National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
- Autism (1)
- Behavioral Health (1)
- Burnout (1)
- Cancer (3)
- Cancer: Colorectal Cancer (1)
- Cancer: Lung Cancer (1)
- Care Coordination (2)
- Caregiving (1)
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- Chronic Conditions (4)
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- Communication (3)
- Community-Based Practice (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (5)
- Decision Making (5)
- Diagnostic Safety and Quality (3)
- Disparities (2)
- Education: Patient and Caregiver (1)
- Elderly (1)
- Electronic Health Records (EHRs) (4)
- Emergency Department (2)
- Healthcare Delivery (2)
- Health Information Technology (HIT) (4)
- Health Services Research (HSR) (1)
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- Kidney Disease and Health (1)
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- Long-Term Care (1)
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- Neurological Disorders (1)
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- Patient and Family Engagement (7)
- (-) Patient Experience (36)
- Patient Safety (4)
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- Primary Care: Models of Care (1)
- Provider: Nurse (1)
- Quality Improvement (4)
- Quality Indicators (QIs) (1)
- Quality Measures (3)
- Quality of Care (5)
- Quality of Life (2)
- Racial and Ethnic Minorities (2)
- Surgery (3)
- System Design (1)
- Telehealth (1)
- Web-Based (2)
- Women (2)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 36 Research Studies DisplayedSenft N, Everson J
eHealth engagement as a response to negative healthcare experiences: cross-sectional survey analysis.
The goal of this study was to determine how the negative healthcare experiences of low patient centeredness and care coordination problems motivate the use of different eHealth activities, and whether more highly educated individuals are more likely than those less highly educated to use eHealth following negative experiences. Researchers used factor analysis to group 25 different eHealth activities into categories, based on the correlation between respondents' reports of their usage. Their findings indicate that individuals use a greater number of eHealth activities, especially activities independent of healthcare providers, when they experience problems with their healthcare; people with lower levels of education who have had negative healthcare experiences seem more inclined to use eHealth. The researchers recommend that, in order to maximize the potential for eHealth to meet the needs of all patients, especially those who are underserved, additional work is needed to ensure that eHealth resources are accessible to all members of the population.
AHRQ-funded; HS026122.
Citation: Senft N, Everson J .
eHealth engagement as a response to negative healthcare experiences: cross-sectional survey analysis.
J Med Internet Res 2018 Dec 5;20(12):e11034. doi: 10.2196/11034..
Keywords: Care Coordination, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient-Centered Healthcare, Patient Experience, Telehealth
Silbverberg JI, Kantor RW, Dalal P
A comprehensive conceptual model of the experience of chronic itch in adults.
This study sought to develop a comprehensive conceptual model of itch to improve the understanding of itch for clinicians and to serve as a framework for development of efficient and valid patient-reported outcome measures (PROMs) of itch. The study’s conceptual model demonstrated the profound patient-burden of itch and identified unmet needs in the evaluation and management of itch.
AHRQ-funded; HS023011.
Citation: Silbverberg JI, Kantor RW, Dalal P .
A comprehensive conceptual model of the experience of chronic itch in adults.
Am J Clin Dermatol 2018 Oct;19(5):759-69. doi: 10.1007/s40257-018-0381-6..
Keywords: Chronic Conditions, Patient Experience
Giardina TD, Haskell H, Menon S
Learning from patients' experiences related to diagnostic errors is essential for progress in patient safety.
Diagnostic error research has largely focused on individual clinicians' decision making and system design, while overlooking information from patients. In this paper, the authors analyzed patient- and family-reported error narratives to explore factors that contribute to diagnostic errors. The authors suggest that health systems should develop and implement formal programs to collect patients' experiences with the diagnostic process and use these data to promote an organizational culture that strives to reduce harm from diagnostic error.
AHRQ-funded; HS022087; HS017820; HS023558.
Citation: Giardina TD, Haskell H, Menon S .
Learning from patients' experiences related to diagnostic errors is essential for progress in patient safety.
Health Aff 2018 Nov;37(11):1821-27. doi: 10.1377/hlthaff.2018.0698..
