Description
Patients seek health related information from the doctor to seek assurance, to help them to decide on the
future course of action, or, for the sake of knowledge. The information seeking behavior of patients is
dependent on a number of factors, such as, the doctors' communication style, gender, consultation time,
and, direct waiting time, amongst others. This study investigates differences in behavior between information
seeking patients and non-information seeking patients in outpatient clinics in India, which is a
medically underserved nation. Results show that differences exist in the satisfaction level of information
seekers and non-seekers in that the non-seekers were less satisfied. Information-seeking behavior of
patients was found to be related to both situational variables and socio-demographic characteristics.
Information seeking patients in India were inhibited by the expressive (also known as the controlling
style of the doctors). The assumption that Indian women are hesitant to seek information from the doctor
is unfounded; more males than females were non-information seekers in the doctorepatient interaction.
The research recommends a socio-structural approach to address the health care issues in India.
Face to face information seeking behavior of patients and impact on in-clinic
satisfaction
Payal Mehra
Department of Communication, Indian Institute of Management, Lucknow, India
a r t i c l e i n f o
Article history:
Received 24 February 2014
Accepted 28 May 2015
Available online 29 November 2015
Keywords:
Patient satisfaction
Information seekers and non seekers
Gender
Socio-demographic factors
GLM multivariate
a b s t r a c t
Patients seek health related information from the doctor to seek assurance, to help them to decide on the
future course of action, or, for the sake of knowledge. The information seeking behavior of patients is
dependent on a number of factors, such as, the doctors' communication style, gender, consultation time,
and, direct waiting time, amongst others. This study investigates differences in behavior between in-
formation seeking patients and non-information seeking patients in outpatient clinics in India, which is a
medically underserved nation. Results show that differences exist in the satisfaction level of information
seekers and non-seekers in that the non-seekers were less satis?ed. Information-seeking behavior of
patients was found to be related to both situational variables and socio-demographic characteristics.
Information seeking patients in India were inhibited by the expressive (also known as the controlling
style of the doctors). The assumption that Indian women are hesitant to seek information from the doctor
is unfounded; more males than females were non-information seekers in the doctorepatient interaction.
The research recommends a socio-structural approach to address the health care issues in India.
© 2015 College of Management, National Cheng Kung University. Production and hosting by Elsevier
Taiwan LLC. All rights reserved.
1. Introduction
Health related communication and information are important in
assisting patients cope with illnesses. Diagnosis often results in
anxiety that can be remedied by information. People, however,
differ in the amount of information they want, and this is re?ected
in their efforts to solicit the same.
Patient question asking is not only a method of information
seeking, but also a means of patient participation in the medical
dialogue (Roter, 1984). Lack of purposeful information seeking
creates challenges, not only for doctors, but also for health com-
municators, commissioned to design health related messages for
appropriate channels for this group of audience (Askelson, Campo,
& Carter, 2011). Many researchers such as Roter (1983), Sleath,
Roter, Chewning, and Svarstad (1999), and McKenzie (2002) have
analyzed the question asking behavior of the patients; however,
they have focused more on the actions of the doctor than that of the
patients. Also, very few studies have segregated patients on the
basis of their information seeking behavior. Consequently, research
is limited on patient satisfaction with the doctor and information
seeking behaviors in medical interactions.
This research addresses these issues in the context of India,
which is a medically underserved nation. Most of the quali?ed
health workers are concentrated in the urban areas; migration of
Indian doctors has further strained the system (Kanchanachitra
et al., 2011). The current doctorepopulation ratio is abysmally
low, at approximately 1:2000. According to latest reports, about
3000 doctors have migrated abroad in the past three years. The
Planning Commission's high-level expert group (HLEG) predicts
that India would take at least 17 more years to achieve the World
Health Organization's recommended norm of one doctor per 1000
people (Source: Press Information Bureau, Government of India
Ministry of Health and Family Welfare press release. 2013: visit.http://pib.nic.in/newsite/PrintRelease.aspx?relid¼77859).
