 28(1), 6-7. https://doi.org/10.1177/1062860612464731 PMid:2328885 
29-Davis MH. Empathy: A social psychological approach. Social psychology series. 1994. Boulder, CO: Westview Press.
30- Suchman A, Markakis K, Beckman H,13. Christie GP, Ratzan SC. Beyond the Bench and Bedside: Health Literacy Is Fundamental to Sustainable Health and Development. Stud Health Technol Inform. 2020;269:544-60.
31- Ağralı, H., & Akyar, İ. (2022). The effect of health literacy-based, health belief-constructed education on glycated hemoglobin (HbA1c) in people with type 2 diabetes: A randomized controlled study. Primary care diabetes, 16(1), 173-178. https://doi.org/10.1016/j.pcd.2021.12.010 PMid:34980562
32- Catapan, S. C., Nair, U., Gray, L., Cristina Marino Calvo, M., Bird, D., Janda, M., Fatehi, F., Menon, A., & Russell, A. (2021). Same goals, different challenges: A systematic review of perspectives of people with diabetes and healthcare professionals on Type 2 diabetes care. Diabetic medicine: a journal of the British Diabetic Association, 38(9), e14625. https://doi.org/10.1111/dme.14625 PMid:34154035
33- White RO, Eden S, Wallston KA, Kripalani S, Barto S, Shintani A, Rothman RL. Health communication, self-care, and treatment satisfaction among low-income diabetes patients in a public health setting. Patient Educ and Couns. 2015:98(2), 144-149. https://doi.org/10.1016/j.pec.2014.10.019 PMid:25468393 PMCid:PMC4282939
34- Nguyen GT, Bowman, MA. Culture, language, and health literacy: communicating about health with Asians and Pacific Islanders. Fam Med. 2007 Mar;39(3):208-10