Keywords: Diagnostic Safety and Quality, Patient Experience, Patient Safety, Quality Improvement
Aiken LH, Sloane DM, Barnes H
Nurses' and patients' appraisals show patient safety in hospitals remains a concern.
This study analyzed if there is a positive correlation between improvements of work environments for nurses and improvements in patient safety. A total of 535 hospitals in four large states at two points in time between 2005 and 2016 were studied. Survey data showed an improvement of work environment with 21% of study hospitals, and 7% had worse scores. For the hospitals with improved work environments, patients and nurses both reported high scores for patient safety indicators. For work environments which deteriorated, favorable patient safety grades went down 21%.
AHRQ-funded; HS022406.
Citation: Aiken LH, Sloane DM, Barnes H .
Nurses' and patients' appraisals show patient safety in hospitals remains a concern.
Health Aff 2018 Nov;37(11):1744-51. doi: 10.1377/hlthaff.2018.0711..
Keywords: Burnout, Hospitals, Patient Experience, Patient Safety, Provider: Nurse, Quality of Care, Quality Improvement
Yan C, Rose S, Rothberg M
Patient perspectives on clinical scribes in primary care.
This study surveyed patients in order to quantitatively describe their opinions and perspectives regarding clinical scribes in primary care. A 16-item questionnaire was administered on-site after completion of the patient’s visit. While nearly 70 percent of patients expressed no preference regarding the scribe’s presence during their visit, slightly more were comfortable with a scribe of a different gender. Almost a third preferred the presence of a scribe and all patients reported that they would visit the physician again if the scribe was present. Patients were comfortable discussing most topics in front of the scribe, except sexual history, which the authors conclude has implications for clinical practice. The authors also note that only patients who agreed to a scribe being present during the visit were available for sampling, and that this may lead to selection bias in their findings.
AHRQ-funded; HS024128.
Citation: Yan C, Rose S, Rothberg M .
Patient perspectives on clinical scribes in primary care.
J Gen Intern Med 2018 Nov;33(11):1859-61. doi: 10.1007/s11606-018-4573-9..
Keywords: Patient Experience, Primary Care
Schoenfeld EM, Kanzaria HK, Quigley DD
Patient preferences regarding shared decision making in the emergency department: findings from a multisite survey.
In this study, the investigators sought to determine patients' desired level of involvement in medical decisions and their perceptions of potential barriers and facilitators to shared decision making in the emergency department (ED). They found that the majority of ED patients wanted to be involved in medical decisions, especially in the case of a "serious" medical problem, and felt that they had the ability to do so. Nevertheless, many patients were unlikely to actively seek involvement and defaulted to allowing the physician to make decisions during the ED visit.
AHRQ-funded; HS025701.
Citation: Schoenfeld EM, Kanzaria HK, Quigley DD .
Patient preferences regarding shared decision making in the emergency department: findings from a multisite survey.
Acad Emerg Med 2018 Oct;25(10):1118-28. doi: 10.1111/acem.13499..
Keywords: Clinician-Patient Communication, Decision Making, Emergency Department, Patient and Family Engagement, Patient Experience
Leyenaar JK, Rizzo PA, O'Brien ER
Paediatric hospital admission processes and outcomes: a qualitative study of parents' experiences and priorities.
The investigators aimed to characterize, among children hospitalised with ambulatory care sensitive conditions, families' experiences as they transitioned from outpatient to inpatient care, identify hospital admission processes and outcomes most important to families and determine how parental perspectives differed between children admitted directly and through emergency departments (ED). They conducted semistructured interviews with parents of hospitalised children at four structurally diverse hospitals.
AHRQ-funded; HS024133.
Citation: Leyenaar JK, Rizzo PA, O'Brien ER .
Paediatric hospital admission processes and outcomes: a qualitative study of parents' experiences and priorities.
BMJ Qual Saf 2018 Oct;27(10):790-98. doi: 10.1136/bmjqs-2017-007442..
Keywords: Children/Adolescents, Hospitalization, Patient Experience, Patient-Centered Outcomes Research, Children/Adolescents
Barnett ML, Clark KL, Sommers BD
State policies and enrollees' experiences in Medicaid: evidence from a new national survey.
