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GPs asking patients to self-rate their health: a qualitative study
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
2015 (English)In: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 65, no 638, e624-e629 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In epidemiological research, self-rated health is an independent predictor of mortality, cardiovascular diseases, and other critical outcomes. It is recommended for clinical use, but research is lacking.

AIM: To investigate what happens in consultations when the question 'How would you assess your general health compared with others your own age?' is posed.

DESIGN AND SETTING: Authentic consultations with GPs at health centres in Sweden.

METHOD: Thirty-three planned visits concerning diabetes, pain, or undiagnosed symptoms were voice-recorded. Dialogue regarding self-rated health was transcribed verbatim and analysed using a systematic text condensation method. Speaking time of patients and doctors was measured and the doctors' assessment of the value of the question was documented in a short questionnaire.

RESULTS: Two overarching themes are used to describe patients' responses to the question. First, there was an immediate reaction, often expressing strong emotions, setting the tone of the dialogue and influencing the continued conversation. This was followed by reflection regarding their functional ability, management of illnesses and risks, and/or situation in life. The GPs maintained an attitude of active listening. They sometimes reported a slight increase in consultation time or feeling disturbed by the question, but mostly judged it as valuable, shedding additional light on the patients' situation and making it easier to discuss difficulties and resources. The patients' speaking time increased noticeably during this part of the consultation.

CONCLUSION: Asking patients to comparatively self-rate their health is an effective tool in general practice.

Place, publisher, year, edition, pages
British Journal of General Practice , 2015. Vol. 65, no 638, e624-e629 p.
National Category
Family Medicine
URN: urn:nbn:se:umu:diva-108085DOI: 10.3399/bjgp15X686557ISI: 000361840400009PubMedID: 26324500OAI: diva2:851073

Funding: County Council of Norrbotten (references NLL-302621; NLL-363851; NLL-300901).

Available from: 2015-09-03 Created: 2015-09-03 Last updated: 2015-11-06Bibliographically approved
In thesis
1. Self-rated health: from epidemiology to patient encounter
Open this publication in new window or tab >>Self-rated health: from epidemiology to patient encounter
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: In epidemiology self-rated health is often measured as people’s subjective answer to a question “How is your health in general?” or “How is your general health compared to persons of your own age?”. The answers have a strong association with significant medical outcomes such as death, diabetes, coronary heart disease, functional ability and depression, medical diagnoses and how these are perceived. The overarching aim of this thesis was to investigate if and how a use of the epidemiologists’ tool of self-rated health might aid GPs in practising medicine with a holistic perspective, contextually sensitive and taking into account the patients’ medical and personal histories.

Methods: In Paper I, I used semantics to elucidate the meaning of self-rated health. Data came from the Northern Sweden Monica Project 1990–1999. In Paper II, with data from the MONICA Project in 1999–2009, I used ordinal regression to investigate associations between self-rated health, medical factors, psychosocial factors and emotions. In Paper III, I used data from the Västerbotten Intervention Programme 1990–2004 in Cox regression analyses to investigate the relationship between self-rated health and standard risk factors for the outcome myocardial infarction. Paper IV is a qualitative study from seven primary care health centres. Actual consultations were audio-recorded and analysed with systematic text condensation, measuring apportionment of speaking time and by taking into account GPs’ assessments of using a question about comparative self-rated health in a consultation.

Results: In Paper I, I found “health” in questionnaires being understood not through definitions of health but through associations of the word “health” with “sense relations”, that are important connotations of the word “health”. Age-comparative self-rated health was semantically clearer as it pointed towards comparison with a reference group. In Paper II, emotions of anxiety or depression and discontent with personal economy were associated with lower self-rated health and were common in the population. Paper III established self-rated health as an independent risk factor for myocardial infarction when adjusted for standard risk factors. In the qualitative Paper IV, self-rated health affected consultations, increased patients’ speaking time in relation to doctors’ when discussing self-rated health and elicited reactions, sometimes with strong language. Reflections ensued that could give vivid descriptions of function, life circumstances and resources or obstacles in handling symptoms and illnesses.

Conclusion: Comparative self-rated health constitutes a feasible tool in general practice, particularly in taking account of patients’ medical and personal histories. It is holistic, sensitive to psychosocial factors. It is useful to solicit information on risk and the patient’s feelings related to an illness/disease, and to encourage the patient’s active reflection on functional abilities, life situation, health and health strategies. However, self-ratings are not to be seen as a standard procedure in all consultations.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2015. 73 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1756
National Category
Family Medicine
Research subject
Family Medicine
urn:nbn:se:umu:diva-109404 (URN)978-91-7601-337-3 (ISBN)
Public defence
2015-10-30, Aulan, Sunderby sjukhus, Luleå, 13:00 (Swedish)
Available from: 2015-10-02 Created: 2015-09-26 Last updated: 2015-10-01Bibliographically approved

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