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Patient compliance and satisfaction with physicianinfluence attempts: A reinforcement expectancy
approach to compliance-gaining over time.
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Patient compliance and satisfaction with physician influence attempts: A reinforcement expectancy approach to compliance-gaining over time
Klingle, Renee Storm, Ph.D.
The University of Arizona, 1994
U·M·I 300 N. Zeeb Rd. Ann Arbor, MI48106
Patient Compliance and Satisfaction with Physician Influence Attempts:
A Reinforcement Expectancy Approach to Compliance-gaining Over Time
by
Renee Storm Klingle
A Dissertation Submitted to the Faculty of the
DEPARTMENT OF COMMUNICATION
In Partial Fulfillment of the Requirements For the Degree of
DOCTOR OF PHILOSOPHY
In the Graduate College
THE UNIVERSITY OF ARIZONA
1994
THE UNIVERSITY OF ARIZONA GRADUATE COLLEGE
2
As members of the Final Examination Committee, we certify that we have
read the dissertation prepared by Renee Storm Klingle
entitled Patient Compliance and Satisfaction with Physician Influence
Attempts: A Reinforcement Expectancy Approach to Compliance-
gaining OVer Time
and recommend that it be accepted as fulfilling the dissertation
requirement for the Degree of Doctor of Philosophy
a~-= .. ~.
&A<I&l Date' P
h-l),o/u Date
Date' 7
1)00/93 Date I I
/2/:zc:0?2 Date7
Final approval and acceptance of this dissertation is contingent upon the candidate's submission of the final copy of the dissertation to the Graduate College.
I hereby certify that I have read this dissertation prepared under my direction and recommend that it be accepted as fulfilling the dissertation
re~t/~
D~47===- (.~(/b
3
STATEMENT BY AUTHOR
This dissertation has been submitted in partial fulfillment of requirements for an advanced degree at The University of Arizona and is deposited in the University Library to be made available to borrowers under rules of the Library.
Brief quotations from this dissertation are allowable without special permission, provided that accurate acknowledgment of source is made. Requests for permission for extended quotation from or reproductions of this manuscript in whole or in part may be granted by the head of the major department or the Dean of the Graduate College when in his or her judgement the proposed use of the material is in the interests of scholarship. In all other instances, however, permission must be obtained from the author.
SIGNED: Ciif ~
ACKNOWLEDGEMENTS
It is a pleasure to finally acknowledge those who have allowed me to reach the completion of my degree.
4
Michael Burgoon's hands-off approach to advising has allowed me to grow tremendously as a scholar and has facilitated my abilities to work indepenrlently. His willingness to listen rather than quickly offer advice enriched my capabilities to think clearly and carefully critique my own work. Judee Burgoon's insights and careful attention to the details in this project forced me to clarify my thinking. Judee's Willingness to assist me as I pursued my degree have always gone well beyond the call of duty for a graduate director, professor, and committee member. I am eternally grateful for her willingness to loan her personal computer for more than a years worth of data collection. David Buller has always humbled me and kept me on my toes with his questions that wind down paths I never expected to travel. His willingness to assist me with statistical questions during the summer was greatly appreciated. Lawrence Aleamoni and Darrell Sabers from Educational Psychology, always seemed to bring me back to the basics with unexpected questions. Their support and kindness throughout the project were very refreshing.
I was fortunate enough to be blessed with two guardian angels during the course of this project. John Hall not only assisted me in all the technical aspects of the dissertation but was always there with a few words of support and assistance when needed. Chris Arslanian made it possible for Alice to get out of Wonderland. I'm afraid I would still be collecting data today if it had not been for her assistance and uplifting personality.
Of course the data collection process would have never even gotten off the ground if it were not for Leslie Boyer's help in developing the scripts and Denise Ahearn's and Frank Hunsaker's willingness to enact the scripts. I am also greatly indebted to the physicians, hospitals, and clinics who allowed me to setup shop for indefinite periods of time: Dr. Kligman and his staff at Family and Community Medicine at the University Medical Center, Dr. Parker and his staff at his private practice clinic, Donna Brewer, Joyce Norman, Laurel Rokowski, and the volunteers at Tucson Medical Center.
Several fellow graduate students, undergraduates, and faculty members in the Department of Communication at the University of Arizona provided assistance with the data collection process as well as emotional support throughout this project. A special thanks to Barb Walkosz, Cindy White, and Kristyn McDermot who went to great lengths to direct the undergraduates during data collection. After collecting over 700 subjects on my own, I understand the frustrations and amusements each of the undergraduates must have encountered. I thank all of you for enduring despite it all. A few students enabled me to keep my sanity through their encouraging words and concern: Mark Adkins, Sarge, Lesa Stern, and Walid Afifi. Dr. Sally Jackson also provided friendly support as well as statistical guidance during several stages of this project.
I would also like to thank a few friends, colleagues, and students in the Department of Speech at the University of Hawaii who provided an invaluable support system as well as a sounding board for my never ending complaints: Miller, Min-Sun, Raja, Basil, Krystyna, Kelly, Geoff, Levine, Rodney, Bill, Ron, Gail, Jodi, Maria, Sarah, and all the others who constantly inquired into the progress of my dissertation.
Finally, I want to thank Cal Morrill who was there for me even when I looked for signatures in the strangest places or when I became concerned that I would lose my "insanity."
DEDICATION
To the people who believed in me and believed in my ideas -
even during the moments in life when I was unable to.
To my parents ...
Who have always believed that it was impossible for me to fail.
To Cal...
For stimulating me intellectually and for teaching me the value of good ideas. For making
me smile when I wanted to cry and for allowing me to cry when I couldn't seem to smile.
Your unconditional support and encouragement made it possible for me to succeed and
persevere. Without you, I'm afraid my parents' belief would have been falsified.
No one could have been a better teacher or a truer friend.
1. Source Manipulation Check: Observed Means on the Source Characteristic Measures for Videotaped and Transcript Versions of the Male and Female Physician . . . . . . . . . . . . . . .. 100
2. Reinforcement Expectations Manipulation Check for Study 2: Observed Means and Standard Deviations for Pure Combinations and Mixed Combinations on Reinforcement Expectations . . . . . . . . . . . . . . . . . . . . . . . .. 102
3. Intercorrelations Among Dependent Variables in Study 1 . . . . . . . . . . . .. 103
4. HI: Univariates on Perceptions of Approval and Valence. . . . . . . . . . .. lOS
5. HI: Observed Means and Standard Deviations on Ratings of Approval and Valence for Regard Strategies . . . . . . . . . . . . . .. 105
6. H2, H3, and H4: Observed Means and Standard Deviations on Ratings of Communication Expectations, Perceptions of Relational Concern, and Communication Appropriateness . . . . . . . . . . . . .. 107
7. H2, H3, and H4: ANOVA for Physician Gender, Strategy, and Session on Communication Expectations, Perceptions of Relational Concern, and Appropriateness. . . . . . . . . . . . . . . . .. lOB
B. H5, RQI, and RQ2: Multiple Regressions of Situational Perceptions and Strategy Type on Communication Expectations and Perceptions of Appropriateness . . . . . . . . . . . . . . . . . . . .. 111
9. RQ3: Multiple Regressions of Situational Perceptions, Strategy Type, and Physician Gender on Communication Expectations and Perceptions of Appropriateness . . . . . . . . . . . . . . . . . . . .. 113
10. H7 and HB: Observed Means and Standard Deviations on Patient Satisfaction in Initial Encounters with a Physician for Physician Gender and Strategy. . . . . . . . . . . . .. 116
11. H7 and HB: ANOVA on Patient Satisfaction in Initial Encounters with a Physician for Physician Gender, Strategy Type, and Consultation Session . . . . . . . . . . . . . . . . . . . . . . . . . . .. 117
12. H9 and HlO: Observed Means on Physician Perceptions in Initial Encounters with a Physician for Physician Gender and Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 119
11
LIST OF T ABLES--continued
13. H9 and HlO: ANOVA on Physician Perceptions in Initial Encounters with a Physician for Physician Gender, Strategy Type, and Consultation Session. . . . . . . . . . . . . . . . . . . . . . . . . . .. 120
14. Hll: Anova on Physician Persuasiveness in Initial Encounters with a Physician for Physician Gender, Strategy Type, and Consultation Session. . . . . . . . . . . . . . . . . . . . . . . . . . .. 122
15. Hll: Observed Means on Physician Persuasiveness in Initial Encounters with a Physician for Physician Gender and Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 122
16. Intercorrelations Among Patient Satisfaction, Physician Perceptions, and Physician Persuasiveness following Strategy Combination in Study 2 . . . . . . . . . . . . . . . . . . . . . . . . . . .. 124
17. H12 and H13: Univariates on Patient Satisfaction and Physician Perception following Strategy Combination in Study 2 . . . . . . . . . . 126
18. H12, H13, and H14: Observed Means on the Patient Satisfaction, Physician Perceptions, and Physician Persuasiveness Measures for Strategy Combination and Gender .. . . . . . . . . . .. 127
19. H14: ANOVA on Physician Persuasiveness following Strategy Combination in Study 2 . . . . . . . . . . . . . . . . . . . . . .. 128
20. Intercorrelations Among Communication Evaluation Variables following Final Strategy in Study 2 . . . . . . . . . . . . . . . . . . . .. 130
21. H6: Observed Means and Standard Deviations of Communication Expectations for Previous Communication Exposure. . . . . . . . . .. 131
22. RQ4: Univariates on Communication Evaluations for Strategy Combination, Physician Gender, and Final Strategy. . . . . . . . . .. 133
23. RQ4: Observed Means and Standard Deviations on Communication Evaluations for Physician Gender, and Final Strategy. . . . . . . . .. 135
24. RQ7, RQ8, and RQ9: Univariates on Patient Satisfaction, Physician Perception, and Physician Persuasiveness for Communication Exposure, Physician Gender, and Final Strategy Type. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 138
12
13
LIST OF T ABLES--continued
25. RQ7, RQ8, and RQ9: Observed Means and Standard Deviations on Patient Satisfaction, Physician Perceptions, and Physician Persuasiveness for Communication Exposure. . . . . . . .. 140
26. RQ7, RQ8, and RQ9: Observed Means and Standard Deviatioas on Patient Satisfaction, Physician Perceptions, and Physician Persuasiveness for Final Strategy Type . . . . . . . . . . . .. 141
14
LIST OF FIGURES
Figure Page
1. Strategy Combinations Created for Study 2 . . . . . . . . . . . . . . . . . . . .. 91
approximate E(1,76) = 9.45,12< .01, eta2=.11, and communicator rewardingness,
approximate 1:(1,76) = 6.51, n< .05, eta2=.08. Males were perceived as more socially
attractive <M = 5.17) than females <M = 4.49), had higher ratings on overall attractiveness
<M = 5.29) than females <M = 4.43), and were perceived as more rewarding <M = 5.06)
than females <M = 4.49). Table 1 summarizes the means and standard deviations for each
source characteristic.
Table 1
Source Maninulation Check: Observed Means and Standard Deviations on the Source Characteristic Measures for Videotaped and Transcrint Versions of the Male and Female Physicians
Videotaged Version Transcrigt Version
Male (n=20) Female (n=20) Male (n=20) Female (n=20)
Order effects were assessed for each of the conceptually similar mixed combinations
to determine if combinations 4a (neutral-positive-neutral-positive) and 4b (positive-neutral
positive-neutral) could be collapsed into an overall mixed positive/neutral condition; if
combinations Sa (neutral-negative-neutral-negative) and Sb (negative-neutral-negative-neutral)
could be collapsed into an overall mixed negative/neutral condition; and if combinations 6a
(positive-negative-positive-negative) and 6b (negative-positive-negative-positive) could be
collapsed into an overall mixed positive/negative condition. Three separate MANOV As were
run for the dependent measures that immediately followed the combinations (persuasion,
satisfaction, physician perception, and affect). The first multivariate analysis examined
differences between combinations 4a and 4b. The second multivariate analysis examined
differences between combinations Sa and Sb. The third multivariate analysis examined
differences between combinations 6a and 6b. All multivariate and univariate tests for each
combination pair were insignificant.
As a further assessment of order effects, three additional MANOV As were run for the
dependent measures that followed the final consultation session (approval, expectancies,
appropriateness, relational concern, persuasion, satisfaction, and physician perceptions). All
multivariate and univariate tests for each combination pair were, again, insignificant. These
findings justified collapsing the conceptually similar mixed combination pairs into the three
mixed combinations of positive/neutral, negative/neutral and positive/negative combinations.
