Impact, barriers and facilitators of the ‘Ask Me 3’ Patient Communication Intervention in a primary care center in Barcelona, Spain: a mixed-methods analysis

Main Article Content

Raluca Oana Groene
Ignasi Bolíbar
Carlos Brotons

Abstract

Introduction: The study aims at assessing the effectiveness of the "Ask Me 3" intervention in increasing the empowerment of patients, while identifying barriers and facilitators to its implementation in primary care.Methods: The study combined quantitative and qualitative methodologies. The quantitative component employed a quasi-experimental design in which participants were assigned to either the Ask me 3 intervention or a control group. Qualitatively, all patients responded after the medical consultation to a questionnaire where empowerment was assessed through the Patient Enablement Instrument. Subsequently, a focus group with patients and another with medical doctors were conducted to identify barriers and facilitators of the Ask me 3 intervention. A content thematic analysis based on literal transcriptions identified barriers and facilitators of Ask me 3.Results: Overall, empowerment levels were low, especially in women and older patients, but higher in people with low health literacy. Adjusted patients’ level of empowerment was significantly higher in the intervention than in the control group (OR = 3.59; CI: 1.53-8.42). The intervention did not extend the duration of the medical consultation.Conclusion and practical implications: Even a simple intervention such as Ask me 3 can contribute to an increase in patients’ level of empowerment. Question-asking interventions have the potential to increase patients’ control over decisions affecting their health and are therefore important instruments for the advancement of person-centered healthcare.

Article Details

Section
Regular Articles

References

Cegala, D.J. & Post, D.M. (2009). The impact of patients' participation on physicians' patient-centered communication. Patient Education and Counseling 77 (2) 202-208.

Epstein, R.M., Alper, B.S. & Quill, T.E. (2004). Communicating evidence for participatory decision making. Journal of the American Medical Association 291 (19) 2359-2366.

Entwistle, V.A., Watt, I.S., Gilhooly, K., Bugge, C., Haites, N. & Walker, A.E. (2004). Assessing patients' participation and quality of decision-making: insights from a study of routine practice in diverse settings. Patient Education and Counseling 55 (1) 105-113.

Roter, D.L. (1977). Patient participation in the patient-provider interaction: the effects of patient question asking on the quality of interaction, satisfaction and compliance. Health Education Monographs 5 (4) 281-315.

Butow, P.N., Dunn, S.M. & Tattersall, M.H. (1995). Communication with cancer patients: does it matter? Journal of Palliative Care 11 (4) 34-38.

Brugge, D., Edgar, T., George, K., Heung, J. & Laws, M.B. (2009). Beyond literacy and numeracy in patient provider communication: focus groups suggest roles for empowerment, provider attitude and language. BMC Public Health 9, 354.

Peek, M.E., Wilson, S.C., Gorawara-Bhat, R., Odoms-Young, A., Quinn, M.T. & Chin, M.H. (2009). Barriers and facilitators to shared decision-making among African-Americans with diabetes. Journal of General Internal Medicine 24 (10) 1135-1139.

Virtanen, H., Leino-Kilpi, H. & Salantera, S. (2007). Empowering discourse in patient education. Patient Education and Counseling 66 (2) 140-146.

Kinnersley, P., Edwards, A., Hood, K., Ryan, R., Prout, H., Cadbury, N., MacBeth, F., Butow, P. & Butler, C. (2008). Interventions before consultations to help patients address their information needs by encouraging question asking: systematic review. British Medical Journal 337, a485.

Harrington, J., Noble, L.M. & Newman, S.P. (2004). Improving patients' communication with doctors: a systematic review of intervention studies. Patient Education and Counseling 52 (1) 7-16.

Coughlan, D., Byrne, S. & Sahm, L. (2009). Why pharmacists should encourage their patients to adopt 'Ask me 3'. The Pharmaceutical Journal 2, 283-330.

Fine, M., Torre, M.E., Boudin, K. et al. (2003). Participatory action research: Within and beyond bars. In: Qualitative research in psychology: expanding perspectives in methodology and design (eds. Camic, P.M., Rhodes, J.E. & Yardley, L.,), pp. 173–198. Washington, DC: American Psychological Association.

Marshall, C. (1990). Designing qualitative research. Newbury Park, CA: Sage.

