Associations of patient health-related problem solving with disease control, emergency department visits, and hospitalizations in HIV and diabetes clinic samples

Felicia Hill-Briggs, Leigh Gemmell, Babul Kulkarni, Brendan Klick, Frederick L Brancati, Felicia Hill-Briggs, Leigh Gemmell, Babul Kulkarni, Brendan Klick, Frederick L Brancati

Abstract

Background: Patient problem solving and decision making are recognized as essential to effective self-management across multiple chronic diseases. However, a health-related problem-solving instrument that demonstrates sensitivity to disease control parameters in multiple diseases has not been established.

Objectives: To determine, in two disease samples, internal consistency and associations with disease control of the Health Problem-Solving Scale (HPSS), a 50-item measure with 7 subscales assessing effective and ineffective problem-solving approaches, learning from past experiences, and motivation/orientation.

Design: Cross-sectional study.

Participants: Outpatients from university-affiliated medical center HIV (N = 111) and diabetes mellitus (DM, N = 78) clinics.

Measurements: HPSS, CD4, hemoglobin A1c (HbA1c), and number of hospitalizations in the previous year and Emergency Department (ED) visits in the previous 6 months.

Results: Administration time for the HPSS ranged from 5 to 10 minutes. Cronbach's alpha for the total HPSS was 0.86 and 0.89 for HIV and DM, respectively. Higher total scores (better problem solving) were associated with higher CD4 and fewer hospitalizations in HIV and lower HbA1c and fewer ED visits in DM. Health Problem-Solving Scale subscales representing negative problem-solving approaches were consistently associated with more hospitalizations (HIV, DM) and ED visits (DM).

Conclusions: The HPSS may identify problem-solving difficulties with disease self-management and assess effectiveness of interventions targeting patient decision making in self-care.

Figures

Figure 1
Figure 1
Mean CD4 or HbA1c by HPSS total score quartiles for HIV and diabetes samples, respectively, with standard error bars. Quartile 1 (lowest HPSS total scores) represents least effective problem solving (EPS) and quartile 4 (highest HPSS total scores) represents most EPS. Health Problem-Solving Scale quartile ranges for the HIV sample are 10.5–16.1 (Q1), 16.2–20.7 (Q2), 20.8–22.9 (Q3), and 23.0–28.0 (Q4). Health Problem-Solving Scale quartile ranges for the DM sample are 10.5–18.5 (Q1), 18.6–21.8 (Q2), 21.9–23.6 (Q3), and 23.7–28.0 (Q4). CD4 count is significantly different between the first and fourth HPSS quartiles and the second and fourth HPSS quartiles in the HIV sample (both P < 0.05). HbA1c is significantly different between the first and third HPSS quartiles, first and fourth HPSS quartiles, and second and fourth HPSS quartiles in the diabetes sample (all P < 0.05). Analysis of variance overall F test, P = .09 in HIV and P = 0.005 in diabetes.

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