Reinforcement Expectations
An unequivocal test of the strategy combination hypotheses for Study 2 required that
there be perceived differences in reinforcement expectations between the three pure
combination types (all neutral regard sessions; all positive regard sessions; all negative regard
102
sessions) and the three mixed combination types (positive/neutral regard sessions;
negative/neutral regard sessions; positive/negative regard sessions) such that the pure
combinations would result in lower reinforcement expectations than the mixed. One way
analysis of variance revealed a significant main effect for combination, E(5,467) = 4.84,
n < .0001, eta2= .08. The direct test of this manipulation check involved a 1 degree of
freedom contrast analysis comparing the pure types (contrast weights of -1, -1, -1) to the
mixed combinations (contrast weights of + 1, + 1, + 1). This test was significant, !(467) =
4.21, n< .0001. Examination of the means in Table 2 shows that reinforcement expectations
were lower in the pure combination types than in the mixed combination types. Thus,
subjects exposed to the mixed combination types were more convinced than subjects exposed
to the pure types that the patient's behavior influenced the physician's communication style.
Table 2
Reinforcement Expectations Manipulation Check for Study 2: Observed Means and Standard Deviations for Pure Combinations and Mixed Combinations on Reinforcement Expectations
Mean SD n
Pure Types 4.16 1.34 234
All Positive Combination 4.13 1.30 80
All Neutral Combination 4.03 1.18 79
All Negative Combination 4.33 1.55 75
Mixed Types 5.00 1.25 238
Positive/Neutral Combination 4.95 1.13 81
Positive/Negative Combination 5.09 1.35 79
Negative/Neutral Combination 4.97 1.26 78
103
Study 1: Initial Strategy Usage
Communication Evaluation of Regard Strategies
Hypotheses 1 through 5 and research questions 1 through 3 concerned the relationship
between the type of influence attempt used in initial encounters with a male or female
physician and patients' communication evaluations. Although the dependent variables in
Study 1 were highly correlated, variables were only analyzed together with multivariate
analysis of variance (MANOV A) when there was a high conceptual interrelatedness between
the variables and when the measures were treated as a set in the same hypothesis (see Table 3
for intercorrelations). In all other instances, hypotheses with categorical predictor variables
were analyzed with a 3 (strategy type) x 2 (physician gender) x 5 (consultation session)
analysis of variance (ANOVA). Consultation session was treated as a replicated factor in
each analysis. Following these analyses, direct tests of the hypotheses were conducted with 1
degree of freedom contrast analyses. The contrast tests are reported as one-tailed! tests.
Hypothesis 5 and research questions 1 through 3 were tested with mUltiple regression.
Table 3
Intercorrelations Among Dependent Variables in Study 1
Valence Approval Expect Concern Approp Satis Percep Pers
Reinforcing quality of regard strategies. The first hypothesis predicted that positive
regard strategies would be perceived as the most reinforcing type of influence attempt
followed by neutral regard strategies, and then negative regard strategies. To test the
conceptualization of positive, neutral, and negative regard strategies, a 3 (strategy type) x 5
(consultation session) multivariate analysis of variance for the dependent measures of approval
and valence was performed. Consultation session was treated as a replicated factor. Bartlett's
sphericity test (203.88, R< .0001) confirmed that a multivariate analysis was appropriate.
Hypothesis 1 was confirmed. The MANOV A was significant for the two dependent
measures, Wilks' lambda = .10, E(4,14) = 7.31, R< .005, R2 = .90. As Table 4 shows, the
analysis revealed significant differences on each of the dependent variables. The direct test of
the hypothesis, using the contrast coefficients of + 1, 0, -1, was significant for both approval,
I(352) = 6.04, R< .0005, and valence, 1(352) = 5.59, R< .001. As indicated by Table 5,
patients perceived positive regard strategies as the most reinforcing, followed by neutral
regard strategies, and then negative regard strategies.
105
Table 4
HI: Univariates on Percentions of Aimroval and Valence
SS DF MS F Sig
Valence
Session (S) vs Within 15.94 4 3.98 1.90 .110
Strategy by Session (ST X S) vs Within 16.34 8 2.04 .97 .456
Strategy vs (ST X S) 65.62 2 32.81 16.07 .002
Within 712.41 340 2.10
Approval
Session (S) vs Within 9.47 4 2.37 1.22 .303
Strategy by Session (ST X S) vs Within 14.69 8 1.84 .94 .480
Strategy vs (ST X S) 72.85 2 36.43 19.83 .001
Within 661.07 340 1.84
Table 5
HI: Observed Means and Standard Deviations on Ratings of Approval and Valence for Regard Strategies
Positive
ill= 123)
Reinforcement Measure M SO
Approval 4.88 1.35
Valence 5.02 1.45
Regard Strategy
Neutral
(n= 117)
M SO
4.43 1.35
4.45 1.40
Negative
(n= 115)
M SO
3.79 1.48
4.00 1.51
106
Communication expectations. Hypothesis 2 predicted gender differences in
expectations of influence behaviors such that male physicians are expected to use neutral
regard strategies and female physicians are expected to used positive regard strategies. A 3
(strategy, type) x 2 (gender) x 5 (consultations sessions) analysis of variance with consultation
sessions as a replicated factor was performed for the dependent variable of expectancy.
Hypothesis 2 was not supported. Although patients did expect females to use positive regard
strategies more than any other strategy, patients did not expect male physicians to use neutral
strategies more than any other strategy. Rather, there was a significant main effect for
strategy, 1:(2,8) = 10.26, p< .01, eta2 =.07, with positive regard strategies the most expected
and negative regard strategies the least expected for both male and female physicians (see
Table 6 for means). The main effect for gender and the predicted interaction effect between
gender and strategy, however, was not significant (Table 7).
Perceptions of relational concern. The predicted interaction between physician gender
and influence strategy for messages of relational concern was tested with the same analysis of
variance design used for hypothesis 2. Hypothesis 3 was not supported. Patients did not
perceive both positive and negative regard strategies as showing relational concern when used
by a male physician (see Table 6 for means). There was a significant main effect for
strategy, 1:(2,8) = 13.32, p< .005, eta2 =.06, with positive regard strategies showing the
most affect and negative regard strategies showing the least affect. However, the main effect
for gender and the predicted interaction effect between gender and strategy were not
significant (Table 7).
Appropriateness. Hypothesis 4 predicted that patients' would perceive negative regard
strategies as more appropriate influence attempts when used by male physicians than when
used by female physicians. The predicted gender effect for perceptions of appropriateness
107
was initially tested with the same analysis of variance design used in Hypothesis 2 and 3.
There was a significant main effect for both strategy, E(I,8) = 17.10, I!< .001, eta2=.IO,
and physician gender, E(2,4) = 8.39, I! < .05, eta2= .02. The gender by strategy interaction
was not significant (Table 7). The direct test of hypothesis 4 used the error term associated
with the strategy by gender interaction and contrast weights of +1,0,0, -1, 0, 0 (+1 was
assigned to negative strategies used by male physicians and -1 was assigned to negative
strategies used by female physicians). Hypothesis 4 was supported, 1(8) = 2.82, I!< .05.
Table 6 shows that negative regard strategies were seen as more appropriate influence
attempts when used by male physicians (M = 4.26) than when used by female physicians (M
= 3.71).
Table 6
H2. H3. and H4: Observed Means and Standard Deviations on Ratings of Communication Expectations. Perceptions of Relational Concern. and Communication Appropriateness
Note: Higher scores on these scales represent higher perceptions that the communication was expected, showed relational concern, and was appropriate. >Ie I! < .05
Table 7
H2. H3. H4: ANOVA for Physician Gender. Strategy. and Session on Communication Expectations. Perceptions of Relational Concern. and Appropriateness
SS DF MS F
112: Communication Expectations
Session (S) vs Within 26.56 4 6.64 3.21
Strategy by Session (ST X S) vs Within 12.57 8 1.57 .76
Physician Gender by Session (P X S) vs Within 14.75 4 3.69 1.78
Physician Gender by Session by Strategy (ST X S X P) vs Within 7.61 8 .95 .46
Strategy vs (ST X S) 43.05 2 21.53 13.70
Physician Gender (P) vs (P X S) 2.57 2.57 .70
Strategy by Physician Gender (S x P) vs (ST X S X P) 3.89 2 1.94 2.04
Within 670.72 324 2.07
03: Perceptions of Relational Concern
Session (S) vs Within 16.09 4 4.02 2.41
Strategy by Session (ST X S) vs Within 17.50 8 2.19 1.31
Physician Gender by Session (P X S) vs Within 20.41 4 5.10 3.05
Physician Gender by Session by Strategy (ST X S X P) vs Within 13.69 8 1.71 1.02
Strategy vs (ST X S) 46.13 2 23.07 10.55
Physician Gender (P) vs (P X S) 4.79 4.79 .94
Strategy by Physician Gender (S x P) vs (ST X S X P) .57 2 .29 .17
Within 543.08 325 1.67
108
Sig
.013
.639
.132
.884
.003
.451
.192
.049
.238
.017
.418
.006
.387
.849
109
Table 7 (continued)
SS DF MS F Sig
H4: Appropriateness
Session (S) vs Within 19.19 4 4.80 2.22 .066
Strategy by Session (ST X S) vs Within 20.44 8 2.55 1.18 .309
Physician Gender by Session (P X S) vs Within 8.16 4 2.04 .94 .438
Physician Gender by Session by Strategy (ST X S X P) vs Within 6.95 8 .87 .40 .919
Strategy vs (ST X S) 87.35 2 43.68 17.10 .001
Physician Gender (P) vs (P X S) 17.11 17.11 8.39 .044
Strategy by Physician Gender (S x P) vs (ST X S X P) .36 2 .18 .21 .817
Within 706.26 327 2.16
Communication evaluation as a function of situational perceptions. Hypotheses 5a
through 5d, and research questions 1 and 2 concerned the interaction between situational
perceptions and strategy type on patients' communication expectancies and patients' views
regarding the appropriateness of certain regard strategies. This set of hypotheses and research
questions was tested through four fully saturated regression analyses. Because the main
concern was assessing the significant two-way interaction, the multiplicative term for each
interaction variable was forced into the model first.
The first regression analysis assessed the possible interaction between severity of
illness and strategy type on communication expectations. When the multiplicative term
composed of severity and strategy type was forced into the model first there was a significant
110
relationship, 1:(3,195) = 9.58,12<.005, R2=.05. When the main effect for severity of
illness and strategy type were entered into the equation, the interaction became insignificant.
As Table 8 shows, severity of illness accounted for most of the variance and, thus, the
significance of the interaction is probably an artifact of its relationship to the situational
percept.
The second regression analyses assessed the possible interaction between severity of
illness and strategy type on communication appropriateness. When the multiplicative term
composed of severity and strategy type was forced into the model first there was a weak, but
statistically significant relationship, 1:(3,195) = 6.07,12< .05, R2=.03. When the main effect
for severity of illness and strategy type were entered into the equation, the interaction became
insignificant. Once again, Table 8 illustrates that perceptions of severity of illness accounted
for most of the variance.
The third regression assessed the possible interaction between perceptions of previous
noncompliance and strategy type on communication expectations. When the multiplicative
term composed of noncompliance and strategy type was forced into the model first there was
a significant relationship, 1:(3,195) = 8.64,12< .001, R2=.04. When the main effect for
perceptions of previous noncompliance and strategy type were entered into the equation the
interaction became insignificant. Similar to severity of illness perceptions, perceptions of
previous noncompliance accounted for most of the variance (Table 8).
The fourth regression assessed the possible interaction between perceptions of
previous noncompliance and strategy type on communication appropriateness. When the
multiplicative term composed of noncompliance and strategy type was forced into the model
first there was a weak, but statistically significant relationship, 1:(3,195) = 4.23, 12 < .05,
R2 = .02. When the main effect for perceptions of previous noncompliance and strategy type
111
were entered into the equation the interaction became insignificant. Once again, perceptions
of previous noncompliance accounted for most of the variance (Table 8).
Table 8
H5. ROI, and R02: Multiple Regressions of Situational Perceptions and Strategy Type on Communication Expectations and Perceptions of Appropriateness
B Beta p
Expectation Regressions
Severity X Strategy .06 .18 .78 .438
Severity .19 .22 3.14 .002
Strategy .13 .08 .36 .723
E(3,195) = 6.63, &=.30, Q<.0005
Noncompliance X Strategy .07 .19 1.08 .283
Noncompliance .55 .60 10.79 .000
Strategy -.09 -.06 -.33 .742
E(3,195) = 43.59, &=.63, Q< .0001
Appropriateness Regressions
Severity X Strategy .05 .12 .53 .596
Severity .22 .22 3.09 .002
Strategy .17 .09 .41 .685
E(3,195) = 5.30, &=.27, Q<.005
Noncompliance X Strategy -.01 -.03 -.17 .864
Noncompliance .67 .63 11.44 .000
Strategy .19 .10 .61 .545
E(3,195)=47.16, &=.65, Q<.OOOI
Note: E values for each equation are listed below each set of predictor variables.
