The Role of Age and Multimorbidity in Shaping Older African American Men's Experiences with Patient-Provider Communication

Background: African American men persistently experience higher levels of multimorbidity (i.e. two or more chronic medical conditions) as they age, in comparison to White and Hispanic men. Managing multiple chronic conditions often necessitates more frequent communication with health care providers, and research has shown that many African American men report suboptimal experiences with medical professionals that may negatively affect their engagement in positive health behaviors and medical decision making. One strategy to improve health outcomes among populations with disproportionate chronic disease risk has been to encourage question asking during medical visits. Few studies have been identified that capture the intersection of health communication difficulties for older African American men with multimorbidity.  The current study addresses this gap by investigating the extent to which age and multimorbidity are associated with African American men’s unmet health communication needs in the context of patient-provider interactions. Specifically, we were interested in instances where older African American men had health-related questions that they were not given the opportunity to ask.

Methods: Study participants were a purposive sample of 430 African American men aged 18 and older who attended a community health fair geared toward minority men and hosted by a large Midwest hospital system in 2011. Respondent mean age was 54.35 years and they were relatively well educated with just under 40% having completed at least high school.  The outcome measure was the extent to which patients were given the opportunity ask their health-related questions during medical visits.

Results: The present study found statistically significant bivariate differences between patients who could ask their health-related questions and patients who were not given the chance to.  Patients who were able to ask their health-related questions were older (56 compared to 51 years, F (1,428)=15.67, P<. 001) and had less comorbidity on average. They also had higher educational attainment, higher annual incomes, and were more likely to be married. Healthcare access factors were also significantly associated with getting to ask health related questions. Nearly 70% of respondents who reported having any type of insurance and 70% of those with one or more than one physician were able to ask their health related questions. Finally, nearly three fourths of those who received care in a doctors’ office reported being able ask their health-related questions compared to under a third of those who received care in a hospital ER. 

Implications: Patient-centered communication, namely question-asking, is critically important to the health care experience and outcomes but may be out of reach for older multimorbid and low-income African American men who face barriers to healthcare access. Health care professionals, particularly in primary care settings, need additional mechanisms to both assess and improve the quality of patient-provider communication with patients, taking into account age, race, gender, and health status.