Reversing social gradient: Impact of patients’ communication with their practitioners on adherence to preventive behaviours

Good communication with a physician has positive effects on the patients’ adopting preventive behaviours. Knowing social inequalities in health, we aimed at analysing in what extent financial situation influences the associations between quality of communication and improved secondary preventive behaviours and limited risk factors - in cardiovascular diseases: hypertension, overweight, obesity, hypercholesterolemia, diabetes.
Methods: 1,289 patients who underwent a coronary angiography in Luxembourg completed a self-administered questionnaire in 2008/09 and 2013/14. The association between improving each preventive eating behaviour (decrease of salt, sugar, fat consumption; increase of fruits/vegetables) and the quality of physician-patient communication (5-items scale) was evaluated using logistic regression models. Perceived financial situation (difficult, easy, and very easy) was introduced in interaction with the communication score.
Findings: Patients declared in a difficult or easy financial situation had a higher probability of decreasing their salt intake when physician-patient communication quality was higher (OR [95% CI] respectively: 1.139 [1.045; 1.240], 1.105 [1.032; 1.182]). The pattern was similar for increased consumption of fruits/vegetables in patients with hypertension, diabetes, overweight and hypercholesterolemia. Reduced sugar consumption was associated with communication quality in hypercholesterolemia patients in financial difficulty (OR [95% CI]: 1.095 [1.009; 1.189]).
Discussion: The quality of communication has a higher impact on adopting healthy behaviours in patients declaring themselves in financial difficulty. These findings raise awareness on the importance, in patients with perceived financial difficulties, of physician-patient quality to improve adherence to the secondary preventive recommendations. Across the lifespan, it highlights the role of physicians in reversing their patients’ social gradient.