112
Research question 3 concerned the possible interaction between physician gender,
situational perceptions, and strategy type on communication evaluation. This research
question was probed through four fully saturated models similar to the ones above except that
a three way interaction term composed of the situational percept, strategy type, and gender
was forced into the model first. The three way interaction between severity of illness,
strategy, and gender on communication appropriateness was insignificant, E(7, 191) = 3.25,
n = .07, and the three way interaction between previous noncompliance, strategy, and gender
on communication appropriateness was insignificant, E(7,191) = 2.25, n=.14. The
regression assessing the interaction between severity of illness, strategy type, and gender on
communication expectations was significant, £(7,191) = 5.17, n< .05, R2=.02. The
regression assessing the interaction between perceptions of noncompliance, strategy type, and
gender on communication expectations was also significant, £(7,191) = 2.25, n< .05,
R2=.02. However, similar to before, when two way interactions and main effects were
entered into the equation, the interaction became insignificant (Table 9)
113
Table 9
R03: Multiple Regressions of Situational Perceptions. Strategy Type. and Physician Gender on Communication Expectations and Perceptions of Appropriateness
B Beta t p
Expectation Regressions
Severity X Strategy X Gender .08 .18 .55 .583 Severity X Strategy .02 .06 .19 .846 Severity X Gender -.04 -.09 -.36 .710 Strategy X Gender -.37 -.16 -.50 .616 Severity .21 .25 2.60 .010 Strategy .30 .18 .63 .531 Gender .31 .19 .51 .608
Noncompliance X Strategy X Gender -.03 -.05 -.20 .843 Noncompliance X Strategy .08 .21 .92 .359 Noncompliance X Gender .06 .02 .10 .922 Strategy X Gender -.08 -.15 -.79 .437 Noncompliance .59 .64 8.69 .000 Strategy -.10 -.07 -.29 .774 Gender .30 .12 .64 .526
Appropriateness Regressions
Severity X Strategy X Gender .01 .02 .07 .947 Severity X Strategy .04 .11 .36 .719 Severity X Gender .06 .11 .44 .661 Strategy X Gender .05 .02 .06 .952 Severity .19 .19 2.02 .045 Strategy .15 .08 .27 .786 Gender .01 .00 .01 .994
Noncompliance X Strategy X Gender -.06 -.11 -.44 .663 Noncompliance X Strategy .00 .01 .04 .967 Noncompliance X Gender .29 .11 .45 .644 Strategy X Gender -.19 -.29 -1.57 .119 Noncompliance .74 .70 9.66 .000 Strategy .13 .07 .31 .754 Gender
Note: £: values are as follows: first expectation equation, £:(7,191}=2.89, R=.29, l?<.05; second expectation equation, £:(7, 191)= 18.52, l? < .001; first appropriateness equation, £:(7,191)=2.57, R=.31, l?<.01; second appropriateness equation, £:(7,191}=20.63, R=.66, l?<.00001.
114
The analyses, as a whole, suggest that these situational perceptions do not significantly
interact with the other variables in the model. Rather, there is a main effect for situational
perceptions such that high perceptions of severity and previous noncompliance are associated
with greater communication expectations and appropriateness for any influence strategy used
by the physician. This supports hypothesis Sa and 5b which predicted a positive relationship
between situational perceptions and communication evaluations for negative regard strategies,
but disconfirms hypothesis 5c and 5d which suggested that neutral strategies are negatively
correlated with these situational perceptions. The analyses also suggest that there is a positive
relationship between perceptions of severity of illness and pervious noncompliance for the use
of positive regard strategies (research questions 1 and 2).
To more precisely determine the role of these situational perceptions in the
framework, a secondary analysis was done treating the situational variables as the dependent
measures rather than the independent measures. A 2 (physician gender) x 3 (strategy type) x
5 (consultation session) multivariate analysis of variance with sessions as the random factor
was done to determine if the independent variables in the framework influenced patients'
perceptions of severity of illness and perceptions of previous noncompliance. MANDV A
revealed a significant main effect for strategy, Wilks' lambda = .19, £:(4,14) = 4.49,
12< .05, R2 =.81, with a significant univariate effect for severity, 1:(2,8)=6.89, Q< .05.
Inspection of the means reveals that patients perceived the situation to be more severe when
the physician used negative regard strategies <M = 4.99) than neutral regard strategies <M =
4.66) or positive regard strategies <M = 4.33). There was no significant main effect for
gender and no significant interaction effect between gender and strategy.
115
Consequences of Initial Strategy Usage
Hypotheses 7 through 11 addressed the effectiveness of different influence attempts
used by male and female physicians during initial encounters. Data were analyzed using a 3
(strategy type) x 2 (physician gender) x 5 (consultation session) analysis of variance design.
Although the dependent variables were highly correlated (see Table 3), ANOV A was used
because the variables of patient satisfaction, physician perceptions, and physician
persuasiveness are conceptually different and the predictions vary slightly for each outcome
measure. Consultation session was treated as a replicated factor in each analysis. Following
these analyses, direct tests of the hypotheses were conducted with 1 degree of freedom
contrast analyses.
Patient satisfaction. Hypotheses 7 and 8 concern the effects of initial strategy usage
by male and female physicians on patient satisfaction. Hypothesis 7, which predicted that
patient satisfaction with physician influence attempts is greater with positive regard strategies
than with either negative or neutral regard strategies, was supported. There was a significant
main effect for strategy, E(2,8) = 15.90, Q<.005, eta2 =.07. Moreover, the means are in the
exact pattern suggested by the hypothesis with more satisfaction following the positive regard
strategies than the neutral or negative regard strategies (see Table 10 for means). The direct
test, comparing the positive regard strategy condition to the neutral and negative regard
condition (contrast coefficients of +2 -1 -1), was significant, 1(8) = 5.32, Q< .001.
Hypothesis 8 predicted that there are gender differences for satisfaction such that
negative regard strategies used by male physicians result in more patient satisfaction than
negative regard strategies used by female physicians. The interaction between physician
gender and strategy was significant, E(2,8) = 4.48, Q < .05, eta2 = .004. Inspection of the
means in Table 10 shows that more satisfaction is reported by patients following the male
116
physician's use of negative regard strategies than following the female physician's use of
negative regard strategies. The direct test of hypothesis 8 used the error term associated the
gender by strategy interaction and compared the male-negative regard condition to the female;-
negative regard condition (contrast coefficients of 0, 0, + 1, 0, 0, -1). The difference was
significant, 1(8) = 4.20, Jl < .005, supporting hypothesis 9. See Table 11 for ANOVA
information. Figure 2 illustrates the gender by strategy interaction for satisfaction and
demonstrates that the predicted main effects for satisfaction are interpretable.
Table 10
H7 and H8: Observed Means and Standard Deviations on Patient Satisfaction in Initial Encounters with a Physician for Physician Gender and Strategy
Strategy
Positive
Neutral
Negative
Male Physician
M SD n
4.94 1.41 57
4.05a 1.31 56
3.99&* 1.38 62
Physician Gender
Female Physician
M SD n
4.44 1.36 58
3.99 1.54 61
3.56* 1.59 64
Note: The means sharing a common subscript within a column are not significantly different from each other (Jl> .05) using the Tukey b post hoc test. * The means are significantly different at Jl < .005
Table 11
H7 and H8: ANOVA on Patient Satisfaction in Initial Encounters with a Physician for Physician Gender, Strategy Type, and Consultation Session
SS DF MS F
Session (S) vs Within 23.43 4 5.86 2.87
Strategy by Session (ST X S) vs Within 14.58 8 1.82 .89
Physician Gender by Session (P X S) vs Within 7.99 4 2.00 .98
Physician Gender by Session by Strategy (ST X S X P) vs Within 3.10 8 .39 .19
Strategy vs (ST X S) 57.97 2 28.98 15.90
Physician Gender (P) vs (P X S) 9.50 9.50 4.75
Strategy by Physician Gender (S x P) vs (ST X S X P) 3.47 2 1.74 4.48
Within 672.50 329 2.04
117
Sig
.023
.524
.420
.992
.002
.095
.049
Figure 2. Interaction of Physician Gender and Strategy Type on Patient Satisfaction.
5.0
4.9
4.8
4.7
4.6
4.5
4.4
4.3
4.2
4.1
4.0
3.9
3.8
3.7
3.6
3.5
3.4
Positive Regard Slralegies
Neulral Regard Slralegies
Male Physician
Female Physician
Negalive Regard Slralegies
Physician perception. Hypotheses 9 and 10 concerned the effects of initial strategy
118
usage by male and female physicians on perceptions of the physician. Hypothesis 9 predicted
a nonlinear relationship for male physicians and a linear relationship for female physicians.
These predictions were supported. There was both a significant main effect for strategy type,
E(2,8) = 12.03, I!< .005, eta2=.07, and the predicted interaction between physician gender
and strategy type, E(2,8) = 5.61, I!<.05"eta2=.01. Moreover, as shown in Table 12, the
means were in the direction predicted by hypothesis 9. For the male condition, physician
perceptions were higher following positive regard strategies than neutral or negative regard
119
strategies. For the female condition, physician perceptions were higher for the positive regard
strategies and decreased with the use of more negative strategies.
Table 12
H9 and HlO: Observed Means and Standard Deviations on Physician Perceptions in Initial Encounters with a Physician for Physician Gender and Strategy
Ph~sician Gender
Male Ph~sician Female Ph~sician
Strateg~ M SD n M SD n
Positive 5.44 1.01 57 4.93 1.37 58
Neutral 4.56. 1.13 56 4.49 l.34 61
Negative 4.55. 1.37 62 4.08 1.48 64
Note: The means sharing a common SUbscript within a column are not significantly different from each other (12 > .05) using the Tukey b post hoc test.
The direct test of hypothesis 9 involved two contrast tests, one for the male condition
testing for a nonlinear relationship and one for the female condition testing for the linear
relationship. Both tests used the error term associated with the strategy by gender interaction.
The predicted nonlinear relationship for males was significant, E(I,8) = 25.24, p< .001,
eta2 = .23 and the predicted linear relationship for females was significant, E(1,8) = 73.72,
HYQothesis 10 predicted that there are gender differences for negative regard strategies
such that communicator evaluations are higher for male physicians using negative regard
strategies than for female physicians Using negative regard strategies. The direct test between
these two groups (contrast coefficients of 0, 0, + I, 0, 0, -1) was significant, !(8) = 4.93,
12 < .001. As shown in Table 12, physician perceptions were higher in the male condition
120
following the use of negative regard strategies than the female condition. Table 13 contains
the ANOY A information and figure 3 illustrates the gender by strategy interaction for person
perceptions.
Table 13
H9 and HlO: ANOYA on Physician Perceptions in Initial Encounters with a Physician for Physician Gender, Strategy Type, and Consultation Session
SS DF MS F Sig
Session (S) vs Within 13.50 4 3.38 1.85 .120
Strategy by Session (ST X S) vs Within 17.79 8 2.22 1.22 .288
Physician Gender by Session (P X S) vs Within 16.21 4 4.05 2.22 .067
Physician Gender by Session by Strategy (ST X S X P) vs Within 2.41 8 .30 .16 .995
Strategy vs (ST X S) 53.50 2 26.75 12.03 .004
Physician Gender (P) vs (P X S) 10.07 10.07 2.48 .190
Strategy by Physician Gender (S x P) vs (ST X S X P) 3.38 2 1.69 5.61 .030
Within 601.45 329 1.83
Figure 3.
Interaction of Physician Gender and Strategy Type on Physician Perception.
5.5
5.4
5.3
5.2
5.1
5.0
4.9
4.8
4.7
4.6
4.5
4.4
4.3
4.2
4.1
4.0
3.9
3.8
Persuasiveness
Positive Regard Strategies
Neutral Regard Strategies
Male Physician
Female Physician
Negative Regard Strategies
Hypothesis 11 predicted that there is an interaction between physician gender and
strategy type for persuasiveness such that a male physician is most persuasive using either
121
positive regard or negative regard strategies and a female physician is most persuasive using
positive regard strategies. ANDV A revealed a significant main effect for strategy, E(2,8) =
7.82, R < .05, eta2= .05 (Table 14). The predicted interaction effect between physician gender
and strategy approached significance, E(2,8) = 4.23, R= .05, eta2 =01. The means are in the
exact pattern suggested by the hypothesis (see Table 15 for Means).
