Master's Project Title:

Work with me: Improving self – management skills through patient centered communication

MCH Student:

Kiana Johnson, PhD

Date of Defense:

March 5, 2015


Objective: We tested relationships between reports of patient – centered communication (PCC),  relatedness to health care providers, and autonomy around management of healthcare among youth with and without mobility limitations (MLs), and examined whether the relationship  between PCC and autonomy was mediated by ratings of how connected youth were to their  health care providers.

Methods: Data were from a Midwest, community – based sample of 436 young people between  the ages of 16 and 24 with (n = 157) and without (n = 152) mobility limitations. The sample  included youth (52% female, 92% White) who participated in the MyPath project, a study  investigating the transition from pediatric to  adult centered healthcare. All participants completed  an online survey at baseline and 1 year following enrollment. Predictor variables included a 3 – item patient – centered communication scale (α= .81) and a 4 – item scale rating the degree of  relatedness to  ealth care provider (α= .76). A 6 – item autonomy for managing health scale (α=  .74) measured 1 year later served as the criterion variable. Covariates included age, sex,  geographic location, health status, mother’s education and assistive equipment use. Stratified  multiple regression models were used to examine predicted associations for youth with and  without MLs.

Results: Reports of patient centered communication were significantly related to both  relatedness to health care providers and autonomy for man aging health care among youth with  and without MLs. After controlling for covariates in multivariate models, we found evidence of  mediation among youth without MLs. However, relatedness was not a significant mediator of the  relation between PCC and autonomy for youth with MLs.

Conclusions: Health care providers who communicate with adolescent and young adult patients  in a patient – centered way increase the likelihood that patients will feel connected to providers  and want to take charge of their own health  care. More frequent patient centered communication  was related to both higher levels of relatedness and health – related autonomy for young people  with and without mobility limitations. For youth without mobility limitations, the association  between how frequently they experienced patient – centered communication from their health care  provider and their self – reports of autonomy one year later was partially mediated (explained) by  their sense of relatedness to their health care providers, suggesting that a young person’s  connection to her healthcare provider contributes to higher levels of autonomy around managing  her own health. However, this was not the case for youth with mobility limitations. Independent  of feelings of connection to health care providers, having experienced more frequent patient – centered communication resulted in higher levels of health – related autonomy for young people  with mobility limitations.

Practice Implications: These findings have implications for medical education, in terms of how we teach providers to support youth in the transition to adult healthcare. Particularly for  providers who work with youth with MLs, autonomy for self – management of healthcare is best  supported by working collaboratively and communicating directly with youth as they strive to  manage their health.