The current study examines gender wise differences in infor-
mation seeking behaviors because, in typical Indian families, roles
are de?ned by age and gender. Indian society is patriarchal with
communication patterns ?owing fromthe top to the bottom. Indian
women are expected to assume household responsibilities, rear
children and defer to the authority of men; as such only fewwomen
feel empowered to seek responses from doctors, and that too, from
a male doctor. India also has a sharp rural urban divide; close to 70
E-mail address: [email protected].
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Kung University.
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Asia Paci?c Management Review 20 (2015) 293e303
percent of the country's population is rural with little or no access
to medical facilities. Most of the rural populace is illiterate or semi-
literate. There are language differences also between different rural
as well urban areas. All these factors can potentially escalate
communication issues between the doctor and the patient.
In this context, the following research questions assume rele-
vance: What is the information seeking behavior of patients in
primary care and how does it impact in clinic satisfaction? What
are the socio-demographic characteristics of the high information
seekers and non-information seekers? Are high health care infor-
mation seekers more satis?ed with the communication skills of the
doctor in comparison to the non-information seekers? Are there
any gender-wise differences between the perceptions of the high
information seekers vis- a-vis the information non-seekers?
2. Literature review
2.1. Health information seeking behavior of patients
Most studies underline that health information seeking
behavior is a positive behavior. Patients seek information to aid
them in medical decision making, for the sake of reassurance or,
simply to gain knowledge. Generally patients rely on traditional
sources of health information such as magazines, doctors, televi-
sion and books (Gollop, 1997; Maibach, Weber, Massett, Hancock, &
Price, 2006; Tu & Hargraves, 2003), however, non-traditional
sources of health information (such as the Internet) are also get-
ting popular.
Patients differ in their approach to seek information from the
doctors. There are those that seek much information from the
doctor (the high information seekers), yet others do not seek any
information from the doctor (the non-information seekers). In
terms of in-clinic satisfaction, there appears to be a gap with
respect to the differences between satisfaction levels of both high,
and low information seekers (Morey, 2007).
Research has noted that the desire for information is especially
higher amongst patients suffering from life threatening diseases,
than for chronic diseases (Blanchard, Labrecque, Ruckdeschel, &
Blanchard, 1988; Molleman et al., 1984; Newall, Gadd, &
Priestman, 1987; Reynolds, Sanson-Fisher, Poole, Harker, & Byrne,
1981; Sutherland et al., 1989). With the paternalistic role of the
doctors replaced by shared decision making, patients now actively
seek information to make more informed decisions (Beinkeiser &
Benkeiser, 1990; Brock & Wartman, 1990; Siminoff & Fetting,
1991; Sutherland et al., 1989).
Information seeking (by both the patient and the doctor), is both
a predictor and an outcome (Hernsel, Leshner, & Logan, 2010). As a
predictor, active health information seeking may bring about
greater therapeutic effects such as improvement in management of
stress and other health improvement measures (Shim, Kelly, &
Hornik, 2006; Van der Molen, 1999). As a variable that impacts
on the outcomes, the need to seek health information can be
dependent on socio demographic variables, media preferences, and
individual differences (Hensel et al., 2010).
Ramanadhan and Viswanath (2006) classify information
seeking behavior as ‘seekers’ and ‘non-seekers’ with the latter likely
to have lower incomes, less education and lower health con-
sciousness. Some studies point out that information seeking is an
‘uncommon behavior’ (Morris, Rooney, Wray, & Kreuter, 2009;
Neiderdeppe et al., 2007). In reality, patients might be merely
‘scanners’ rather than ‘seekers’ of information.
Doctors often misread the patients' desire for more information
(Waitzkin, 1991). Tidwell and Sias (2005) suggest that traits or
personality plays an important role in information seeking
behavior. Dutta-Bergman (2004) also classi?es channels as active
and passive, and conclude that the health conscious patients prefer
the active channels whereas the less health conscious people
gravitate towards passive channels.