Table 14
H 11: ANOV A on Physician Persuasiveness in Initial Encounters with a Physician for Physician Gender. Strategy Type. and Consultation Session
SS DF MS F
Session (S) vs Within 21.95 4 5.49 2.95
Strategy by Session (ST X S) vs Within 19.15 8 2.39 1.29
Physician Gender by Session (P X S) vs Within 8.40 4 2.10 1.13
Physician Gender by Session by Strategy (ST X S X P) vs Within 6.82 8 .85 .46
Strategy vs (ST X S) 37.42 2 18.71 7.82
Physician Gender (P) vs (P X S) 7.55 7.55 3.60
Strategy by Physician Gender (S x P) vs (ST X S X P) 7.21 2 3.60 4.23
Within 617.93 332 1.86
Table 15
H 11: Observed Means and Standard Deviations on Physician Persuasiveness in Initial Encounters with a Physician for Physician Gender and Strategy
Strategy
Positive
Neutral
Negative
Male Physician
M
5.23
4.35
4.63
SD n
1.06 57
1.30 56
1.39 62
Physician Gender
Female Physician
M SD n
4.78 1.21 58
4.39 1.49 61
4.09 1.43 64
122
Sig
.020
.250
.343
.885
.013
.131
.050
123
The direct test of the hypothesis involved two contrast tests. The predicted curvilinear
relationship for the male physician was tested using the error term associated with the strategy
by gender interaction and contrast coefficients of + 1, -2, + 1. The predicted linear
relationship for the female physician was tested using the same error term but with contrast
coefficients of + 1, 0, -1. Hypothesis 11 was supported with both a significant curvilinear
relationship for the male physician, .E(1,8) = 17.03, Q < .005, eta2= .45, and a significant
linear relationship for the female physician, .E(1,8) = 18.37, Q < .005, eta2= .69. Figure 4
illustrates the gender by strategy interaction for physician persuasiveness.
Figure 4. Interaction of Physician Gender and Strategy Type on Physician Persuasiveness.
5.5
5.4
5.3
5.2
5.1
5.0
4.9
4.8
4.7
4.6
4.5
4.4
4.3
4.2
4.1
4.0
3.9
3.8
Positive Regard Strategies
Neutral Regard Strategies
Male Physician
Female Physician
Negative Regard Strategies
124
Study 2: Consequences of Strategy Combinations
Hypotheses 12 through 14 concern the effectiveness of different strategy combinations
represented in ongoing interactions with a male or female physician. The dependent variables
assessing the effectiveness of strategy combinations were all highly correlated (see Table 16
for intercorrelations). A 2 (physician gender) x 6 (strategy combination) MANOVA was used
to test hypothesis 12 dealing with patient satisfaction and hypothesis 13 dealing with physician
perceptions because the predictions were identical for both hypotheses. Bartlett's sphericity
test (690.95, R < .0001) confirmed that a multivariate analysis was appropriate. Persuasion is
conceptually different from patient satisfaction and physician perceptions. Additionally,
because hypothesis 14 predicted a slightly different relationship, the persuasion prediction was
tested in a separate 2 x 6 ANOV A. Research questions were probed using Tukey b post hoc
tests.
Table 16
Intercorrelations Among Patient Satisfaction. Physician Perceptions. and Physician Persuasiveness following Strategy Combination in Study 2
Patient Satisfaction
Physician Perceptions
Physician Persuasiveness
Satisfaction
1.00
Perceptions
.89
1.00
Persuasiveness
.84
.80
1.00
125
Patient Satisfaction and Physician Perceptions
Hypothesis 12 and hypothesis 13 predicted an interaction between physician gender
and strategy combination such that the pure positive combination, the mixed positive/neutral
combination, and the mixed negative/neutral combination result in more overall satisfaction
than the pure negative combination or the pure neutral combination for male physicians;
among female physicians the pure positive combination and the mixed positive/neutral
combination are predicted to be the most satisfying. The predicted interaction was not
significant (see Table 17). However, there was a significant main effect for strategy
univariate effects for both satisfaction, 1:(5,461) = 8.46, p< .0001, eta2=.08, and physician
perceptions, 1:(5,461) = 8.32, p < .0001, eta2= .08. As Table 18 shows, the means for both
the male and the female physician are in the direction of the prediction for the male condition.
This main effect for strategy combination was probed using the contrast codes originally
designed to test the male physician condition (-2, + 1, -2, + 1, + 1, + 1). These codes follow
the theoretical framework advanced in Chapter 1 if gender was not a factor. The contrast was
significant for both patient satisfaction, 1(462) = 5.61, p< .0001, and physician perceptions,
1(462) = 5.95, p < .0001.
Research question 5 asks which combination results in the most patient satisfaction
and the highest physician perceptions. The research question was probed using Tukey b post
hoc tests on the six strategy combinations. As shown in Table 18, the pure negative
combination resulted in significantly less patient satisfaction and lower physician perceptions
than all of the combinations except the pure neutral combination (p < .05). The pure neutral
combination resulted in significantly less patient satisfaction and lower physician perceptions
than the mixed positive/neutral combination, p < .05. Additionally, for physician perceptions,
126
the pure neutral combination resulted in significantly lower physician perceptions than the
pure positive combination, Q < .05. Thus, the pure negative and the pure neutral
combinations are the least satisfying and result in the lowest physician perceptions, whereas
the mixed combinations and the pure positive combination are the most satisfying and result in
the highest physician perceptions. Inspection of the means shows that the most effective
strategy was the mixed/positive combination. This combination, however, was not
significantly different from the other mixed combinations.
Table 17
H12 and H13: Univariates on Patient Satisfaction and Physician PerceQtion following Strategy Combination in Study 2
SS DF MS F
Patient Satisfaction
Combination (C) 107.27 5 21.45 8.46
Gender (G) 2.72 2.71 1.07
Combination by Gender (C X G) 7.22 5 1.45 .57
Within 1168.50 461 2.55
Physician Perceptions
Combination (C) 92.58 5 18.52 8.31
Gender (G) 5.85 1 5.85 2.63
Combination by Gender (C X G) 10.03 461 2.00 .90
Within 1026.45 2.23
Note: Combination differences on these measures are associated with a multivariate E(10,920) = 4.99, Q< .0001.
Sig
.000
.301
.723
.000
.106
.480
127
Table 18
H12, H13, and H14: Observed Means and Standard Deviations on the Patient Satisfaction, Physician Perception, and Physician Persuasiveness Measures for Strategy Combination and Gender
Note: For strategy combination means representing the main effect for strategy, those means sharing a common subscript within a column are not significantly different from each other.
128
Persuasiveness
Hypothesis 14 concerns an interaction between physician gender and strategy
combination such that male physicians are predicted to be most persuasive when using mixed
positive/neutral combinations, mixed negative/neutral combinations, or mixed
positive/negative combinations, and female physicians are expected to be most persuasive
when using mixed positive/neutral combinations. The predicted interaction was not significant
(see Table 19). There was, however, a significant main effect for combination, 1:(5,462) =
5.58, R< .0001, eta2 =.06. As indicated by Table 18, the means were in the direction of the
male condition prediction. This main effect for combination was probed using the contrast
codes originally designed to test the male condition (contrast coefficients of -2, + 1, -2, + 1,
+ 1, + 1). These codes follow the theoretical framework advanced in Chapter 1 if gender was
not a factor. The contrast was significant, 1(462) = 3.99, Q< .0001.
Table 19
H14: ANOVA on Physician Persuasiveness following Strategy Combination in Study 2
Combination (C)
Gender (G)
Combination by Gender (C X G)
Within
SS
57.49
.35
6.45
952.13
DF
5
1
5
462
MS
11.50
.35
1.29
2.06
F
5.58
.17
.63
Sig
.000
.680
.680
Research question 6 asks which combination results in the most persuasiveness for the
male and female physician. Since gender did not significantly interact with strategy
129
combination, the assessment of mean differences was limited to the six combination means.
Tukey b post hoc test revealed the pure negative combination was significantly less persuasive
than the pure positive combination, and all the mixed combinations, Q< .05. Inspection of the
means shows that, for both the male and the female physician, the greatest physician
persuasiveness occurred following the positive-neutral combination. The persuasiveness of
this combination, however, was not significantly different from the other mixed combinations.
Consequences of Future Strategy Usage
Two sets of hypotheses and research questions concerned the effects of previous
communication exposure on the evaluation of future strategy usage. The first set, hypotheses
6a through 6c, examined the relationship between exposure to various influence attempts and
expectations for those influence attempts in the future. Research question 4 also probed the
relatIonship between exposure to strategy combinations, gender, and final strategy type on
other communication evaluation variables. The second set, research questions 7 through 9,
probed the relationship of different types of communication exposure to the outcome variable
of patient satisfaction, physician perceptions, and physician persuasiveness.
Communication Evaluations as a Function of Previous Communication Usage
Hypotheses 6a through 6c indicates that previous strategy usage by physicians
influences future communication expectations. Research question 4 concerns the possible
interaction between previous strategy usage, physician gender, and final strategy type on
communication evaluation. These hypotheses and research questions were tested using Study
2 data. Direct tests of the hypotheses were conducted with 1 degree of freedom contrast
analyses. The contrast tests are reported as one-tailed! tests. Research question 4 was tested
using MANOV A. See Table 20 for intercorrelations among dependent variables that followed
final strategy type.
Table 20
Intercorrelations Among Communication Evaluation Variables following Final Strategy in Study 2
Expect Approp Approv Valence Concern Satis Persu Percep
E(4,S4S) = 8.08, Q< .0001, eta2 =.06; and a significant main effect for physician gender,
Wilks' lambda = .98, E(3,S43) = , Q < .OS, R2= .02 with a significant univariate only for
perception, E(1,S4S)=S.79, Q< .OS, eta2 =.01. The three-way and two-way interactions were
all insignificant (Table 24). Thus, there is not a significant difference between regard strategy
types for patients exposed to a physician's communication style and for patients not exposed
to a physician's communication style.
Post hoc comparisons using Tukey b revealed that patients previously exposed to a
physician's communication style were more satisfied, evaluated the physician more highly,
and were more persuaded than patients not previously exposed to a physician's communication
style (Q < .OS). There were no significant differences between the consistent positive,
consistent neutral, consistent negative, or the intermittent reinforcement communication style
(Table 2S). The post hoc comparisons on final strategy type revealed that patients were more
satisfied, evaluated the physician more highly, and were more persuaded if they received
positive regard strategies than if they received either negative regard strategies or neutral
regard strategies (Q < .OS) (Table 26).
138
Table 24
R07, R08, and R09: Univariates on Patient Satisfaction, Physician Perception, and Physician Persuasiveness for Communication Exposure, Physician Gender, and Final Strategy ~
SS DF MS F Sig
Patient Satisfaction
Communication Exposure by Gender by Final Strategy (E X G X S) 12.03 8 1 50 .88 .529
Communication Exposure by Gender (EX G) 4.13 4 1.03 .61 .657
Communication Exposure by Final Strategy (E X S) 17.97 8 2.25 1.32 .230
Gender by Final Strategy (G X S) 1.44 2 .72 .43 .654
Communication Exposure (E) 51.21 4 12.80 7.53 .000
Gender (G) 3.63 1 3.63 2.14 .144
Final Strategy (S) 68.24 2 34.12 20.07 .000
Within 926.54 545 2.54
Physician Perceptions
Communication Exposure by Gender by Final Strategy (E X G X S) 14.80 8 1.85 .97 .454
Communication Exposure by Gender (EX G) 4.73 4 1.18 .62 .646
Communication Exposure by Final Strategy (E X S) 23.93 8 2.88 1.52 .148
Gender by Final Strategy (G X S) 1.94 2 .97 .51 .600
Communication Exposure (E) 47.53 4 11.88 6.26 .000
Gender (G) 10.99 10.99 5.79 .016
Final Strategy (S) 66.89 2 33.44 17.62 .000
Within 1033.97 545 1.90
139
Table 24 (continued)
SS DF MS F Sig
Physician Persuasiveness
Communication Exposure by Gender by Final Strategy (E X G X S) 8.67 8 1.08 .54 .825
Communication Exposure by Gender (E X G) 6.09 4 1.52 .76 .551
Communication Exposure by Final Strategy (E X S) 20.23 8 2.53 1.26 .261
Gender by Final Strategy (G X S) 2.74 2 1.37 .68 .506
Communication Exposure (E) 64.72 4 16.18 8.08 .000
Gender (G) 1.41 1.41 .71 .401
Final Strategy (S) 61.84 2 30.92 15.44 .000
Within 1091.37 545 2.00
140
Table 25
RQ7, RQ8, and RQ9: Observed Means and Standard Deviations on Patient Satisfaction, Physician PerceQtions and Physician Persuasiveness for Communication EXl!Qsure
No Previous Exposure to 3.12 1.31 124 4.43 1.40 124 4.15 1.45 124 Reinforcement Style
Note: Those means sharing a common subscript within a column are not significantly different from each other.
Table 26
R07, ROg, and R09: Observed Means and Standard Deviations on Patient Satisfaction, Physician Perceptions and Physician Persuasiveness for Final Strategy Type
neutral, neutral, positive, positive. Either of the first four combinations would have been fair
tests of the positive-neutral combination and should result in similar outcomes. However,
since logistical constraints limited the number of orders to be tested only the first two orders
depicted above were used in Study 2.
