The effect of health care provider persuasive strategy on patient compliance and satisfaction

American Journal of Health Studies, Spring-Summer, 2003 by Carrie J. Cropley

Abstract: This study hypothesized that both female and male health providers would elicit the greatest patient/consumer satisfaction when using "pro-social" compliance gaining strategies. Female providers were expected to be less likely than male providers to gain patient compliance and satisfaction when using verbal strategies that appear more negative, or anti-social. The participants consisted of 180 undergraduate students at a large western university. Results indicated that a combination of positive regard followed by negative regard after noncompliance elicited the greatest patient satisfaction for both male and female providers. These results suggest that gender stereotypes are not as prevalent in provider-patient communication as they may be in other communication contexts due the to relative power and status relationships between a provider and patient. In addition, patients may prefer a negative reaction from the provider after admitting to noncompliance because it confirms their expectations and may be perceived as provider concern for the patient.

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Although health communication covers a wide range of topics, a central focus of the literature is provider-patient communication, specifically, issues involving patient compliance and patient satisfaction. Patient compliance is defined as "the extent to which patients follow clinical prescriptions" (Burgoon, Bark, & Hall, 1991, p. 178) and includes all types of behavior and behavior modifications recommended by a doctor for the purpose of helping, curing or preventing various medical problems. Patient satisfaction is less easily defined, as it is highly dependent upon what the patient considers satisfying.

Understanding the behaviors that lead to both patient compliance and patient satisfaction could be the key to experiencing medical encounters with more positive outcomes for both the patient and the provider. Clearly most health care providers hope that their patients comply with the treatment prescribed. Equally, patients desire to be treated in a way that leaves them satisfied with the experience. However, investigations regarding the provider-patient relationship over the past 50 years have resulted in little consensus, establishing the need for more research in this area.

Recent estimates indicate that anywhere from 46% to 62% of patients fail to comply with drug regimens (Burgoon et al., 1991). Specifically, compliance rates for such ailments as diabetes, hypertension and asthma range from only 30-50% (O'Brien & McLellan, 1996). Such drastic numbers lead to the conclusion that "noncompliance is the most significant problem facing medicine today" (Eraker, Kirscht, & Becker, 1984, p. 259).

Most current researchers agree that provider communication has the potential to significantly increase patient compliance. In a study on compliance with mammogram referrals, Fox, Siu and Stein (1994) found that compared to other variables such as age, race and medical history, "Only the communication variables significantly predicted a recent mammogram" (p. 2,058) to such an extent that "Women whose physicians discussed mammography with some or a great deal of enthusiasm were over four and a half times more likely to report having had a mammogram in the previous year than women whose physicians had little or no enthusiasm" (p. 2,063).

The extent of a providers responsibility for patient compliance is an area of heated debate in health communication literature, and has resulted in various perspectives ranging from paternalistic to deliberative. Regardless of the perspectives implemented in their practices, doctors as a group are clearly an important force behind the health status of the country in which they practice. Whether their motives are money, prestige, or benevolence, it is largely the work of providers that leads to the control and prevention of disease. Patient noncompliance can be seen, to some extent, as counterproductive to medical progress. As suggested by Ley (1988) and Farberow (1986), "In economic terms, the expense of noncompliance is staggering ... in human terms, the expense is tragic."

Aimed at highlighting those behaviors that constitute a successful medical encounter, this study is guided by the premise that compliance-gaining and patient satisfaction should be accorded the same stature as goals in provider-patient interactions. Based on the reinforcement expectancy approach, independent strategies that are likely to increase patient compliance and those that are likely to increase satisfaction will be examined, with the view that both satisfaction and compliance are necessary ingredients for a successful, ethical, and mutually beneficial medical encounter.

PATIENT COMPLIANCE

Research addressing patient compliance originally focused on patient-centered explanations for noncompliance such as patients' age, sex, intelligence and severity of illness. More recently, researchers have concluded that there is no single patient attribute that determines or predicts patient compliance (Hanson, 1986; Burgoon & Burgoon, 1990; Burgoon et al., 1991; Fox et al., 1994). A recent re-conceptualization of noncompliance has thus shifted the research focus to the behaviors of health care providers as one of the main predictors of patient behavior (Burgoon et al., 1991; Klingle & Burgoon, 1995; Klingle, 1996).