This study examined patient satisfaction among Medicaid enrollees nationally from 2014-2015. Significant disparities were found among racial/ethnic groups. Managed care enrollees had higher satisfaction ratings than those with fee-for-service. If the patient had a personal doctor that increased satisfaction for an average 4.6 percent.
AHRQ-funded; HS021291.
Citation: Barnett ML, Clark KL, Sommers BD .
State policies and enrollees' experiences in Medicaid: evidence from a new national survey.
Health Aff 2018 Oct;37(10):1647-55. doi: 10.1377/hlthaff.2018.0505..
Keywords: Access to Care, Disparities, Medicaid, Patient Experience, Policy, Racial and Ethnic Minorities
Roydhouse JK, Gutman R, Keating NL
The association of proxy care engagement with proxy reports of patient experience and quality of life.
The purpose of this study was to assess the association of proxy-specific covariates with proxy-reported patient cancer care experience, quality rating, and quality of life. The investigators concluded that collecting data on proxy engagement in care is warranted if proxy responses are used.
AHRQ-funded; HS000011.
Citation: Roydhouse JK, Gutman R, Keating NL .
The association of proxy care engagement with proxy reports of patient experience and quality of life.
Health Serv Res 2018 Oct;53(5):3809-24. doi: 10.1111/1475-6773.12980..
Keywords: Cancer, Patient Experience, Patient and Family Engagement, Quality of Life
Davis MM, Gunn R, Gowen LK
A qualitative study of patient experiences of care in integrated behavioral health and primary care settings: more similar than different.
In this study, the authors examined, using qualitative methods, patients' experiences of care in integrated settings. The study included 24 patients receiving care across five practices participating in Advancing Care Together (ACT)-a 4-year demonstration project (2010-2014) of primary care and community mental health centers (CMHCs) integrating care. The investigators found that patients in both primary care and CMHCs perceived similar benefits from integrated care related to personal growth, improved quality, and access to care.
AHRQ-funded; HS022981.
Citation: Davis MM, Gunn R, Gowen LK .
A qualitative study of patient experiences of care in integrated behavioral health and primary care settings: more similar than different.
Transl Behav Med 2018 Sep 8;8(5):649-59. doi: 10.1093/tbm/ibx001..
Keywords: Community-Based Practice, Healthcare Delivery, Behavioral Health, Patient Experience, Primary Care
Gonzalez CM, Deno ML, Kintzer E
Patient perspectives on racial and ethnic implicit bias in clinical encounters: implications for curriculum development.
Patients describe feelings of bias and prejudice in clinical encounters; however, their perspectives on restoring the encounter, once bias is perceived, are not known. In order to inform the design of novel patient-centered curricular interventions, this study explored patients' perceptions of bias, and suggestions for restoring relationships if bias was perceived. The investigators concluded that participant lived experience and physician behaviors influence perceptions of bias, however clinical relationships can be restored following perceived bias.
AHRQ-funded; HS023199.
Citation: Gonzalez CM, Deno ML, Kintzer E .
Patient perspectives on racial and ethnic implicit bias in clinical encounters: implications for curriculum development.
Patient Educ Couns 2018 Sep;101(9):1669-75. doi: 10.1016/j.pec.2018.05.016..
Keywords: Racial and Ethnic Minorities, Disparities, Education: Patient and Caregiver, Patient Experience
Poon BY, Shortell S, Rodriguez HP
Physician practice transitions to system ownership do not result in diminished practice responsiveness to patients.
The purpose of this study was to examine the extent to which physician-to-system ownership transitions were associated with declines in practice-reported patient responsiveness (PRPR). Data were collected from three nationally representative surveys of physician organizations - the National Survey of Large Physician Organizations/National Survey of Small- and Medium-Sized Physician Organizations and the National Survey of All-Size Physician Organizations - consisting of 40-minute interviews with medical directors, presidents, or chief executive officers. Multivariable regression estimated the effect of ownership on changes in PRPR, controlled for practice size, specialty composition, and market characteristics. The study results showed that practices that switched to system ownership did not have significantly lower PRPR at baseline, when compared to practices that were continuously physician-owned, but continuously system-owned practices did. Transitions to system ownership were associated with increased PRPR when compared to continuously physician ownership. Increased practice size and changes in specialty composition were associated with diminished PRPR.