S Phi coefficients were computed for each of the items on individual scales to
determine which items were poor discriminators. The phi coefficient was used because it
measures the strength of relationship between item scores and the total scores of the scale to
which that item is a part. If the item has high discriminatory power, respondents who score
high on a particular item should also score high on the overall scale and respondents who
score Iowan a particular item should score Iowan the overall scale. Items were removed
from the survey if the phi test had a phi less than .50.
164
6 Reliabilities for the dependent measures assessing evaluation of future strategies in
Study 2 were as follows: persuasiveness (a = .96), patient satisfaction (a = .96), physician
perceptions (a = .96), appropriateness (a = .67), expectancies (a = .66), valence
(a = .93), approval (a = .73), and affect (a = .88).
APPENDIX A
Verbal Strategy Definitions and Examples
NEUTRAL REGARD STRATEGY
Definition
Communication requests which are simple directives or justifications. These verbal strategies neither signal approval or disapproval for the patient or the patient's actions.
Types and Examples
Direct Request: requests which tell the patient what to do.
"There are several changes I would like you to make in your diet. "
"You need to change your eating habits."
"I want you to have a number of tests done. "
"Make sure you are keeping an accurate log of your eating patterns."
"You need to change your present eating habits."
Justification Based on Expertise: requests based on expertise or research.
"A substantial amount of research has shown that these changes can prevent other health problems from occurring in the future. "
"In my opinion, regular eating habits are key in these situations."
"In my opinion, you shouldn't put this off."
"Since research indicates that diet is key in your situation, I want you to keep a log of your eating habits."
"I want you to start exercising regularly and continue keeping a dietary log since all the best sources indicate that dietary changes and exercise in these situations are necessary. " .
Justification Based on Patient Condition: requests made because of the patients particular illness.
"Seeing a dietitian is the best advice I can give you for your situation."
165
"If this is diabetes, the same dietary changes we've discussed will be needed to deal with the condition. "
"The food choices the dietitian discussed with you and the recommendations to avoid sweets and eat a high fiber diet are necessary to keep diabetes under control. "
"I've seen individuals who are in your same situation and eating habits are generally key. "
166
"I know from treating similar cases that these changes usually can solve the problem. "
POSITIVE REGARD STRATEGY
Definition
Communication requests which are supportive, understanding, or stress concern for the patient. These verbal strategies signal approval of the patient and/or the patient's actions.
Types and Examples
Supportive Requests: requests which reinforce, reassure, compliment, or promise good things for compliance.
"You'll feel so much better about yourself because you'll know you're doing what it takes to feel better now and prevent problems in the future. "
"Regular eating habits will make you feel so much better. "
"If this is diabetes, don't worry, you're going to be okay as long as you stick to the same dietary changes you've been working so hard on already. "
"I can tell you've been trying really hard to change your diet -- now if you can just take the extra step and eliminate all the foods we discussed you will feel better."
"Make sure you keep an accurate log so we can see all the wonderful progress you are making on your diet. "
Validation Requests: requests which acknowledge the difficulty of the compliance act and indicate confidence in the patient following the request.
"I know that changing ones eating habits is very difficult, but you're the kind of person who can do it and make it work for you."
"A lot of patients have difficulty making these changes, but with your determination I know you can do it. "
"I realize these tests sound inconvenient, but I know you'll try to fit them into your schedule and be glad you did. "
167
"If you make these changes -- which I know you can -- everyone will be so proud of you because we all know how difficult it is to make these changes."
"I know it's difficult, but I want to see you feeling good everyday, so please avoid sweets and eat a high fiber diet like the dietitian discussed. "
Commonality of Goals: requests which stress mutual concern, affect, or "we"ness.
"I really like you and would like to see you feeling better the next time I see you, so please make sure you try to make some of these changes."
"I'm really concerned about you so I want you to see the dietitian so you can get some help fitting these dietary changes into your busy lifestyle. "
"We both want to find out what could be causing you to feel so run down so please make the appointment to have the tests done. "
"We both want you to get better, so please eat right everyday, okay?"
"I care about you a great deal and want to see you get better, so make sure that you make these changes in your eating habits."
NEGATIVE REGARD STRATEGIES
Definition
Communication requests which attack or criticize the patient's past behaviors or potential future behavior, or requests that attribute primary responsibility to the patient for ill feeling. These verbal strategies signal disapproval for the patient and/or the patient's actions.
Nonsupportive Requests: requests which suggest the simplicity of the request and/or indicate disbelief in the patient's Willingness to make changes.
"You really have two choices -- change your diet or spend the rest of your life wishing you had."
"It's not going to take that much of your time to see a dietitian as recommended -- and it should make it possible for you to meet your goals."
"If this is diabetes, the solution is generally quite simple -- stick to your diet."
"Make sure you keep an accurate log so you can note when you aren't sticking to your diet. "
"There's not a reason in the world why you shouldn't change your eating habits and exercise regularly. "
Invalidation Requests: requests which criticize or attack the patient's selfconcept and/or indicate disappointment in the patient's previous actions.
"Unless you want to be foolish and take the risk of developing a serious health problem like heart disease ot diabetes you have to start changing your eating habits. "
"You have to see by now that it's absolutely irrational not to make the changes we discussed. "
"And I'm not going to debate with you on this one -- you have to have these tests done. "
"You can't keep fooling around with our diet -- a responsible person would know that now is the time to take charge and make all the changes necessary. "
"There's no doubt about it. You must eat right everyday -- not just occasionally -- to get better. "
Negative Consequences: requests which suggest noncompliant actions will lead or have caused negative consequences.
"You're going to continue to feel tired unless you make these basic changes."
"Your irregular eating habits are bound to make you overeat and gain weight. "
"If you don't have these tests done immediately you could end up with a very serious situation and wish you had taken the time out of your schedule. "
"If you want to make sure you don't end up with a serious problem later in life it's as simple as ABC - change your eating habits. "
If you won't follow this advice you're going to continue to feel run down and tired -- it's that simple."
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APPENDIX B
Transcripts
SESSION 1
Let me review what you've just told me to make sure I have everything. You've
been gaining some weight over the last 10 years and when you went to your high school
reunion you felt "yucky" and out of shape. However you can exercise the same as usual
without getting out of breath. You also said that you're not urinating real often, no unusual
bowel movements, no chest pains or palpitations. You said that there's no history of cancer
but you thought one of your cousins had diabetes and maybe a distant aunt had some heart
trouble. Is that correct? Now looking at your physical exam, your blood pressure is a little
high but everything else seems normal so your problem may be related to simply being
slightly overweight and out of shape and we talked about some changes you might try making
in your diet and exercise. In most situations like yours, the problem can be solved with a
change in diet and making regular exercise a part of your life. But I do think it would be
good idea to rule out the possibility that it isn't something more serious by doing some simple
screening tests. Before you leave the clinic today I'd like you to have a urinalysis, blood
count, and a standard set of chemistry tests including a look at your blood sugar, cholesterol,
and fat. These tests will only take a few minutes. In the mean time, try eating more
nutritional foods like the ones we discussed and going for regular walks. Do you have any
questions? Okay. Well, if you coul~, take this down to the lab and make an appointment to
see me at the end of the week.
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SESSION 2
NEUTRAL
Most of the tests came back normal. Cholesterol is at the high end of normal. Your
blood sugar is borderline high at 130 -- the normal range is 80 - 120. It might be that way if
you had just eaten so it's not usually something to get too alarmed about. However, the fact
that you're overweight and the possible family history of diabetes does put you at risk. In
order to regain your energy and lose some weight, I think you should make some changes in
your eating habit. There are several changes I would like you to make in your diet. What
I'd like you to do is cut back on fat and the amount of sweets you eat. Both of these are high
in calories. I want you to try eating more foods that are natural sources of carbohydrates and
high in tiber. For instance, try to eat whole wheat bread instead of white bread. I know
from treating similar cases that these changes usually can solve the problem. Also. a
substantial amount of research has shown that these changes can prevent other health
problems from occurring in the future. You might also want to set up an appointment with a
dietitian to get some advice on meal preparation. Okay?
POSITIVE
Most of the tests came back normal. Cholesterol is at the high end of normal. Your
blood sugar is borderline high at 130 -- the normal range is 80 - 120. It might be that way if
you had just eaten so it's not usually something to get too alarmed about. However, the fact
that you're overweight and the possible family history of diabetes does put you at risk. In
order to regain your energy and lose some, weight, I think you should make some changes in
your eating habit. I know that changing ones eating habits is very difficult. but you're the
kind of person who can do it and make it work for you. What I'd like you to do is cut back
on fat and the amount of sweets you eat. Both of these are high in calories. I want you to
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try eating more foods that are natural sources of carbohydrates and high in fiber. For
instance, try to eat whole wheat bread instead of white bread. I really like you and would
like to see you feeling better the next time I see you. so please make sure you try to make
some of these changes. Also. you'll feel so much better about yourself because you'll know
you're doing what it takes to feel better now and prevent problems in the future. You might
also want to set up an appointment with a dietitian to get some advice on meal preparation.
Okay?
NEGATIVE
Most of the tests came back normal. Cholesterol is at the high end of normal. Your
blood sugar is borderline high at 130 -- the normal range is 80 - 120. It might be that way if
you had just eaten so it's not usually something to get too alarmed about. However, the fact
that you're overweight and the possible family history of diabetes does put you at risk. In
order to regain your energy and lose some weight I think you should make some changes in
your eating habit. Unless you want to be foolish and take the risk of developing a serious
health problem like heart disease or diabetes you have to start changing your eating habits.
What I'd like you to do is cut back on fat and the amount of sweets you eat. Both of these
are high in calories. I want you to try eating more foods that are natural sources of
carbohydrates and high in fiber. For instance, try to eat whole wheat bread instead of white
bread. You're going to continue to feel tired unless you make these basic changes. You
really have two choices -- change your diet or spend the rest of your life wishing you had.
You might also want to set up an appoin~ent with a dietitian to get some advice on meal
preparation. Okay?
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SESSION 3
NEUTRAL
From what you told me, it really seems like the way you feel is related to your eating
habits. Your chart also indicates that you've gained some weight over the last few months
and your blood pressure is a bit higher. You need to change your eating habits. It's
important that you eat the foods high in fiber and low in refined sugars and carbohydrates as
we discussed. I'd also like you to try to figure out a way to space out your eating times
throughout the day so you aren't overeating in one meal. Usually it's a good idea to make
sure your meals are about 4 to 5 hours a part. In my opinion. regular eating habits are key in
these situations. You commented that you don't have time to plan the appropriate meals.
Since you said you didn't meet with a dietitian I'm going to write down a dietitian I'd like
you to meet with. She'll give you a list of specific things that will help you fit these dietary
changes into your busy lifestyle. Seeing a dietitian is the best advice I can give you for your
situation.
POSITIVE
From what you told me, it really seems like the way you feel is related to your eating
habits. Your chart also indicates that you've gained some weight over the last few months
and your blood pressure is a bit higher. A lot of patients have difficulty making these
changes. but with your determination I know you can do it. It's important that you eat the
foods high in fiber and low in refined sugars and carbohydrates as we discussed. I'd also like
you to try to figure out a way to space out your eating times throughout the day so you aren't
overeating in one meal. Usually it's a good idea to make sure your meals are about 4 to 5
hours a part. Regular eating habits will make you feel so much better. You commented that
you don't have time to plan the appropriate meals. Since you said you didn't meet with a
173
dietitian I'm going to write down a dietitian I'd like you to meet with. She'll give you a list
of specific things that will help you fit these dietary changes into your busy lifestyle. I'm
really concerned about you so I want you to see the dietitian so you can get some help fitting
these dietary changes into your busy lifestyle.
NEGATIVE
From what you told me, it really seems like the way you feel is related to your eating
habits. Your chart also indicates that you've gained some weight over the last few months
and your blood pressure is a bit higher. You have to see by now that it's absolutely irrational
not to make the changes we discussed. It's important that you eat the foods high in fiber and
low in refined sugars and carbohydrates as we discussed. I'd also like you to try to figure out
a way to space out your eating times throughout the day so you aren't overeating in one meal.
Usually it's a good idea to make sure your meals are about 4 to 5 hours a part. Your
irregular eating habits are bound to make you overeat and gain weight. You commented that
you don't have time to plan the appropriate meals. Since you said you didn't meet with a
dietitian I'm going to write down a dietitian I'd like you to meet with. She'll give you a list
of specific things that will help you fit these dietary changes into your busy lifestyle. It's not
going to take that much of your time to see a dietitian as recommended -- and it should make
it possible for you to meet your goals.
SESSION 4
NEUTRAL
Your urinalysis showed that you tested positive for glucose. It's not very high but the
fact that you're still feeling tired and you're urinating more frequently may indicate a mild
diabetes condition. I think it's time we do some screening tests for diabetes. I want you to
have a numher of tests done. I'd like you to make an appointment to have a glucose tolerance
174
test and a hemoglobin A1C which will show us how high your sugar has been running.