2.2. Information seeking and communication behaviors
Instrumental (cure or task focused) and affective (care or socio-
emotional) communication behaviors have both been found to in-
?uence patients' perception of doctors (Blanchard et al., 1983; Hall,
Roter, & Katz, 1987; Hall, Roter, & Katz, 1988; Roter, Hall, & Katz,
1987). It may also impact the information seeking behavior of pa-
tients. Instrumental utterances include: giving information, asking
questions, advising, giving directions, discussing test results, future
course of treatment, and the like. Affective utterances include:
openness, empathy, reducing anxiety, showing concern, verbal
support, and addressing patients' by name (Blanchard et al., 1983).
Buller and Buller (1987) report that patients' information
seeking behavior is largely determined by the communication style
of the doctor (controlling or af?liate). In a typical doctorepatient
encounter, the contribution of the doctor is about 60 percent while
that of the patient is 40 percent. The use of language-both
nonverbal as well as verbal-may also hinder or promote doctor
patient communication (though research is limited on this theme).
Doctors tend to easily switch fromthe normal everyday language to
the medical language, and reverse, to in?uence the patients (Roter,
Hall, & Katz, 1988).
2.3. Health outcome: satisfaction
Research by Levinson and Chaumeton (1999) demonstrates, that
effective communication enhances patient recall of information,
generates compliance, yields satisfaction, creates psychological
well-being, and results in improved biomedical outcomes. Patient
outcomes de?ned in research include satisfaction, compliance,
recall, recovery, and knowledge.
By far the most widely used outcome variable is perhaps patient
satisfaction. Satisfaction is the cognitive and affective evaluation
based on the personal experience across all service episodes within
the relationship (Davis-Sramek, Droge, Mentzer, & Myers, 2009).
Older studies, as early as 1965, reveal that empathy demonstrated
by the doctors was proportionately related to patient satisfaction.
This view is supported in later research by Jensen (1981), Pantell,
Stewart, Dias, Wells, and Ross (1982) and Friedman, Di Matteo,
and Taranta (1980). Similarly, Street and Wiemann (1987) found
that involved, expressive physicians had more satis?ed patients.
Conversely, satisfaction was perceived to be low when the doctors
used too much jargon, were too curt in their responses to the
concerns and queries of patients, and spent too little a time
consulting them. Studies by Hall, Roter, and Rand (1981), Lane
(1983), Lavin (1983), and Street and Wiemann (1987) found that
patients were dissatis?ed with controlling and assertive doctors.
Buller and Buller used the measure of the physician's commu-
nication ability to evaluate the health care, rather than the level and
quality of medical information provided by him/her. Accordingly,
patients who expressed satisfaction with the communication style
of the doctors, were more satis?ed with the health care they
received. They concluded that patients who perceived that their
doctor's style was af?liative, were more satis?ed with the quality of
health care than when the doctor used the af?liative and non-
controlling style when interacting with patients. Their report also
noted that the average waiting time of patients in their survey was
about 25 min and each patient spent approximately 21 min or so
consulting with the physician.
The research review suggests that communication behaviors
have been found to in?uence patients' perception of doctors and
P. Mehra / Asia Paci?c Management Review 20 (2015) 293e303 294
the manner of information seeking. The task was to investigate
whether the communication style of doctors inhibited the quality
of information seeking behavior of patients. In this context the ?rst
null hypothesis is as below:
Hypothesis 1. The communication style of the doctor that is
whether they are receptive or expressive (controlling), does not
impact the patient satisfaction with the quality of information
sharing by doctors
2.4. Socio-demographic variables
Studies have investigated doctor characteristics, such as socio-
demographic (gender, age) and personality variables (communi-
cation styles, information giving, expression of empathy and non-
verbal behavior) and their impact on satisfaction and compliance.
However, patient characteristics (information seeking, gender, age)
also impacts the in clinic interaction between the doctor and the
patient. Cartwright and Anderson (1981) found that older re-
spondents expected less information from their doctor and
consequently sought less information.
