Implementing Ask Me 3(tm) to Improve African American Patient Satisfaction and Perceptions of Physician Cultural Competency
Michalopoulou, Georgia, Falzarano, Pamela, Arfken, Cynthia, Rosenberg, David, Journal of Cultural Diversity
Abstract: Objective: Improve African American patient satisfaction and perceptions of physician cultural competency through the implementation of Ask Me 3(TM) pamphlet which encourages patients to ask questions of physicians. Methods: Intervention participants received the pamphlet prior to their visit with the physician. Analysis evaluated differences in patient satisfaction and perceptions of physician cultural competency between intervention participants and controls. Results: Intervention participants who saw their regular physician reported higher satisfaction. All found the questions to be helpful and reported knowing more about their medical condition or illness after the visit. Conclusions: The Ask Me 3(TM) pamphlet is a low cost and logistically feasible tool that could be readily implemented in medical settings to facilitate physician-patient interaction. Improved satisfaction with the visit was found when the pamphlet was implemented during visits with a regular physician. Thus, our research findings suggest implementation of the Ask Me 3(TM) pamphlet has the potential to improve health care behaviors and health outcomes and may ultimately lead to a reduction in health care disparities.
Key Words: Cultural Competency, Physician-Patient Relationship, Communication, Patient-centered Care, Ask Me 3(TM)
Differences in cultural values and beliefs between physicians and African American patients account for many misunderstandings in health interactions. Cultural differences affect satisfaction with the medical encounter, influence patient health behaviors and health practices, and ultimately impact decisions of patients to adhere or not to adhere to treatment protocols (Ahmed, 2007; Berger, 1998; Betancourt, Green, Carrillo, & Park, 2005; Cline & Mckenzie, 1998; Turnbull & Mui, 1995). When cultural differences are not acknowledged, poor health outcomes arise.
Health care studies addressing these health disparities have highlighted the need for culturally sensitive and appropriate care. As a result, the development of cultural competency training initiatives has emerged. Physicians have been assigned the primary responsibility of learning to manage complex differences in communication styles, attitudes, behaviors, and worldviews in their everyday encounters with culturally different patients (Betancourt, Green, Carrillo, & Ananeh-Firempong, 2003; Betancourt et al., 2005; Culhane-Pera, Reif, Egli, Baker, & Kassekert, 1997; Like, 1996; Narayan, 2001).
Recent studies have shown, however, that culturally sensitive care is not only dependent on the "sensitivity" of physicians, it also hinges on the development of congruence between the needs of patients to relate information regarding their illness and the needs of physicians to listen, diagnose the problem, and prescribe appropriate treatment options (Ashton, Haidet, Paterniti, Collins, Gordon, O'Malley, Petersen, Sharf, Suarez-Almazor, Wray, & Street, 2003; Perloff, Bonder, Ray, Ray, & Siminoff, 2006). The communicative behaviors of patients such as, providing a health narrative, asking questions, expressing concerns, and being assertive, influence the behavior of physicians and the events of the visit (Ashton, et al., 2003; Street, 2001). Patients who ask more questions and express more concerns receive more information from physicians (Ashton et al., 2003; Greenfield, Kaplan, & Ware, 1985; Street, 1992; Street, 1991). Similarly, patients who participate actively in the medical interaction are better able to recall what the physician recommended and what health issues were discussed (Ashton et al., 2003; Carter, Inui, Kukull, & Haigh, 1982; Heszen-Klemens & Lapinska, 1984). Physicians perceive patients who state their concerns and ask questions as better communicators (Ashton et al., 2003; Frederikson & Bull, 1995; Merkel, 1984). When patients are actively engaged in the interaction, physicians can better assess the needs of their patients and the extent to which they are satisfying or meeting those needs, (Ashton et al. …