You'll need to block off a whole day in your schedule to have these tests done. Your
schedule this week is very busy so schedule an appointment early next week. You'll need to
fast the day before. When you come in for the test, they'll start by taking a blood sample and
then you will drink a sugary drink that doesn't taste real good and have several more blood
tests over the next few hours. In my opinion. you shouldn't put this off. In the mean time,
you have to make the changes we discussed in your diet. If this is diabetes. the same dietary
changes we've discussed will be needed to deal with the condition.
POSITIVE
Your urinalysis showed you tested positive for glucose. It's not very high but the fact
that you're still feeling tired and you are urinating more frequently may indicate a mild
diabetes condition. I think it's time we do some screening tests for diabetes. We both want
to find out what could be causing you to feel so run down so I'd like you to make an
appointment to have a glucose tolerance test and a hemoglobin Al C which will show us how
high your sugar has been running. You'll need to block off a whole day in your schedule to
have these tests done. Your schedule this week is very busy so schedule an appointment early
next week. You'll need to fast the day before. When you come in for the test, they'll start
by taking a blood sample and then you will drink a sugary drink that doesn't taste real good
and have several more blood tests over the next few hours. I realize these teste; sound
inconvenient. but I know you'll try to fit them into your schedule and be glad you did. In the
mean time, you have to make the changes we discussed in your diet. If this is diabetes. don't
worry. you're going to be okay as long as you stick to the same dietary changes you've been
working so hard on already.
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NEGATIVE
Your urinalysis showed you tested positive for glucose. It's not
very high but the fact that you're still feeling tired and you're urinating more frequently may
indicate a mild diabetes condition. I think it's time we do some screening tests for diabetes.
And I'm not going to debate with you on this one -- you have to have these tests done. I'd
like you to make an appointment to have a glucose tolerance test and a hemoglobin Ale
which will show us how high your sugar has been running. You'll need to block off a whole
day in your schedule to have these t~sts done. Your schedule this week is very busy so
schedule an appointment early next week. You'll need to fast the day before. When you
come in for the test, they'll start by taking a blood sample and then you will drink a sugary
drink that doesn't taste real good and have several more blood tests over the next few hours.
If you don't have these tests done immediately you could end up with a very serious situation
and wish you had taken the time out of your· schedule. In the mean time, you have to make
the changes we discussed in your diet. If this is diabetes, the solution is generally guite
simple -- stick to your diet.
SESSION 5
NEUTRAL
Some of your test results came back positive. Glucose was basically normal but your
hemoglobin Ale was slightly higher than normal. What this means is you have mild diabetes
or what's sometimes called prediabetes. Now mild diabetes isn't serious -- you don't have to
inject yourself with insulin - but you. do need to monitor your diet as we've talked about so
you don't feel run down and tired all the time. Since research indicates that diet is key in
your situation, I want you to keep a log of your eating habits. I'm going to give you a
special book which will help you keep track of what you're eating. Okay? Make sure you're
176
keeping an accurate log of your eating patterns. And think about what we've already talked
about. The food choices the dietitian discussed with you and the recommendations to avoid
sweets and eat a high fiber diet are necessary to keep diabetes under control. Do you have
any questions?
POSITIVE
Some of your test results came back positive. Glucose was basically normal but your
hemoglobin A 1 C was slightly higher than normal. What this means is you have mild diabetes
or what's sometimes called prediabetes. Now mild diabetes isn't serious -- you don't have to
inject yourself with insulin -- but you do need to monitor your diet as we've talked about so
you don't feel run down and tired all the time. I can tell you've been trying really hard to
change your diet -- now if you can just take the extra step and eliminate all the foods we
discussed you will feel better. I'm going to give you a special book which will help you keep
a log of what you're eating. Make sure you keep an accurate log so we can see all the
wonderful progress you are making on your diet. And think about what we've already talked
about. I know it's difficult. but I want to see you feeling good everyday. so please avoid
sweets and eat ~ high fiber diet like the dietitian discussed. Do you have any questions?
NEGATIVE
Some of your test results came back positive. Glucose was basically normal but your
hemoglobin A1C was slightly higher than normal. What this means is you have mild diabetes
or what's sometimes called prediabetes. Now mild diabetes isn't serious -- you don't have to
inject yourself with insulin - but you do need to monitor your diet as we've talked about so
you don't feel run down and tired all the time. You can't keep fooling around with your diet
-- a responsible person would know that now is the time to take charge and make all the
changes necessary. I'm going to give you a special book which will help you keep a log of
177
what you're eating. Make sure you keep an accurate log so you can note when you aren't
sticking to your diet. And think about what we've already talked about. If you want to make
sure you don't end up with a serious problem later in life it's as simple as ABC -- change
your eating habits. Do you have any questions?
SESSION 6
NEUTRAL
I reviewed your lab tests and there's no serious problem with them. It all comes
down to your eating habits. In looking over your dietary log it's clear that you're diet is
good some days but at other times you're eating a lot of junk food. You need to change your
present eating habits. First, I want you to include more nutritional, high fiber foods in your
diet. Second, you need to reduce the amount of high caloric, less nutritional foods you're
presently eating. If you want to snack, eat fruits and vegetables, but avoid the junk foods
you've been eating. I've seen individuals who are in your same situation and eating habits are
generally key. You told me that you enjoy going for an occasional walk. I'd like you to
continue going for walks and work towards a more regular exercise schedule. I want you to
start exercising regularly and continue keeping a dietary log since all the best sources indicate
that dietary changes and exercise in these situations are necessary. Do you understand
everything we've talked about? Okay.
POSITIVE
I reviewed your lab tests and there's no serious problem with them. It all comes
down to your eating habits. In looking Over your dietary log it's clear that you're diet is
good some days but at other times you're eating a lot of junk food. We both want you to get
better. so please eat right everyday. Okay? First, I want you to include more nutritional,
high tiber foods in your diet. Second, you need to reduce the amount of high caloric, less
178
nutritional foods you're eating. If you want to snack, eat fruits and vegetables, but avoid the
junk foods you've been eating. I care about you a great deal and want to see you get better.
so make sure that you make these changes in your eating habits. You told me that you enjoy
going for an occasional walk. I'd like you to continue going for walks and work towards a
more regular exercise schedule. If you make these changes -- which I know you can -
everyone will be so proud of you because we all know how difficult it is to make these
changes. Do you understand everything we've talked about? Okay.
NEGATIVE
I reviewed your lab tests and there's no serious problem with them. It all comes
down to your eating habits. In looking over the dietary log it's clear that you're diet is
good some days but at other times you're eating a lot of junk food. There's no douht about
it. You must eat right everyday -- not just occasionally -- to get better. First, I want you to
include more nutritional, high fiber foods in your diet. Second, you need to reduce the
amount of high caloric, less nutritional foods you're eating. If you want to snack, eat fruits
and vegetables, but avoid the junk foods you've been eating. If you won't follow this advice
you're going to continue to feel run down and tired -- it's that simple. You told me that you
go for an occasional walk which you enjoy doing. I'd like you to continue going for walks
and work towards a more regular exercise schedule. There's not a reason in the world why
you shouldn't change your eating habits and exercise regularly. Do you understand
everything we've talked about? Okay.
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APPENDIX C
Manipulation Check Instrument
Instructions: Based on the scenario you just read, please indicate how strongly you disagree or agree with each of the statements below by circling the appropriate number.
Strongly Strongly Disagree Neutral Agree
1. I w9u1d like being told this. 2 3 4 5 6 7
2. The physician was very disappointed in the patient. 2 3 4 5 6 7
3. I would enjoy my interaction with the physician if the physician communicated with me this way. 2 3 4 5 6 7
4. The physician showed clear signs of disapproval. 2 3 4 5 6 7
5. The physician seemed very frustrated with the patient 2 3 4 5 6 7
Based on the scenario you just read, how would you rate the physician's communication:
very undesirable 1 2 3 4 5 6 7 very desirable
very unrewarding 1 2 3 4 5 6 7 very rewarding
very unpleasant 1 2 3 4 5 6 7 very pleasant
very distasteful 1 2 3 4 5 6 7 very enjoyable
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APPENDIX D
Study 1 Consent Form
Purpose and Benefits
This project is designed to gather information about the ways in which doctors communicate with their patients. Specifically, health researchers in the Department of Communication at the University of Arizona are interested in examining how people make evaluations about doctors' communication styles in the clinical setting. The information you provide will help researchers understand how health care providers may more effectively communicate with their patients to improve patient care.
Procedures
You will be asked to watch a video which contains an actual physician-patient consultation session. While viewing the video, you will be instructed to imagine yourself as the patient the physician is consulting. After watching the video you will be asked a number of questions concerning the physician you observed and your feelings as a patient.
The physician-patient interaction and questions will all be on a computer. A researcher will show you how to use the computer and will also assist you during the project if you have any difficulty reading or understanding the questions. Most people find using the computer for this project both easy and enjoyable. Your names will not be linked to the answer you supply in the computer so all answers will be anonymous. The study will take approximately 10 minutes to complete. You may refuse to participate or may withdraw from the study at any time without upsetting the researcher.
Risks. Stress. and Discomfort
You will not incur any physical risks by participating in this study. You will not be asked questions of a personal nature and participation should not result in any discomfort.
Confidentiality
Only researchers from the Communication Department at the University of Arizona will have access to your answers and your name will not be linked with the answers you choose. Hospitals will receive a summary of the study in statistical form but will not see individual answers.
Principle Investigator
Renee S. Klingle 621-1366
Subject's Statement
"The study described about has been explained to me. I voluntarily consent to participate in this activity. I understand that any questions I may have about the research or about my rights as a subject will be answered by the investigator listed above or the research assistant running the study. "
Signature of Subject Date
APPENDIX E
Computer Instructions
If you would like instructions for using the computer mouse, please press the letter "Y" on the keyboard.
If not, click on the "Begin" button below.
BEGIN
[new screen page]
181
During the next few minutes, you will be asked to answer a few questions regarding your opinion about certain topics. Before we begin, however, we must be sure you know how to operate the program. Please use the mouse to point to the cursor arrow (it looks like this ) at the box below labeled "Click Here." Then briefly press and release the left mouse button (this is called "clicking on a button").
If you do not understand these directions, please ask the facilitator for assistance.
CLICK HERE
[new screen page]
Good! if you prefer to use the keyboard, you can press the Enter key to continue on any screen. Press the Enter key or click on the button below to continue.
CONTINUE
[new screen page]
Most of the time you will be asked to indicate how much you agree with a statement. In this case, we use the scale below. To register your opinion, click the left mouse button while pointing the cursor arrow at the appropriate place on the scale. Try it now.
Or you can use the right and left arrow keys of the computer keyboard to adjust the marker on the scale. Try it below. When you are done, click on the "Continue" button below (or press the ENTER key).
Sample: I am comfortable using co~put~rs (indicate your agreement below).
Strongly 1 ___ 1 ___ 1 ___ 1 ___ 1 ___ 1 ____ 1
Disagree
Indicate your opinion by clicking on the scale line.
Strongly Agree
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[new screen page]
It looks like you've got it. One important thing to remember, however, is that once you click on "Continue" for any screen, you will not be able to return to change your answer. However, until you click on the continue button, you can change your opinion on the scale as many times as you like. When you are ready to continue, click on the button below (or press ENTER).
CONTINUE
[new screen page]
In a minute 'you will be asked to view a segment of video. To make sure that the videodisc is working properly, put on the earphones now and then click on the "Test video" button below. You should see the image on the television screen next to the computer monitor.
TEST VIDEO
Did you see a picture on the television monitor and hear the audio?
YES NO TEST VIDEO AGAIN
183
APPENDIX F
Single Session Instrument: Study 1 and Study 2 (Part B)
Introduction to Study 1
This project is designed to gather information about the ways in which doctors communicate with their patients. Specifically, health researchers in the Department of Communication at the University of Arizona are interested in examining how people make evaluations about doctors' communication styles in the clinical setting.
Introduction to Video Segment for Study 1 and Study 2 (Part B)
You will be watching [Study 1: "a" /Study 2B: "one more"] videotaped physician-patient consultation session. After the segment, we will ask you a series of questions. In this session the patient has consulted Dr: Jones because the patient has not felt very well for a couple of weeks. Dr. Jones is a primary care physician who has been practicing medicine in a large southwestern city for a number of years. The patient's dialogue has been excluded so that you can more easily imagine yourself taking part in this consultation.
We ask that you imagine yourself as Dr. Jones' patient as you watch this videotaped segment. When you are ready to watch the consultation session, click on the button below.