Research by Turk-Charles, Meyerowitz, and Gatz (1997) vali-
dates this. According to them, information seeking is too narrowly
de?ned and needs to include other sources of information, besides
face to face interaction with the doctor in the clinic. These include
traditional media such as brochures, the newspaper and television,
as well as the new media such as email, internet, blogs, etc. Their
study reveals the extent to which individual characteristics of the
patients (type of disease: acute, chronic or life threatening; and
stage of the illness) have the potential to affect howdoctors interact
with their patients.
Older patients tend to seek more information (Jenkins,
Fallow?eld, & Saul, 2001). Their ?nding indicates that situa-
tional factors (such as a longer interaction time) may be neces-
sary for patients to perceive that the doctor is supportive towards
information sharing communication behaviors. Older patients are
more prone to anxiety and have many questions to ask once they
perceive that the doctor is giving more time to the interaction
and is supportive to information seeking communication behav-
iors. Thus research suggests that patient attitudes became
important in predicting information-seeking behavior only when
the doctorepatient interaction was a longer one (19 min or
more).
This appears to suggest that more than the attitude of the pa-
tient (active information seeking or inactive information seeking),
it is the situational factors that impact the quality of face to face
information seeking. The doctor might have too many patients to
attend or may be unwilling to disclose much. This leads to the
following two hypotheses below (Fig. 1):
Hypothesis 2. Lowinformation seekers (patients who do not seek
health care information actively) are satis?ed with the communi-
cation style of the doctor
Hypothesis 3. Longer interaction time may be necessary for pa-
tients to perceive that that the doctor is supportive towards infor-
mation sharing communication behaviors and the null hypothesis
Hypothesis 4. Gender wise there is no difference between the less
educated, low income, the highly educated patients, and the high
income patients in the desire to seek more information
3. Procedures
3.1. Setting
This cross sectional study was conducted in three major cities of
IndiaeLucknow, Kanpur, and New Delhi. Using strati?ed random
sampling, a structured questionnaire was used to collect data from
525 patients visiting 33 private clinics and two public hospitals in
Lucknow over a period of eight months. In Delhi and Kanpur, data
was collected from 121 patients from seven private clinics. The
cronbach's alpha for 55 questionnaire items was .913 (overall) and
.921 for construct related to 22 communication variables. Data was
analyzed using the SPSS v16 (See Tables 1.1 and 1.2).
4. Findings
4.1. Sources of information for patients
Interpersonal sources, mass media and magazines, constituted
relevant sources of health related information. About 61 percent of
the interviewed patients said that they actively sought out infor-
mation fromthe doctors during a face to face medical encounter. 24
percent of the sample said that they relied primarily on doctors to
provide relevant health information in the clinic (brochures, post-
ers etc.). Only 3 percent sought health information from the
internet. About 68 percent of the patients said that they would
prefer targeted information from the clinic.
4.2. Communication skills
A factor analysis reveals two communication styles of doctors as
perceived by the patients- Receptive and Expressive Communica-
tion skills (See Tables 2.1 and 2.2).
The KMO and Bartlett test is signi?cant with a sampling ade-
quacy of .881. This indicates that the test is reliable. The analysis
clubbed the variables into two most important communication
behaviors expected from Doctors- Receptive skills and Expressive
High
Information
Seekers
Non
Information
Seekers
Sasfacon with
communicaon
factors
Overall sasfacon with the primary
care at the clinic
Expectaons met
Covariates
1. Communicaon factors
2. In?uence factors
Fixed factors:
Gender, Type of informaon
seeker
Fig. 1. The research model.
P. Mehra / Asia Paci?c Management Review 20 (2015) 293e303 295
Table 1.1
Demographic details of Lucknow (Sample size 505: In %).
