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.