Study 1 and Study 2 (Part B) Questionnaire
The questions you will be asked on the next few screens concern the video you just watched and your feelings as Dr. Jones' patient. The questions are worded as if you were actually the patient who visited Dr. Jones. Think carefully about how you would actually feel and what you would actually do as Dr. Jones' patient.
For each screen, you will be presented with a statement about the consultation session you just viewed. Please indicate how much you agree with the statement by clicking on the point of the scale that most closely approximates where your opinion falls in relation to the extremes of the scale.
*1. Dr. Jones' arguments in this session were very convincing.
Strongly Disagree
1---1---1---1---1---1---1 Strongly Agree
2. I would try very hard to follow the advice Dr. Jones gave in this session.
Strongly Disagree
1---1---1---1---1---1---1 Strongly Agree
3. I would be motivated to change my behavior.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
184
4. In this session, Dr. Jones used effective strategies to get me to change my behavior.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
*5. I would have confidence in Dr. Jones' abilities as a physician.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
6. If Dr. Jones used these strategies on me, I would change my eating habits.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
*7. I would follow Dr. Jones' advice.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
8. Dr. Jones convinced me to change my behavior.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
9. I would try very hard to please Dr. Jones by following her advice.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
*10. Dr. Jones caused me to think about my behavior very much.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
11. In this visit, Dr. Iones used effective strategies to persuade me.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
185
The following statements concern your feelings about Dr. Jones. Once again, please indicate where your opinion falls in relation to the extremes.
12. Dr. Jones seemed experienced in dealing with patients' problems.
Strongly Disagree
1---1---1---1---1---1---1 Strongly Agree
*13. Dr. Jones did not take my problems as a patient seriously.
Strongly Disagree
1---1---1---1---1---1---1
14. Dr. 'Jones is a very competent physician.
Strongly Disagree
1---1---" 1 ___ 1 ___ 1 ___ 1 ___ 1
Strongly Agree
Strongly Agree
* 15. There are some things about the way Dr. Jones communicated that could have been better.
Strongly Disagree
1---1---1---1---1---1---1 Strongly Agree
16. I am perfectly satisfied with the care I just received from Dr. Jones.
Strongly Disagree
1---1---1---1---1---1---1
17. I would feel much better after this visit with Dr. Jones.
Strongly Disagree
1---1---1---1---1---1---1
*18. Dr. Jones was friendly in this visit.
Strongly Disagree
1---1---1---1---1---1---1
19. I would have confidence in Dr. Jones.
Strongly Disagree
1---1---" 1 ___ " 1 ___ 1 ___ 1 ___ 1
Strongly Agree
Strongly Agree
Strongly Agree
Strongly Agree
20. Dr. Jones seemed devoted to me as a patient.
Strongly Disagree
1---1---1---1---1---1---1 Strongly Agree
186
21. I think if I were really a patient, this visit with Dr. Jones would have relieved my worries about the problem.
Strongly Disagree
1---1---1---1---1---1---1
22. Dr. Jones is good at dealing with patients.
Strongly Disagree
1---1---1---1---1---1---1
Strongly Agree
Strongly Agree
23. I would trust Dr. Jones to deal with my medical problems.
Strongly Disagree
1---1---1---1---1---1---1
24. This visit made me feel understood by Dr. Jones.
Strongly Disagree
1---1---1---1---1---1---1
Strongly Agree
Strongly Agree
25. I was very satisfied with Dr. Jones' style of communication in this session.
Strongly Disagree
1---1---1---1---1---1---1 Strongly Agree
26. How would you rate Dr. lones' interaction with the patient on a scale ranging from very inappropriate to very appropriate?
*27. How would you rate Dr. lones' interaction with the patient on a scale ranging from very unprofessional to very professional?
Very Unprofessional
1---1---1---1---1---1---1 Very Professional
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28. How would you rate Dr. Jones' interaction with the patient on a scale ranging from very pleasant to very unpleasant?
Very Unpleasant
1 ___ 1 ___ 1 ___ 1_1 ___ 1 ___ 1 Very Pleasant
29. How would you rate Dr. Jones' interaction with the patient on a scale ranging from very unenjoyable to very enjoyable?
Very Unenjoyable
1 ___ 1 ___ 1 ___ 1_1_1_1 Very Enjoyable
30. How would you rate Dr. Jones' interaction with the patient on a scale ranging from very undesirable to very desirable?
Very Undesirable
1_1_· 1_1_1_1_1 Very Desirable
The following questions also ask you to consider the way Dr. Jones interacted with the patient. Once again, please indicate on the scale where your opinion falls.
31. I think it is normal for Dr . Jones to respond to a patient this way.
Strongly Disagree
1_1_1_1_1_1_1
32. This would be Dr. Jones' way of showing concern.
Strongly Disagree
1_1_1_1_1_1_1
33. Dr. Jones interacted with me the way I liked.
Strongly Disagree
1---1_1_1_1_1_1
Strongly Agree
Strongly Agree
Strongly Agree
34. Dr. Jones' communication style during this visit is what I anticipated.
Strongly Disagree
1---1---1_1_1_1---1 Strongly Agree
35. If I were the patient, I would object to the manner in which Dr. Jones talked to me.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
36. Dr. Jones acted like I wasn't trying hard enough to change my health problem.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
37. Telling me this shows Dr. Jones cares about me as a patient.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
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38. If I were the patient, I would think Dr. Jones was annoyed with me during this visit.
49. If I were actually the patient I would be convinced that following the physician's suggestions would make me feel much better.
Strongly Disagree
1_1_1_1 ____ 1 ____ 1_1 Strongly Agree
50. This patient probably doesn't make the changes the physician recommends.
Strongly Disagree
1_1 ____ 1 ____ 1 ____ 1 ____ 1_1 Strongly Agree
51. I don't think this patient generally follows the physician's advice.
Strongly Disagree
1_1 ____ 1 ____ 1 ____ 1 ____ 1_1 Strongly Agree
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This last set of questions is very short. Here we ask you for some background information about yourself. These questions are just to see if our sample is like the general population. Please indicate the appropriate response by clicking on the button that corresponds to your answer, then clicking the "continue" button. Keep in mind that your answers are strictly confidential.
1. Has your physician ever recommended that you make changes in your diet?
YES NO
190
2. What condition was your physician trying to treat or prevent when recommending the dietary changes?
DIABETES/HYPERGLYCEMIA WEIGHT PROBLEM
HEART DISEASE ULCER/DIGESTIVE PROBLEM
CANCER OTHER
3. Have you ever found it difficult to follow your physician's recommendations?
YES NO
4. How important do you think it is for you to change your present eating habits?
Not at all 1_1_1_1_1_1_1 Very important
5. How often have you tried to change your eating habits?
Never 1_1_1_1_1_1_1 Very often
6. How much would you like to change your present eating habits?
Not at all 1_1_1_1_1_1_1 Very much
7. How difficult is it for you to follow a physician's advice when it requires you to make a change in your lifestyle?
Not at all 1_1_1_1_1_1_1 Very difficult
8. How similar was the patient's situation to those you have experienced?
Not at all 1_1_1_1_1_1_1 Very similar
9. Have you ever visited the physician(s) you saw in the video?
YES NO
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to. Who do you primarily visit for your health care needs?
A MALE PHYSICIAN A FEMALE PHYSICIAN I VISIT BOTH OTHER
11. Approximately how many days each year do you visit a physician?
LESS THAN 2 2 - 5 DAYS 6 - 10 DAYS 11 - 20 DAYS MORE THAN 20 DAYS
12. What is your gender?
FEMALE MALE
13. What is your age group?
LESS THAN 20 YEARS OLD 41-50 YEARS OLD
20-30 YEARS OLD 51-60 YEARS OLD
31-40 YEARS OLD OVER 60 YEARS OLD
14. What is the highest education level of schooling you have completed?
LESS THAN HIGH SCHOOL TRADE SCHOOLl2 YEAR COLLEGE
HIGH SCHOOL GRADUATE 4 COLLEGE PROGRAM
SOME COLLEGE GRADUATE DEGREE
15. How would you describe your ethnic background?
AFRICAN AMERICAN HISPANIC
AMERICAN INDIAN WHITE/ANGLO
ASIAN/PACIFIC ISLANDER OTHER
16. What was your estimated annual household income before taxes last year?
* Note:
LESS THAN $10,000
$10,001 - $15,000
$15,001 - 20,000
$20,001 - 30,000
$30,001 - 45,000
MORE THAN $45,000
You have finished the survey. Thank you for your help.
These items did not discriminate well and were omitted from Study 2 to shorten the survey.
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APPENDIX G
Study 2 Consent Form
Pumose and Benefits
This project is designed to gather infonnation about the ways in which doctors communicate with their patients. Specifically, health researchers in the Department of Communication at the University of Arizona are interested in examining how people make evaluations about doctors' communication styles in the clinical setting. The infonnation you provide will help researchers understand how health care providers may more effectively communicate with their patients to improve patient care.
Procedures
You will be asked to watch a computer videodisc which contains episodes from actual physician-patient consultation sessions. While viewing the video, you will be instructed to imagine yourself as the patient the physician is consulting. Following the video you will be asked a number of questions concerning the physician you observed and your feelings as a patient. You will then be asked to view one final consultation session nd asked to answer several more questions regarding the physician depicted in the tape.
The physician-patient interaction and questions will all be on a computer. A researcher will show you how to use the computer and will also assist you during the project if you have any difficulty reading or understanding the questions. Most people find using the computer for this project both easy and enjoyable. Your names will not be linked to the answer you supply in the computer so all answers will be anonymous. The study will take approximately 25 minutes to complete. You may refuse to participate or may withdraw from the study at any time without upsetting the researcher.
Risks. Stress, and Discomfort
You will not incur any physical risks by participating in this study. You will not be asked questions of a personal nature and participation should not result in any discomfort.
Confidentiality
Only researchers from the Communication Department at the University of Arizona will have access to your answers and your name will not be linked with the answers you choose. Hospitals will receive a summary of the study in statistical fonn but will not see individual answers.
Principle Investigator
Renee S. Klingle 621-1366
Subject's Statement
"The study described about has been explained to me. I voluntarily consent to participate in this activity. I understand that any questions I may have about the research or about my rights as a subject will be answered by the investigator listed above or the research assistant running the study. "
Signature of Subject Date
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APPENDIX H
Over Time Instrument: Study 2 (Part A)
Introduction to Study 2 (Part A)
This project is designed to gather information about the ways in which doctors communicate with their patients. Specifically, health researchers in the Department of Communication at the University of Arizona are interested in examining how people make evaluations about doctors' communication styles in the clinical setting.
Introduction to Video Segments
The video you are about to watch contains several episodes of actual physician-patient consultation sessions.
Each episode involves Dr. Jones and a patient she has been seeing for a number of years. Dr. Jones is a primary care physician who has been practicing medicine in a large southwestern city for a number of years. The patient's dialogue has generally been excluded from the videotape and the session has been edited because we would like you to imagine yourself as the patient in each situation. As you watch each segment, please imagine yourself as Dr. Jones' patient.
First Episode:
Second Episode:
Third Episode:
Fourth Episode:
Fifth Episode:
In this first segment, the patient has gone to see Dr. Jones because the patient had been tired, rundown, and generally not feeling very well for a couple of weeks. The following conversation took place at the end of this consultation.
One week later, the following discussion took place ....
Several months later, the patient returns complaining that the condition does not seem to be getting better. Like many patients, the patient has not been able to make all the dietary changes that had been suggested.
During an annual physical, the following conversation took place ....
And one week later, the following conversation took place ....
Study 2 (Part A) Ouestionnaire
The questions you will be asked on the next few screens concern the video you just watched and your feelings as Dr. Jones' patient. The questions are worded as if you were actually the patient who has been visiting Dr. Jones. Think carefully about how you would actually feel and what you would actually do as Dr. Jones' patient.
194
For each screen, you will be presented with a statement about the consultation sessions you just viewed. Please indicate how much you agree with the statement by clicking- on the point on the scale that most closely approximates where your opinion falls in relation to the extremes of the scale.
1. I would try very hard to please Dr. Jones.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
*2. I would see the dietitian Dr. Jones' recommended.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
*3. I would follow Dr. Jones' advice to keep a log of my eating habits.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
4. Dr. Jones used effective strategies to persuade me to follow her recommendations.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
5. Dr. Jones made me want to change my behavior.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
*6. I would be motivated to change my behavior.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
7. I would think of Dr. Jones whenever I was tempted to cheat on my diet.
Strongly Disagree
1_1_1_1 __ 1_1_1 Strongly Agree
*8. I would follow Dr. Jones' advice.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
9. If a physician used these strategies on me, I would change my eating habits.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
10. Dr. Jones used effective strategies to get me to change my behavior.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
11. Dr. Jones was a very motivating physician.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
12. Dr. Jones caused me to think about my behavior very much.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
13. Dr. Jones' arguments were very convincing.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
*14. I would be willing to make changes in my behavior for Dr. Jones even if it was inconvenient for me.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
*15. I would try hard to win Dr. Jones' approval.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
16. I think I would make all the changes Dr. Jones recommended.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
17. Dr. Jones convinced me to cbangemy behaviors.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
195
196
Again, these questions concern the video you just watched. Please indicate what your feeling would be if you were actually the patient who had been visiting Dr. Jones.
