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This chapter discusses challenges faced by older adult health-care consumers in obtaining access to responsive care from physicians relevant to a broad spectrum of health issues ranging from prevention to chronic illness and end-of-life care. Based on our prior research with community-dwelling elders (E. Kahana & B. Kahana, 2003, 2010), we propose a conceptual model of consumer self-advocacy for better access to effective health care in late life. We argue that older adults who are well informed and confident health-care partners and who involve their physicians in active dialogue will experience better care, and will be more satisfied with their health care. We present findings from our studies of cancer prevention and from our research focused on end-of-life care relevant to patient self-advocacy. We also discuss the role of educational interventions and of patient empowerment in facilitating greater access to responsive health communication and health care, particularly among elders who are disadvantaged and who have low health literacy.

Active interaction and knowledge contribution are vital yet challenging elements of the sustainable development of online health communities (OHCs). To investigate the cognitive mechanisms underlying these behaviours in doctors' and patients' use of OHCs, this study develops a theoretical model to examine the relationships among cognitive modes, patterns of interaction, perceived usefulness, and contribution behaviour and the impact of user identity on these relationships.

To test the research hypotheses, structural equation modelling and multiple-group analysis were used to analyse survey data from 207 doctors and 213 patients.

The results indicate that dual processes and perceived usefulness are the key cognitive antecedents of interaction and knowledge contribution, respectively. However, the correlation of the rational mode and instrumental interaction is significantly stronger in the doctors' group than in the patients' group, while a stronger correlation between the experiential mode and instrumental interaction is observed in the patients' group.

These findings support the development of information and system strategies to support the operation of dual processes underlying doctors' and patients' instrumental and affective interactions, facilitate evaluation and sense-making of interaction activities, and motivate knowledge contribution.

This study uncovers the invariance and variability in the relationships between salient cognitive activities and behavioural responses in doctors' and patients' use of OHCs and the impact of user identity on variability.

The purpose of this paper is to propose a general model that examines the contextual factors underlying the decision‐making process of international hospital outshopping.

Patients who chose medical treatment abroad were selected to analyze the drivers of internationalization in medical services. A total number of 27 international patients who traveled from developed countries to receive medical treatment at the largest hospital in Thailand were interviewed and their responses assessed through narrative analysis.

The narrative analysis reveals that while high costs and the deteriorating conditions of health care in developed countries are initially driving consumers to leave their local service area and choose foreign service providers, pull factors such as innovation, organizational efficiency, emotional service quality and patient‐doctor relationships in service encounters are nurturing a real preference for choosing foreign health care providers.

This exploratory study is limited to the largest hospital in South East Asia. Future research could expand upon its findings and comparisons be made with other different foreign health care providers.

In order to attract foreign customers a personal service, such as medical treatment, must be based on and sustained by continuous innovation in service quality.

The paper is the first empirical in‐depth study that examines the factors underlying the decision‐making process of international hospital outshopping.

The study aims to examine how communication, provider courtesy, support/care, environment of the facility and waiting time significantly predict patients' satisfaction with quality of healthcare in two hospitals located in northern Ghana.

An exploratory study of which 324 respondents were selected using stratified and convenient sampling techniques. Results are presented using a multiple regression model.

The results revealed that of the five‐factor model, support/care, environment of the facility and waiting time determine patients' satisfaction with quality of healthcare delivery. The explanatory power of the dependent variable was explained by 51 percent.

The findings suggest that internal and external health sector stakeholders may possibly use this study as a precursor to improve service quality in the two hospitals in particular and others in general.

This paper reports on an action research study that aimed to collaboratively develop a complementary therapy care intervention to augment palliative care choices available to nursing home residents with advanced dementia.

An action research design was adopted that consisted of a series of action cycles involving collaborative exploration, problem-solving planning, development and evidence gathering. A combination of mixed methods was used when gaining data at the different stages, including face to face delivered questionnaires, observational notes, focus groups, and the objective measure of the Neuropsychiatric Inventory adapted for Nursing Homes (NPI-NH).

Care home staff and relatives considered the use of Complementary Therapy to be a helpful intervention promoting that it can reduce a sense of loneliness and provide companionship for residents experiencing distress. Analysis of NPI-NH scores showed a reduction in presenting neuropsychiatric behaviours associated with stress and distress.

Differing levels of participant group engagement may affect this study’s findings as it was noted that care home staff provided a fuller contribution to the project in comparison to relatives.

Implementation guidance is needed when implementing complementary therapy within the nursing home practice to promote consistency and successful integration of an intervention that is not provided as routine care.

The findings of this study are encouraging and demonstrate the acceptability of complementary therapies to residents with advanced dementia, where positive impacts on otherwise difficult to address dementia symptoms related to stress and distress are highlighted.

This research paper aims to identify dimensions of patient‐perceived total quality service (TQS) in the healthcare sector. Further, the impact of the dimensions of patient‐perceived TQS on patient satisfaction is examined.

A questionnaire has been developed based on an extensive literature review of research in service quality and based on responses of the pilot survey among patients recently discharged from hospital. The instrument thus developed has been examined for its psychometric properties using tests of reliability and validity. Multiple regression analysis has been used to examine the impact of the dimensions of patient‐perceived quality on patient satisfaction.

Findings highlight seven distinct dimensions of patient‐perceived TQS and the relationships among them. Positive and significant relationships among the dimensions and patient satisfaction have been found.