AHRQ-funded; HS024075.
Citation: Poon BY, Shortell S, Rodriguez HP .
Physician practice transitions to system ownership do not result in diminished practice responsiveness to patients.
Health Serv Res 2018 Aug;53(4):2268-84. doi: 10.1111/1475-6773.12804.
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Keywords: Healthcare Delivery, Health Systems, Patient Experience
Meyerhoefer CD, Sherer SA, Deily ME
Provider and patient satisfaction with the integration of ambulatory and hospital EHR systems.
This study examined how the installation of an ambulatory EHR at OB/GYN practices and its subsequent interface with an inpatient perinatal EHR affected providers' satisfaction with the transmission of clinical information and patients' ratings of their care experience. The study concluded that dissatisfaction of providers with an EHR system and difficulties incorporating EHR technology into patient care may negatively impact patient satisfaction.
AHRQ-funded; HS018649.
Citation: Meyerhoefer CD, Sherer SA, Deily ME .
Provider and patient satisfaction with the integration of ambulatory and hospital EHR systems.
J Am Med Inform Assoc 2018 Aug;25(8):1054-63. doi: 10.1093/jamia/ocy048..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Experience, Patient Experience, System Design
Quigley DD, Elliott MN, Setodji CM
Quantifying magnitude of group-level differences in patient experiences with health care.
The purpose of this paper is to review approaches for assessing magnitude of differences in patient experience scores between different providers. The authors suggest routine estimation of magnitude in patient experience research. More work is needed documenting magnitude of differences between providers to make patient experience data more interpretable and usable.
AHRQ-funded; HS016980.
Citation: Quigley DD, Elliott MN, Setodji CM .
Quantifying magnitude of group-level differences in patient experiences with health care.
Health Serv Res 2018 Aug;53 Suppl 1:3027-51. doi: 10.1111/1475-6773.12828..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Health Services Research (HSR), Patient Experience, Patient Experience, Quality Measures
Schoenfeld EM, Goff SL, Downs G
A qualitative analysis of patients' perceptions of shared decision making in the emergency department: "let me know i have a choice.".
In this study, the investigators sought to explore the use of shared decision making (SDM) from the perspectives of emergency department (ED) patients, focusing on what affects patients' desired level of involvement and what barriers and facilitators patients found most relevant to their experience. The investigators concluded that this exploration suggested that most patients wanted some degree of involvement in medical decision making but more proactive engagement of patients by clinicians was often needed.
AHRQ-funded; HS024311.
Citation: Schoenfeld EM, Goff SL, Downs G .
A qualitative analysis of patients' perceptions of shared decision making in the emergency department: "let me know i have a choice.".
Acad Emerg Med 2018 Jul;25(7):716-27. doi: 10.1111/acem.13416.
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Keywords: Clinician-Patient Communication, Decision Making, Emergency Department, Patient and Family Engagement, Patient Experience
Parast L, Burkhart Q, Gidengil C
Validation of new care coordination quality measures for children with medical complexity.
The purpose of this paper was to validate new caregiver-reported quality measures assessing care coordination services for children with medical complexity (CMC). Results showed that 19 newly-developed Family Experiences with Coordination of Care quality measures demonstrated convergent validity with previously-validated CAHPS measures. These new measures are valid for assessing the quality of care coordination services provided to CMC and may be useful for evaluating new models of care focused on improving these services.
AHRQ-funded; HS020506.
Citation: Parast L, Burkhart Q, Gidengil C .
Validation of new care coordination quality measures for children with medical complexity.
Acad Pediatr 2018 Jul;18(5):581-88. doi: 10.1016/j.acap.2018.03.006..