1.1. Age group in years 20e25 26e30 31e40 41e55 >55
9.8 19 23.8 25.2 21.6
1.2. Visit for this problem First time Second time Third time Many times
13.1 17.8 18.2 50.9
1.3. Did you know the provider before? Yes Referred by someone
48.7 51.3
1.4. Gender Male Female
51.3 48.7
1.5. Category Rural Urban
26.3 73.7
1.6. Purpose of visit Acute Chronic Injury Emergency
39 50.3 6.7 4.0
1.7. Doctor on email Yes No
2 97.3
1.8. Waiting time Very less Somewhat less Acceptable Delayed Highly delayed
.8 14.7 71.1 9.7 3.8
1.9. Time spent with the doctor (APPROX) 25 min
11.5 6.9 31.3 48.7 .2
1.10. Location of clinic Very near Close by Some distance Large distance Far away
2.8 17.4 38.8 18.2 22.8
1.11. Income High Middle Low
5.7 56 38.2
1.12. Employment Private Public Self Employed
22.4 20.8 56.4
1.13. Education Literate Semi-literate Illiterate
64.2 19.6 16.2
1.14. Do you actively seek health care information? Yes No
63.8 36.2
1.15. If yes to above, where do you MAINLY access health related information? Doctors clinic TV/Radio Internet All of the above None of the above
17.2 30.1 3.8 13.9 35
1.16. Do you prefer targeted messages by the clinic itself? Yes No
64.7 35.3
Table 1.2
Demographic details of N. Delhi and Kanpur (Sample size 121) (In %).
1.1. Age group in years 20e25 26e30 31e40 41e55 >55
16.5 43.8 24.8 8.3 6.6
1.2. Visit for this problem First time Second time Third time Many times
16.5 12.4 4.1 66.9
1.3. Did you know the provider before? Yes Referred by someone
95.1 4.9
1.4. Gender Male Female
85.1 14.9
1.5. Category Rural Urban
.8 99.2
1.6. Purpose of visit Acute Chronic Injury Emergency
65.3 22.3 5 7.4
1.7. Doctor on email Yes No
.8 99.2
1.8. Waiting time Very less Somewhat less Acceptable Delayed Highly delayed
5.8 23.1 52.9 18.2 0
1.9. Time spent with the doctor (APPROX) 25 min
15.7 75.2 6.6 2.5 0
1.10. Location of clinic Very near Close by Some distance Large distance Far away
17.4 39.7 18.2 24.8 0
1.11. Income High Middle Low
59.5 38.8 1.7
1.12. Employment Private Public Self Employed
75.2 23.1 1.7
1.13. Education Literate Semi-literate Illiterate
100
1.14. Do you actively seek health care information? Yes No
47.9 52.1
1.15. If yes to above, where do you MAINLY access
health related information?
Doctors clinic TV/Radio Internet All of the above None of the above
39.7 2.5 5.8
1.16. Do you prefer targeted messages by the clinic itself? Yes No
47.1 1.8
1.17. Overall experience Unfavorable Favorable
8.3 92.7
P. Mehra / Asia Paci?c Management Review 20 (2015) 293e303 296
skills, accounting for 65% variance. The default correlation method
was applied for the factor analysis. It produces the default prin-
cipal components analysis of variables. Those with eigenvalues
greater than 1 (the default criterion for extraction) are rotated
using varimax rotation (the default). The default is the number of
eigenvalues greater than mineigen .500 speci?ed for the analysis.
A simple regression run on the high information seeking pa-
tients' perception of doctors' communication style and satisfaction
with primary care shows, that communication style-both receptive
and expressive-is positively associated with satisfaction. The
impact of consultation time and waiting time are signi?cant, but
only at 10 percent con?dence interval (R square is .537). Longer
consultation time is desirable but not a guarantee of satisfaction
with primary care.
Results of the regression run on the low information seeking
patients (R square is .612) show that waiting time and consultation
time do not signi?cantly affect satisfaction level with the primary
care. Consultation time is found to be inversely related to satis-
faction level in the low information seeking group (See Tables 3.1
and 3.2 and also Table 4).
Results of the Anova show that the high information seeking
patients differ signi?cantly at .05 signi?cance level from the low
information seeking in their overall satisfaction level with the
health services provided at the clinic (See Table 5).
