University of Hawai‘i at Manoa Department of Public Health Sciences, JABSOM Hyun-Hee Heo, MA

1. The Role of Response Efficacy on the Relationship between Cultural Orientation and Decision-Making Preference in the Patient-Physician Communication University of Hawai‘i at Manoa Department of Public Health Sciences, JABSOM Hyun-Hee Heo, MA * Preliminary

2. Does Patient Involvement matter? • Increasing patient involvement in health care via consensus-seeking and negotiation improves patient satisfaction and outcomes.

3. Theoretical Background • Patients who desire to get involved in the process of medical decision-making must overcome the high level of power distance . • Social cognitive theory may be applicable in the context of patient-physician communication • The patients’ beliefs about their participation (response efficacy) will enable patients to choose preferred decision-making strategies.

4. Rationale • As power distance between patients and physicians enlarge, patients’ confidence in effectively communicating with physicians (i.e., response efficacy) in the process of decision-making may decrease. • The patients’ confidence in the process of decision-making positively affects patients’ preference for participatory decision-making, whereas it negatively affects patients’ preferences for physician only decision-making.

5. Hypotheses • H1: The higher the power distance, the lower the level of response efficacy in patient-physician relationship. • H2: The higher the level of response efficacy, the higher the level of joint decision-making by patient and physician. • H3: The higher the level of response efficacy, the lower the level of physician only decision-making.

6. Measures • Power distance • Modified from Dorfman and Howell’s article (1988) • 5 items (α=.66) • * χ² (5) = 16.36, p =.006; GFI=.96; CFI=.86 • Patients’ beliefs of Participation (Response Efficacy) • Modified from Kim et al.’s article (2000) • 8 items (α=.79) • * χ² (20) = 102.96, p <.001; GFI=.83; CFI=.80

7. Measures, cont’d. Preference for Participation in Medical Decision-Making : Smith et al. (1994) Physician only decision-making 5 items (α=.70) * χ² (5) = 5.41, p =.37; GFI=.98; CFI=1.00 • Joint decision-making by physician and patient • 6 items (α=.88) * χ² (9) = 18.04, p =.04; GFI=.96; CFI=.98

8. Demographics (n=135) • Sex: Female (57%) • Age : M =23.7, SD = 7.73 (College students) • Ethnicity

9. Background Information • How many days each year do you visit a physician? • dfafd

10. Background Information, cont’d. • How often have you visited the physician in the last 30 days? • dfafd

11. Background Information, cont’d. • The problem(s) that usually make you visit a physician

12. Descriptive Statistics and Correlations Note. *p <.05 ; **p <.01.

13. Theoretical Path Model Joint Patient-physician − + − Power Distance Response Efficacy − + Physician 13

14. Path Analysis Joint Patient-physician −.07 .51* −.40* Power Distance Response Efficacy .03 .53* Physician Note. *p <.001; n=138. χ² (1) = 1.02, p =.31; RMSEA = .01 (90% CI =.00-.23); CFI=1.00 14

15. Path Analysis, Cont’d. Joint Patient-physician .51* Response Efficacy −.40* Power Distance .53* Physician Note. Non-significant paths are not shown. *p <.001; n=138. 15

16. Discussion • Patient-physician relationship is challenged by a significant power distance between physicians and patients. • Participatory decision-making depends on how patients perceive their participatory roles in the context of patient-physician communication (e.g., Is it beneficial for patients?). • The level of response efficacy mediates the level of power distance and the level of shared decision-making. • The level of power distance directly influences patients’ preference for unilateral physicians’ decision-making.

17. Implication • Knowing how cultural orientations and patients’ beliefs about involvement influence patients’ preferences for decision making will… • Shed light on how to produce culturally appropriate intervention programs designed to build collaborative medical practices . • Help physicians to establish strong patient-physician relationships from patient-oriented perspectives. • Guide medical policy makers to reconsider how to facilitate participatory decision-making through enabling patients to feel empowered.

18. Limitations and Future Research • College student samples may limit generalization of the present study. • The process of medical decision-making under serious disease conditions may differ. • Cross-sectional study • Dyadic relationships between patients and physicians may evolve over time. In the future research, the duration of the patient-physician interaction should be considered to assess the dynamics of their relationships.

19. Comments? Questions? • Thank you so much for listening! • Contact. hyunheeh@hawaii.edu