Ožvačić Adžić, Z., Katić, M., Kern, J., Lazić, D., Cerovečki Nekić, V. & Soldo, D. (2008). Patient, physician, and practice characteristics related to patient enablement in general practice in Croatia: cross-sectional survey study. Croatian Medical Journal 49 (6) 813-823.

Howie, J.G., Heaney, D.J., Maxwell, M. & Walker, J.J. (1998). A comparison of a Patient Enablement Instrument (PEI) against two established satisfaction scales as an outcome measure of primary care consultations. Family Practice 15 (2) 165-171.

Beaton, D.E., Bombardier, C., Guillemin, F. & Ferraz, M.B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 25 (24) 3186-3191.

Morris, N.S., MacLean, C.D., Chew, L.D. & Littenberg, B. (2006). The Single Item Literacy Screener: evaluation of a brief instrument to identify limited reading ability. BMC Family Practice 7, 21.

Tong, A., Sainsbury, P. & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal of Quality in Health Care 19 (6) 349-357.

Miller, M.J., Abrams, M.A., McClintock, B., Cantrell, M.A., Dossett, C.D., McCleeary, E.M., McGee, M.J., O'Keefe, K.J. & Sager, E.R. (2008). Promoting health communication between the community-dwelling well-elderly and pharmacists: the Ask Me 3 program. Journal of the American Pharmacists Association 48 (6) 784-792.

Galliher, J.M., Post, D.M., Weiss, B.D., Dickinson, L.M., Manning, B.K., Staton, E.W., Brown, J.B., Hickner, J.M., Bonham, A.J., Ryan, B.L. & Pace, W.D. (2010). Patients' question-asking behavior during primary care visits: a report from the AAFP National Research Network. Annals of Family Medicine 8 (2) 151-159.

Jovell, A.J., Navarro Rubio, M.D., Fernandez Maldonado, L. & Blancafort, S. (2006). Involvement of the patient: the new role of patients in the health system. Atencion Primaria 38 (4) 234-237.

Michalopoulou, G., Falzarano, P., Arfken, C. & Rosenberg, D. (2010). Implementing Ask Me 3 to improve African American patient satisfaction and perceptions of physician cultural competency. Journal of Cultural Diversity 17 (2) 62-67.

Wilson, A. & Childs, S. (2006). The effect of interventions to alter the consultation length of family physicians: a systematic review. British Journal of General Practice 56 (532) 876-882.

Wilkinson, C. (1989). Time to let the patient speak. British Medical Journal 298 (6670) 389.

Brown, R., Butow, P.N., Boyer, M.J. & Tattersall, M.H. (1999). Promoting patient participation in the cancer consultation: evaluation of a prompt sheet and coaching in question-asking. British Journal of Cancer 80 (1-2) 242-248.

Nutbeam, D. (2000). Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International 15 (3) 259-267.

Newton, P., Sasha, S. & Koula, A. (2011). Marrying contradictions: Healthcare professionals perceptions of empowerment in the care of people with Type 2 Diabetes. Patient Education and Counseling 85 (3) e326-329.

Arthur, S.A., Geiser, H.R., Arriola, K.R. & Kripalani, S. (2009). Health literacy and control in the medical encounter: a mixed-methods analysis. Journal of the National Medical Association 101 (7) 677-683.

Kirkegaard, P., Edwards, A.G., Hansen, B., Hansen, M.D., Jensen, M.S., Lauritzen, T., Risoer, M.B. & Thomsen, J.L. (2010). The RISAP-study: a complex intervention in risk communication and shared decision-making in general practice. BMC Family Practice 11, 70.

Pawlikowska, T.R., Walker, J.J., Nowak, P.R. & Szumilo-Grzesik, W. (2010). Patient involvement in assessing consultation quality: a quantitative study of the Patient Enablement Instrument in Poland. Health Expectations 13 (1) 13-23.

Howie, J.G., Heaney, D.J. & Maxwell, M. (1997). Measuring quality in general practice. Pilot study of a needs, process and outcome measure. Occasional Paper (Royal College of General Practitioners) 75, i-xii 1-32.

Lam, C.L., Yuen, N.Y., Mercer, S.W. & Wong, W. (2010). A pilot study on the validity and reliability of the Patient Enablement Instrument (PEI) in a Chinese population. Family Practice 27 (4) 395-403.