Willingness to Communicate about Health as an Underlying Trait of Patient Self-Advocacy: The Development of the Willingness to Communicate about Health (WTCH) Measure

Article excerpt

Introduction

Provider-patient communication traditionally has been characterized as an asymmetric relationship in which providers exert more power and control over the interaction in comparison to patients (Ballard-Reisch, 1990; Brashers, Haas, & Neidig, 1999). In recent years, however, health communication scholars, medical researchers, and health care practitioners have examined the benefits of patient empowerment through the practice of collaborative communication between providers and patients. This approach involves open discussion between patients and providers about health concerns and opportunities for mutual problem solving and decision making when discussing patient cases and treatment options (Balint & Shelton, 1996; Levinson et al., 1999; Young & Flower, 2002). Collaborative communication has been linked to greater satisfaction with medical encounters, better adherence to treatments, and positive health outcomes, such as reduced stress, pain, and symptom distress (see Brown, Stewart, & Ryan, 2003; Golin, DiMatteo, & Gelberg, 1996; Greenfield, Kaplan, & Ware, 1985).

In order for these benefits to accrue, people must take a more active role and engage in self-advocacy during interactions with their health-care providers. Patient self-advocacy can be defined as representing one's own interests within the healthcare decision-making process (Brashers et al., 1999; Brashers & Klingle, 1992). According to Brashers et al. (1999) patient self-advocacy demands three characteristics on the part of those seeking health care. First, people must have relevant medical knowledge to participate in making decisions about their health. Second, people need to be assertive to a certain degree with their health care providers in terms of initiating topics, seeking clarification, and questioning suggested treatment recommendations. Third, people must sometimes be willing to challenge their health care providers when they feel that the treatments suggested are insufficient or incompatible with their needs.

Patient self-advocacy rests on the assumption that people are willing to discuss health issues. However, as in other contexts of communication, where people vary in their willingness to communicate about topics in general (see McCroskey & Richmond, 1998), there is evidence that individuals vary in their willingness to communicate about health issues (see Brashers et al., 1999; Gotcher & Edwards, 1990; Morgan & Miller, 2002; Smith, Kopfman, Massi-Lindsey, Yoo, & Morrison, 2004). Moreover, physicians often ignore their patients' questions and concerns, forcing patients to be even more assertive if they intend to meet their needs in these situations (Beisecker, 1990). In such situations, those who are unwilling to communicate with their health care providers may suffer more.

In addition, there are many other situations where people communicate about their health with other providers and medical staff, family and friends, and other people with similar health care needs, such as in support groups (Smith et al., 2004; Wright & Frey, in press). These relationships are also important sources of health information for people, yet health issues are often difficult topics for people to discuss due to the social stigma attached to some diseases and conditions (e.g., HIV, AIDS, mental illness, and alcoholism) and the potentially embarrassing information about one's body that can come up in conversations about health, among other reasons (see DiMatteo & Hays, 1981; Gotcher & Edwards, 1990).

Given the importance of patient empowerment and self-advocacy, there is a need to explore underlying traits, such as willingness to communicate about health. Given the significance of the communication trait of willingness to communicate in other contexts and within the health care context, in particular, the purpose of this study was to develop a measurement instrument to assess people's willingness to communicate about their health and to see how this communication predisposition might be related to health information-seeking behaviors and patient assertiveness. …