Keywords: Care Coordination, Children/Adolescents, Chronic Conditions, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Quality Indicators (QIs), Quality Measures, Quality Improvement, Quality of Care
Martinez M, Thomas KC, Williams CS
Family experiences with the diagnosis of autism spectrum Disorder: system barriers and facilitators of efficient diagnosis.
This paper examines family experiences with the efficiency of Autism Spectrum Disorder diagnosis. Screening, travel distance, and delay in diagnosis were associated with shifting diagnoses and being told child did not have ASD. Physician and parent training in communication and addressing mental health professional shortages and maldistribution may improve the diagnosis experiences of families of children with ASD.
AHRQ-funded; HS000032.
Citation: Martinez M, Thomas KC, Williams CS .
Family experiences with the diagnosis of autism spectrum Disorder: system barriers and facilitators of efficient diagnosis.
J Autism Dev Disord 2018 Jul;48(7):2368-78. doi: 10.1007/s10803-018-3493-1..
Keywords: Autism, Children/Adolescents, Diagnostic Safety and Quality, Patient-Centered Healthcare, Patient Experience
Al Danaf J, Chang BH, Shaear M
Surfacing and addressing hospitalized patients' needs: proactive nurse rounding as a tool.
This paper reported on rounding interventions employed at high performing hospitals, and provided three case studies on how proactive nurse rounding was successfully implemented to improve patient-centredness. The investigators concluded that proactive rounding interventions are a feasible approach to help surface and address hospitalized patients' needs in a timely manner.
AHRQ-funded; HS021921.
Citation: Al Danaf J, Chang BH, Shaear M .
Surfacing and addressing hospitalized patients' needs: proactive nurse rounding as a tool.
J Nurs Manag 2018 Jul;26(5):540-47. doi: 10.1111/jonm.12580..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Hospitalization, Hospitals, Inpatient Care, Nursing, Patient-Centered Healthcare, Patient Experience, Quality Improvement
Bardach NS, Burkhart Q, Richardson LP
Hospital-based quality measures for pediatric mental health care.
The objective of this study was to develop and test medical record-based measures used to assess quality of pediatric mental health care in the emergency department (ED) and inpatient settings. The investigators drafted an evidence-based set of pediatric mental health care quality measures for the ED and inpatient settings and used them to identify sex and race disparities and substantial hospital variation.
AHRQ-funded; HS020506.
Citation: Bardach NS, Burkhart Q, Richardson LP .
Hospital-based quality measures for pediatric mental health care.
Pediatrics 2018 Jun;141(6). doi: 10.1542/peds.2017-3554..
Keywords: Cancer, Caregiving, Children/Adolescents, Clinician-Patient Communication, Communication, Decision Making, Diagnostic Safety and Quality, Patient Experience, Patient and Family Engagement
Aysola J, Schapira MM, Huo H
Organizational processes and patient experiences in the patient-centered medical home.
The objective of this study was to examine associations between organizational processes that practices adopt to become patient-centered medical home (PCMH) and patient experiences with care. The researchers concluded that although some organizational processes related to patients' experiences with care irrespective of the background of the patient, further efforts are needed to align practice efforts with patient experience.
AHRQ-funded; HS021706.
Citation: Aysola J, Schapira MM, Huo H .
Organizational processes and patient experiences in the patient-centered medical home.
Med Care 2018 Jun;56(6):497-504. doi: 10.1097/mlr.0000000000000910.
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Keywords: Patient-Centered Healthcare, Patient Experience, Primary Care: Models of Care, Primary Care
Nuckols TK, Conlon C, Robbins M
Quality of care and patient-reported outcomes in carpal tunnel syndrome: a prospective observational study.
This prospective observational study examined the association of higher quality care for carpal tunnel syndrome (CTS) with better outcomes. Adults diagnosed with CTS from 30 occupational health centers were recruited and their physicians' adherence to recommended care processes evaluated. Among 343 individuals, receiving better was associated with greater improvements. CTS symptoms showed greater improvement when physicians assessed and managed patient activity, when patients underwent necessary surgery, and when employers adjusted job tasks. The researchers conclude that efforts should be made to ensure patients with CTS receive essential care processes, including activity assessment and management as well as necessary surgery.