Contribution to research on healthcare services by the development of a comprehensive instrument of patient‐perceived healthcare quality.

This instrument would enable patients to provide feedback to hospitals regarding the quality of healthcare received by them. Hospitals could use this feedback to analyze their performance, gauge patient satisfaction and benchmark their performance against competitive hospitals.

This paper illustrates a comprehensive instrument of patient‐perceived healthcare quality.

This paper aims to investigate doctor‐patient communication in consultations of newly qualified general practitioners (GPs) in a newly reorganised health care system and differences in consultation characteristics and communication patterns between new European Union (EU)‐countries (Estonia, Poland and Romania) and the old West‐European EU‐countries.

Observation of videotaped doctor‐patient consultations by means of Roter's Interactional Analysis System; GP, patient and observer questionnaires. Data were collected from 92 GPs and 1,376 patients in Estonia, Poland and Romania and compared with known data from old EU countries. Main outcome measures were verbal and nonverbal communication of GPs and patients, as well as consultation characteristics.

Differences were found in the communication patterns of the new EU‐countries Estonia, Poland and Romania compared to the old EU‐countries. For instance, the verbal contribution of the GPs in the new EU‐countries was greater than in the old EU‐countries. Differences were also found between the three new EU‐countries. In Romania there was more psychosocial talk than in the two other new EU‐countries, whereas in Poland and Estonia there was more biomedical talk. The Estonian communication was more affective, the Polish and Romanian more instrumental. In general, the differences were not found to be related to a “new‐old” or “east‐west” distinction. Clearly, cultural norms and values play an important role in doctor‐patient communication.

The sampling method differed somewhat from one country to another.

With the integration of Europe in progress, cross‐cultural aspects should be addressed when doctors are being trained in communication skills in their undergraduate and postgraduate education.

This is the first study to investigate doctor‐patient communication in newly reorganised health care systems and differences in doctor‐patient communication between new and old EU‐countries.

The purpose of this paper is to explore employee perceptions of communication in psychologically safe and unsafe clinical care environments.

Clinical providers at the USA Veterans Health Administration were interviewed as part of planning organizational interventions. They discussed strengths, weaknesses, and desired changes in their workplaces. A subset of respondents also discussed workplace psychological safety (i.e. employee perceptions of being able to speak up or report errors without retaliation or ostracism – Edmondson, 1999). Two trained coders analysed the interview data using a grounded theory-based method. They excerpted passages that discussed job-related communication and summarized specific themes. Subsequent analyses compared frequencies of themes across workgroups defined as having psychologically safe vs unsafe climate based upon an independently administered employee survey.

Perceptions of work-related communication differed across clinical provider groups with high vs low psychological safety. The differences in frequencies of communication-related themes across the compared groups matched the expected pattern of problem-laden communication characterizing psychologically unsafe workplaces.

Previous research implied the existence of a connection between communication and psychological safety whereas this study offers substantive evidence of it. The paper summarized the differences in perceptions of communication in high vs low psychological safety environments drawing from qualitative data that reflected clinical providers’ direct experience on the job. The paper also illustrated the conclusions with multiple specific examples. The findings are informative to health care providers seeking to improve communication within care delivery teams.

This paper aims to show that whether new customers respond well or poorly to small talk at the beginning of a service encounter depends on their relationship orientation, i.e. how exchange or communally oriented they are. The authors provide service providers with tactics to identify first-time customers’ relationship orientation or set customers’ small talk expectations and thus help them use small talk more effectively.

The authors examine the effect of small talk and relationship orientation on customer intentions to use a service provider in three experiments and one cross-sectional survey. The scenario-based experiments show causality and the effect in online and in-person scenarios. The survey replicates the effect among current customers of a small business.

Communally oriented customers respond positively to small talk, but exchange-oriented customers respond negatively to it. Mediation analyses reveal this occurs because small talk differentially leads to initial feelings of rapport and impatience for people high (versus low) in relationship orientation.

Service providers should consider customers’ relationship orientation before starting a conversation with small talk. The authors find providers can identify exchange-oriented customers by their choice of meeting format (in-person v. video chat). Managers can also use marketing materials to attract customers with a specific relationship orientation or to set customer expectations for small talk in the interaction.

Prior research has largely shown benefits to small talk, but the authors show significant downsides for some customers and to the best of the authors’ knowledge are the first to show process evidence of why these drawbacks occur.

Efficacious self-management at older ages requires the ability to make an accurate appraisal of one’s current and future health situation. Therefore, the purpose of this study is to explore how community living older adults, with different self-perceived health status, appraise their future health status and their future health-care and housing needs.

The study population, 555 community living older adults, aged 65–75, completed a questionnaire for self-screening of their general health status.

The results show that over 70% of the older adults, even many of those who perceive their own health status to be “poor” or “fair” and those who are “frail”, do not expect deterioration in their physical or mental health nor extra health-care or housing needs within the next half year. In addition, a substantial part of the respondents, particularly those who perceive their general health as less favourable, tend to have a “wait-and-see” attitude and want to live their life day-to-day.

Community living older adults may not always be able or motivated to monitor their own health condition and prepare themselves for changing needs. Supporting older adults by motivating and teaching them to monitor their condition and overcome barriers to engage in pro-active coping can help older adults to manage the negative consequences of ageing while they have still sufficient resources available.

The findings of this study can help health-care professionals to tailor the support of older adults’ self-management.