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BRIEF CLINICAL UPDATE Health Care Provider′s Motivation to Improve Communication SkillsAnne M. Walling1 , M.D., Julie A. Brown2 , BA, Samuel A. Skootsky1 , M.D., Stephanie S. Teleki2, Ph.D., Denise D. Quigley2 , Ph.D., Donna O. Farley2, Ph.D., and Ron D. Hays1,2 , Ph.D. 1 University of California, Los Angeles Supported by a cooperative agreement from the Agency for Healthcare Research and Quality (U18 HS016980) BackgroundQuality Improvement (QI) is as an attempt to "bridge the gap between available tools and actual health care practices.1" Providing high-quality ambulatory care is challenged by limited interactions between providers and patients. Office visit lengths are brief and providers need to be efficient to address the multitude of issues that may arise.2-5 Improvements in provider-patient communication can enhance efficiency and lead to higher-quality care.6-10 The success of communication interventions depends in large part on the motivation and skill of the participating providers, including clinicians, office managers, and other office staff. The UCLA Faculty Practice Group is actively engaged in various interventions targeted at enhancing communication between individuals involved with health care delivery and patients. This study describes the development of a self-report measure of providers' motivation to improve their communication skills that can be used to assess physician readiness for interventions as well as help to evaluate outcomes of QI projects. Conceptual ModelValue-expectancy theories of behavior (e.g., theory of planned behavior) hypothesize that behavior change is determined by intentions, which is driven by social norms and attitudes.11 Thus, intentions and motivation to change are predictive of future behavior. But behavior change also requires acquisition of specific behavioral skills. Hence, a critical factor in predicting behavior change is one's belief that one can do the target behavior (i.e., self-efficacy). While value-expectancy theories distinguish between motivation and self-efficacy, there is evidence that beliefs about the importance of the patient role, confidence and knowledge needed to take action, as well as initiating and maintaining behavior change, may constitute a unidimensional activation continuum.12 We hypothesized a similar degree of covariation among items assessing motivation and self-efficacy for communication behavior change among physicians. MethodsWe developed self-report survey items that address motivation and self-efficacy to improve a physician's communication skills with patients. Initial items were based on an existing survey13 or newly drafted by the research team. A 3-page survey was created that assessed motivation to improve communication skills. The survey was administered to 35 health care providers and staff. Minor modifications were made to the survey and then it was administered to an additional 54 providers and staff. The total sample of 89 included 73 physicians, 8 practice management staff, 1 practice office staff, and 4 others (n = 3 did not answer). The first motivation-to-improve-communicationskills item is a global rating of the respondent's current communication skills while the third question assesses a rating of what one would like one's communication skill level to be in the next 6 months (see Figure 1). The difference between the latter item and the first item were used to construct an indicator of how much the respondent desires to improve his communication. The second question asks directly how much the person wants to improve. Questions 4 to 6 assess expectations about improving, action to improve, and desire for help in improving communication with patients. A question about confidence (self-efficacy) in one's ability to improve communication in the next 6 months was added to the survey administered to the final 54 providers in the sample (item 7). ResultsThe majority of the sample was male (55%) and within the age range of 18 to 44 years old (67%). Of the physicians surveyed, 58% had been in practice for more than 10 years, 51% of the sample's main practice was specialty care while 35% were primary care providers and the remaining 14% provided both primary and specialty care. We estimated item-scale correlations and internal consistency reliability for a 6-item (excluding the self-efficacy item) and a 7-item (including self-efficacy item) scale. Item-scale correlations ranged from 0.36 (item 5, taking steps) to 0.53 (item 6, want help) for the 6-item scale and 0.18 (item 5, taking steps) to 0. 60 (item 4, going to improve) for the 7item scale. Coefficient alphas were 0.69 and 0.65, respectively, for the 6-item and 7-item scales. We also estimated internal consistency reliability for a 5item scale that was similar to the 6-item scale but dropped item 5 "taking steps"; alpha was 0.68 for this scale. The 5-item motivation-to-change scale (see Figure 2) was deemed to have adequate reliability and to be parsimonious. This 5-item measure was not significantly associated with type of respondent (physician, practice management staff, office staff, other), specialty (primary care, specialty care, both), location (Westwood, Santa Monica, community practice network), years in medicine, age, or gender of respondent. Motivation to change was significantly related to reporting a need for “training for myself” (r = 0.30, p = 0.0067), tools to better elicit information on patient concerns or questions (r = 0.29, p = 0.0093), and tools to measure “how I communicate with patients” (r = 0.34, p= 0.0018). DiscussionThis study provides initial support for the reliability and validity of a 5-item motivation to improve communication skills measure. The items display minimal floor and ceiling effects. Item scale correlations ranged from 0.39 (going to improve) to 0.56 (want support), internal consistency reliability was 0.68, and construct validity was supported. We developed a simple 5-item motivation-toimprove-communication-skills measure that can be administered to physicians and other individuals involved with health care delivery at the baseline of QI interventions and then used to help explain change in communication with patients over time. Assessment of motivation to change might be useful for identifying individuals to target for QI efforts. It may also be used as an indicator of success or failure during QI implementation. Figure 1: Motivation to Change Communication Skills Items
Please indicate how much you agree or disagree with the statements in #4 through #6.
Figure 2: Five-item Measure of Motivation to Change Communication Skills
Please indicate how much you agree or disagree with the statements below
REFERENCES
Submitted on March 4, 2009 |
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