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? 2 o Increasing patient involvement in health care via consensus-seeking and negotiation improves patient satisfaction and outcomes.

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

4. Rationale 4 o 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. o 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 5 o H1: The higher the power distance, the lower the level of response efficacy in patient- physician relationship. o H2: The higher the level of response efficacy, the higher the level of joint decision-making by patient and physician. o H3: The higher the level of response efficacy, the lower the level of physician only decision-making.

6. Measures 6 o Power distance Modified from Dorfman and Howell’s article (1988) 5 items (α=.66) * χ² (5) = 16.36, p =.006; GFI=.96; CFI=.86 o 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. Joint decision-making by physician and patient 6 items (α=.88) * χ² (9) = 18.04, p =.04; GFI=.96; CFI=.98 Physician only decision- making 5 items (α=.70) * χ² (5) = 5.41, p =.37; GFI=.98; CFI=1.00 7

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

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

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

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

12. Descriptive Statistics and Correlations 12 VariablesMSD1234 1. Power distance 2.940.95___ 2. Response efficacy 5.500.96-.40**___ 3. Joint decision-making 3.940.97-.28**.54**___ 4. Physician decision-making 5.701.10.52**-.19*-.07___ Note. *p <.05 ; **p <.01.

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

14. 14 Path Analysis Power Distance −.40*.53* −.07.51*.03 Note. *p <.001; n=138. χ ² (1) = 1.02, p =.31; RMSEA =.01 (90% CI =.00-.23); CFI=1.00 Response Efficacy Joint Patient- physician Physician

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

16. Discussion 16 o Patient-physician relationship is challenged by a significant power distance between physicians and patients. o 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?). o The level of response efficacy mediates the level of power distance and the level of shared decision-making. o The level of power distance directly influences patients’ preference for unilateral physicians’ decision-making.

17. Implication 17 o 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 18 o College student samples may limit generalization of the present study. o The process of medical decision-making under serious disease conditions may differ. o Cross-sectional study o 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? 19 Thank you so much for listening! Contact. hyunheeh@hawaii.edu