18. I am perfectly satisfied with the care I have received from Dr. Jones.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
*19. Dr. Jones was friendly.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
20. I was very satisfied with Dr. Jones' style of communication.
Strongly Disagree
1_1_' 1_1_1_1_1 Strongly Agree
21. I would feel understood as a patient of Dr. Jones.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
22. Dr. Jones would have relieved my worries about my problems.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
23. Dr. Jones cared about me as a patient.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
*24. There are some things about the way Dr. Jones communicated that could have been better.
Strongly Disagree
1_1_1_1_1 __ 1_1 Strongly Agree
*25. My problems, as a patient, were not taken seriously by Dr. Jones.
Strongly Disagree
1_1_1_' 1_1_1_1 Strongly Agree
26. Dr. Jones showed concern for me.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
27. I would feel much better after each visit with Dr. Jones.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
28. Dr. Jones is devoted to me as a patient.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
*29. Dr. Jones is a very competent physician.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
30. I would have confidence in Dr. Jones' abilities as a physician.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
31. I would trust Dr. Jones to deal with my medical problems.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
32. Dr. Jones seemed experienced in dealing with patients' problems.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
33. Dr. Jones is good at dealing with patients.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
197
198
The following questions are designed to assess your reactions to the situation you were asked to imagine yourself participating in. Again, please indicate your level of agreement or disagreement with the following screens.
34. I could put myself in the patient's shoes.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
35. Dr. Jones would give the patient a compliment if the patient deserved one.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
36. I could actually imagine myself as Dr. Jones' patient.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
37. I think a patient's behavior affects Dr. Jones' communication style.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
38. It would be easy to follow Dr. Jones' recommendations.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
*39. I think Dr. Jones would be very disappointed in me if I didn't follow the suggestions given.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
40. People can change Dr. Jones' communication behavior towards them by following or not following the advice given.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
41. I think it would be difficult to actually make the changes Dr. Jones suggested.
Strongly Disagree
1_1_1_1_1_1_1 Strongly Agree
*Note: These items did not discriminate well and were omitted from Study 2 to shorten the survey.
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APPENDIX I
Individual Scale Items
STUDY 1 AND STUDY 2 (PART B) SCALES Persuasiveness Scale
Motivation to Comply Items
1. I would be motivated to cbange my behavior
... 2. Dr. Jones caused me to think about my behavior very much.
3. I would try very hard to follow the advice Dr. Jones gave in this session.
4. I would try very bard to please Dr. Jones by following her advice.
Likelihood of Compliance Items
5. If Dr. Jones used these strategies on me, I would change my eating habits.
* 6. I would follow Dr. Jones' advice.
Physician Perceived Persuasiveness Items
... 7. Dr. Jones' arguments in this session were very convincing.
8. In this session, Dr. Jones used effective strategies to get me to change my behavior
9. Dr. Jones convinced me to change my behavior.
10. In this visit, Dr. Jones used effective strategies to persuade me.
Patient Satisfaction Scale
Affective Satisfaction Items
... 1. Dr. Jones did not take my problems as a patient seriously.
2. I would feel much better after this visit with Dr. Jones .
... 3. Dr. Jones was friendly in this visit.
4. I think if I were really a patient, this visit with Dr. Jones would have relieved my worries about the problem.
5. This visit made me feel understood by Dr. Jones.
6. I am perfectly satisfied with the care I just received from Dr. Jones.
200
Communication Satisfaction Items
* 7. There are some things about the way Dr. Jones communicated that could have been better.
8. I was very satisfied with Dr. Jones' style of communication in this session.
Physician Perception Scale
1. Dr. Jones seemed experienced in dealing with patients' problems.
2. Dr. Jones is a very competent physician.
3. Dr. Jones is good at dealing with patients.
4. I would trust Dr. Jones to deal with my medical problems.
5. I would have confidence in Dr. Jones' abilities as a physician.
6. Dr. Jones seemed devoted to me as a patient.
Communication Appropriateness Scale
1. How would you rate Dr. Jones' interaction with the patient on a scale ranging from very inappropriate to very appropriate?
* 2. How would you rate Dr. Jones' interaction with the patient on a scale ranging from very unprofessional to very professional?
3. If I were a patient, I would object to the manner in which Dr. Jones talked to me.
Communication Expectancy Scale
1. I think it is normal for Dr. Jones to respond to a patient this way.
2. Dr. Jones' communication style during this visit is what I anticipated.
3. I did not expect Dr. Jones to communicate this way.
Communication Valence Scale
1. How would you rate Dr. Jones' interaction with the patient on a scale ranging from very pleasant to very unpleasant?
2. How would you rate Dr. Jones' interaction with the patient on a scale ranging from very unenjoyable to very enjoyable?
3. Dr. Jones interacted with me the way I liked.
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Communication Valence Scale (continued)
4. How would you rate Dr. Jones' interaction with the patient on a scale ranging from very undesirable to very desirable?
Approval Scale
I. Dr. Jones acted like I wasn't trying hard enough to change my health problem.
2. If I were the patient. I would think Dr. Jones was annoyed with me during this visit.
3. I get the impression that Dr. Jones has faith that the patient will follow the advice given.
Affect Scale
I. This would be Dr. Jones' way of showing concern.
2. Telling me this shows Dr. Jones cares about me as a patient.
3. Dr. Jones seemed very concerned about me.
Situational Perception Scales
Prior Contact Items
1. It seemed like this was one of the first times the patient had visited Dr. Jones.
2. The physician has probably seen this patient a number of times.
Severity of Illness Items
1. It seemed like the patient's health problem was very serious.
2. I would consider this a serious medical problem if I were the patient.
Previous Noncompliance Items
1. This patient probably doesn't make the changes the physician recommends.
2. I don't think this patient generally follows the physician's advice.
Confidence in Physician's Recommendations Itemli
1. I felt confident that the physician's recommendations would solve the patient's problems.
2. If I were actually the patient I would be convinced that following the physician's suggestions would make me feel much better.
Personal Relevancy Scales
Identification with Patient Items
1. I could put myself in the patient's shoes.
2. I could actually imagine myself as Dr. Jones' patient.
Relevancy of Physician'S Advice
1. How important do you think it is for you to change your present eating habits?
2 How often have you tried to change your eating habits?
3. How much would you like to change your present eating habits?
STUDY 2 (pART A) SCALES
Overall Persuasiveness Scale
Motivation to Comply Items
1. I would try very hard to please Dr. Jones.
2. Dr. Jones made me want to change my behavior.
* 3. I would be motivated to change my behavior.
4. Dr. Jones was a very motivating physician.
5. Dr. Jones caused me to think about my behavior very much.
* 6. I would try hard to win Dr. Jones' approval.
Likelihood of Compliance Items
* 7.
* 8.
* 9.
* 10.
11.
12.
I would see the dietitian Dr. Jones' recommended.
I would follow Dr. Jones' advice to keep a log of my eating habits.
I would follow Dr. Jones' advice.
I would be willing to make cbanges in my behavior for Dr. Jones ~ if it was inconvenient for me.
If a physician used these strategies on me, I would change my eating habits.
I think I would make all the changes Dr. Jones reconmlended.
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203
Physician Perceived Persuasiveness Items
13. Dr. Jones used effective strategies to persuade me to follow her recommendations.
14. I would think of Dr. Jones whenever I was tempted to cheat on my diet.
15. Dr. Jones used effective strategies to get me to change my behavior.
16. Dr. Jones' arguments were very convincing.
17. Dr. Jones convinced me to change my behaviors.
Overall Patient Satisfaction Scale
Affective Satisfaction Items
* 1. My problems, as a patient, were not taken seriously by Dr. Jones.
2. I would feel much better after each visit with Dr. Jones.
* 3. Dr. Jones was friendly.
4. Dr. Jones would have relieved my worries about my problems.
5. I would feel understood as a patient of Dr. Jones.
6. I am perfectly satisfied with the care I have received from Dr. Jones.
Communication Satisfaction Items
* 7. There are some things about the way Dr. Jones communicated that could have been better.
8. I was very satisfied with Dr. Jones' style of communication.
Physician Perception Scale
1. Dr. Jones seemed experienced in dealing with patients' problems.
* 2. Dr. Jones is a very competent physician.
3. Dr. Jones is good at dealing with patients.
4. I would trust Dr. Jones to deal with my medical problems.
5. I would have confidence in Dr. Jones' abilities as a physician.
6. Dr. Jones is devoted to me as a patient.
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Affect Scale
1. Dr. Jones cared about me as a patient.
2. Dr. Jones showed concern for me.
Reinforcement Expectations Scale
1. Dr. Jones would give the patient a compliment if the patient deserved one.
2. I think a patient's behavior affects Dr. Jones' communication style.
3. People can change Dr. Jones' communication behavior towards them by following or not following the advice given.
* 4. I think Dr. Jones would be very disappointed in me if I didn't follow the suggestions given.
Perceived Compliance Difficulty Items
1. It would be easy to follow Dr. Jones' recommendations.
2. I think it would be difficult to actually make the changes Dr. Jones suggested.
* Note: These items did not discriminate well and were omitted from Study 2 to shorten the surveyS
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APPENDIX J
Physician Characteristics Instrument for Episode 1
Instructions Prior to Video Viewing
This project is designed to gather information about the ways in which doctors communicate with their patients. Specifically, health researchers in the Department of Communication at the University of Arizona are interested in examining how people make evaluations about doctors' communication styles in the clinical setting.
You will be watching a videotaped physician-patient consultation session. After the segment, we will ask you a series of questions. In this session the patient has consulted Dr. Jones because the·patient has not felt very well for a couple of weeks. Dr. Jones is a primary care physician who has been practicing medicine in a large southwestern city for a number of years. The patient's dialogue has been excluded so that you can more easily imagine yourself taking part in this consultation.
We ask that you imagine yourself as Dr. Jones' patient as you watch this videotaped segment. When you are ready to watch the consultation session, click on the button below.
Instructions for Questionnaire
The questions you will be asked on the next few screens concern the video you just watched and your feelings as Dr. Jones' patient. The questions are worded as if you were actually the patient who visited Dr. Jones. Think carefully about how you would actually feel and what you would actually do as Dr. Jones' patient.
Credibility Scale
For each screen, you will be presented with a rating scale like the practice scale you saw earlier. Each scale uses two descriptive adjectives representing the extremes of a judgment about Dr. Jones. Please indicate the point on the scale that most clearly approximates where your opinion falls in relation to these extremes.
21. Based on the video you just watched, how would you rate the opportunity to consult with Dr. Jones in the future, from undesirable to desirable?
very undesirable 1 ___ 1 ___ 1 ___ 1_1 ___ 1 ___ 1 very desirable
22. Based on the video you just watched, how would you rate the opportunity to consult with Dr. Jones in the future, from unrewarding to rewarding?
very unrewarding 1 ___ 1 ___ 1_' _1 ___ 1_1 ___ 1 very rewarding
23. Based on the video you just watched, how would you rate the opportunity to consult with Dr. Jones in the future, from unpleasant to pleasant?
very unpleasant 1 ___ 1 ___ 1 ___ 1_1_1 ___ 1 very pleasant
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Physician Rewardingness Scale (continued)
24. Based on the video you just watched, how would you rate the opportunity to consult with Dr. Jones in the future, from distasteful to enjoyable?
very distasteful 1_1_1_1_1_1_1 enjoyable
Physician Attractiveness Scale
For the next few screens, you will be presented with a statement about the consultation session you just viewed. Please indicate how much you agree with the statement by clicking on the point of the scale that most closely approximates where your opinion falls in relation to the extremes of the scale.
25. I could discuss personal medical concerns with Dr. Jones.
Strongly Disagree
1_1_1_1---1_1_1
26. I think Dr. Jones could solve my medical problems.
Strongly Disagree
1_1_1_1---1---1---1
Strongly Agree
Strongly Agree
27. I could establish a friendly physician-patient relationship with Dr. Jones.
Strongly Disagree
1---1---1_1---1---1---1
28. I would like to have a physician like Dr. Jones.
Strongly Disagree
1---1---1---1---1---1_1
Strongly Agree
Strongly Agree
29. I would have confidence in Dr. Jones' abilities as a physician.
Strongly Disagree
1_1---1---1---1_1_1
30. Dr. Jones seems like a very competent physician.
Strongly Disagree
1_1---1_1---1---1_1
Strongly Agree
Strongly Agree
Physician Attractiveness Scale (continued)
31. I would find it difficult to talk to Dr. Jones.