AHRQ-funded; HS018982.
Citation: Nuckols TK, Conlon C, Robbins M .
Quality of care and patient-reported outcomes in carpal tunnel syndrome: a prospective observational study.
Muscle Nerve 2018 Jun;57(6):896-904. doi: 10.1002/mus.26041..
Keywords: Neurological Disorders, Outcomes, Patient Experience, Patient-Centered Outcomes Research, Quality of Care
Hatfield LA, Zaslavsky AM
Separable covariance models for health care quality measures across years and topics.
Public quality reports for Medicare Advantage health plans include 11 measures of patient experiences reported in the annual Consumer Assessment of Healthcare Providers and Systems surveys. To summarize associations among measures and years, the authors model the variance-covariance matrix governing the plan-level vectors of yearly quality measures as a Kronecker product of an across-measure matrix and an across-year matrix, or a sum of such Kronecker products.
AHRQ-funded; HS016978.
Citation: Hatfield LA, Zaslavsky AM .
Separable covariance models for health care quality measures across years and topics.
Stat Med 2018 May 30;37(12):2053-66. doi: 10.1002/sim.7656..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality Measures, Quality of Care, Patient Experience, Medicare
DuGoff EH
Continuity of care in older adults with multiple chronic conditions: how well do administrative measures correspond with patient experiences?
The objective of this study was to assess the concordance of administrative continuity indices and patient reports of continuity among older adults with multiple chronic conditions (MCCs). The investigators concluded that among older adults with two or more conditions, the Usual Provider of Care Index was not associated with any patient experience measure; Continuity of Care Index was associated with informational and management continuity items.
AHRQ-funded; HS000029.
Citation: DuGoff EH .
Continuity of care in older adults with multiple chronic conditions: how well do administrative measures correspond with patient experiences?
J Healthc Qual 2018 May/Jun;40(3):120-28. doi: 10.1097/jhq.0000000000000051..
Keywords: Patient Experience, Chronic Conditions, Elderly
Lyndon A, Malana J, Hedi LC
Thematic analysis of women's perspectives on the meaning of safety during hospital-based birth.
This study used an interdisciplinary team of five investigators to examine women’s birth experiences in the perspective of patient safety. Five investigators in the fields of nursing, medicine, product design, and journalism analyzed transcripts to see how women felt about their physical or emotional safety during birth, and to identify opportunities for improvement in care. Teams that were well-organized promoted feelings of safety as well as human connection.
AHRQ-funded; HS023506.
Citation: Lyndon A, Malana J, Hedi LC .
Thematic analysis of women's perspectives on the meaning of safety during hospital-based birth.
J Obstet Gynecol Neonatal Nurs 2018 May;47(3):324-32. doi: 10.1016/j.jogn.2018.02.008..
Keywords: Labor and Delivery, Pregnancy, Women, Patient Safety, Patient Experience
Shaffer VA, Focella ES, Hathaway A
On the usefulness of narratives: an interdisciplinary review and theoretical model.
This article addresses the questions: How can stories from other people be used to promote better health experiences, improve judgments about health, and increase the quality of medical decisions without introducing bias, persuading listeners to change their attitudes or altering behaviors? Should narratives be used in health education, promotion, or behavior change interventions? Researchers conducted a review of literature on narratives from several disciplines to gain a better understanding about what narratives do, including their roles in communication, engagement, recall, persuasion, and health behavior change. Broad theories about information processing and persuasion from psychology and models about narrative messaging found in the health communication and marketing literature were also reviewed to provide insight into the processes by which narratives have their effect on health behavior. The researchers conclude there are important communication gaps in areas of behavioral medicine that could be addressed with narratives, but more work is needed to employ narrative messaging systematically.
AHRQ-funded; HS021681; HS023328.
Citation: Shaffer VA, Focella ES, Hathaway A .
On the usefulness of narratives: an interdisciplinary review and theoretical model.
Ann Behav Med 2018 Apr 19;52(5):429-42. doi: 10.1093/abm/kax008..
Keywords: Clinician-Patient Communication, Communication, Decision Making, Patient Experience, Patient and Family Engagement