Understanding Reception of Advice About Antibiotics by Emerging Adults in Primary Care Settings
Restricted (Penn State Only)
- Author:
- Foley, Kasey
- Graduate Program:
- Communication Arts and Sciences
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- March 22, 2022
- Committee Members:
- Denise Solomon, Major Field Member
Kathleen Bieschke, Outside Unit & Field Member
Erina Macgeorge, Chair & Dissertation Advisor
Andrew High, Professor in Charge/Director of Graduate Studies
Rachel Smith, Major Field Member - Keywords:
- interpersonal communication
advice
provider-patient communication
clinician-patient communication
antibiotic resistance
antibiotic stewardship
primary care - Abstract:
- Antibiotic-resistant infections, fueled by unwarranted antibiotic prescribing, are an increasing threat to public health. Reducing overprescribing and promoting antibiotic stewardship requires patient perceptions and understanding of the utility of antibiotics. One hotspot for overprescribing is upper respiratory tract infections, for which the best treatment is often non-antibiotic symptom management advice. Guided by Advice Response Theory (Feng & MacGeorge, 2010; MacGeorge, Guntzviller, Hanasono, & Feng, 2016), my dissertation examines behaviors employed by primary care providers when offering symptom management advice for patients presenting with URI symptoms, with a focus on how clinician reason-giving (i.e., the ways in which clinicians support or argue for their advice) and advice quantity (i.e., the amount of advice) relate to visit outcomes. I conducted two studies – the second study is a replication and extension of the first. In Study 1, I utilized an observational study design to examine the influence of clinician symptom management advice on URI patients who were not prescribed antibiotics. Transcribed medical visits were coded for clinician advising behaviors (i.e., reason-giving and advice quantity) and associated with post-visit patient self-report outcomes. In Study 2, I employed a recall design to examine the impact of clinician symptom management advice on both URI patients who reported receiving an antibiotic and those who did not. Patients who had reported visiting a primary care clinician in the past 3 months for URI symptoms were asked, via an online survey, to recall their clinicians’ advising behaviors (i.e., reason-giving and advice quantity). These reported behaviors were associated with patient self-reported outcomes. Results from these two studies provide practical guidance to primary care clinicians on behaviors they can employ to optimize emerging adult patients’ responses to URI symptom management advice and point to opportunities for advancing theory about advice. Data from these dissertation studies offer evidence to support the claim that advisor behaviors affect recipient responses. Specifically, the arguments that advisors employ to support their advice, as well as the quantity of advice they provide, impact recipient evaluations in complex ways. Multiple reason types, including instruction provision and talk about the challenges or barriers to advice, emerged as particularly impactful advisor behaviors and their role should be considered in future theorizing on advice. Results from this dissertation with regard to the impact of advice quantity are mixed and add to the competing perspectives on the benefits of offering more than one piece of advice within a single interaction.