The Anova was applied to statistically compare the differences in
the response of the high and the non-information seekers with
respect to the communication skills of the doctor. The groups' differ
signi?cantly at .05 level of signi?cance with respect to demon-
stration of empathy, time given to the patient; response to queries,
clari?cation of doubts, indulging in informal chat, reducing fear,
providing additional information, and advising future course of
action (low information seeking patients are less satis?ed-see
Table 6).
4.3. Analysis by gender
Among the 363 male patients and 263 female patients, 205 and
177 patients respectively were high information seekers. The in
clinic experience of both groups was neutral (neither favorable nor
unfavorable) with respect to the query handling of the doctor on
phone. Experience of both groups-the active information seekers
and the non-information seekers-was only ‘somewhat favorable’
with respect to the query handling of the doctor in person. Expe-
rience of both groups was quite favorable on the perception of the
medical competency of the doctor, empathy, and understanding
demonstrated by the doctor in assisting the patients to decide the
future course of action. Again, the difference in responses was not
signi?cant at .05 signi?cance level. Males were more favorably
in?uenced by the provider than the females, though the difference
was not signi?cant at 95% con?dence interval.
In the current study, more female patients reported that they
would recommend the doctor. The male patients reported greater
expectation ful?llment though the difference was not statistically
Table 2.1
Factor analysis on patient satisfaction with the communication skills of the doctor:
KMO and Bartlett's Test.
KaisereMeyereOlkin measure of sampling adequacy .881
Bartlett's test of sphericity Approx. Chi-Square 3582.585
df 91
Sig. .000
Table 2.2
Rotated component matrix.
Communication skills of the doctor as perceived by the patients Component
1 2
Emotional support À.115 .816
Rarely interrupted .705 .321
Eye contact .816 .159
Probing questions .119 .412
Responded queries .430 .602
Clari?ed doubts .459 .505
Informal remarks À.094 .721
Decision-making .301 .649
Understood conversation .697 À.201
Paraphrased concerns .514 .497
Reduced fear .436 .580
Advised future action .429 .579
Simple language .554 À.125
Additional information .161 .699
Extraction method: principal component analysis.
Rotation method: varimax with Kaiser normalization.
Rotation converged in 3 iterations.
Table 3.1
Coef?cients: High Information seekers and satisfaction with the doctors wrt. the time spent at the clinic.
Model Unstandardized coef?cients Standardized coef?cients T stat Signi?cance P value
B Std. Error Beta B
1 (Constant) 8.561 .505 16.952 .000
Waiting time .185 .156 .049 1.181 .239
Time spent À.034 .098 À.017 À.351 .726
REGR factor score 1 Expressive Communication Style .755 .101 .359 7.479 .000
REGR factor score 2 Receptive Communication Style 1.612 .098 .665 16.428 .000
Dependent Variable: satisfaction_provider.
Selecting only cases that are high information seekers ¼ 2.00.
P. Mehra / Asia Paci?c Management Review 20 (2015) 293e303 297
signi?cant at .05 signi?cance level. Female patients reported lower
satisfaction than the male patients and the difference was signi?-
cant. The waiting time was somewhat less to acceptable for both
the male as well as female patients. Both groups report less time
spent on consultation, even as female patients reported greater
consultation time. Both males and female patients report that they
preferred the doctor over popular health care messages. Both
groups were unanimous in their opinion that they would not like to
receive targeted messages from the clinic in the form of short
messaging services or chats. Both groups were satis?ed with
respect to the perception of cure and relief, medical competency of
the doctor, support provided by the doctor in deciding the future
course of action, and the empathy demonstrated by the doctor in
the clinic.
4.4. Testing the model
Using the GLM Multivariate procedure, the values of multiple
dependent scale variables were modeled, based on their re-
lationships to categorical and scale predictors. The 2 Â 2 matrix in
the table is the hypothesis matrix for testing the signi?cance of all
independent variables (regression scores of satisfaction with the
communication skills of the doctor) on ‘Overall Satisfaction’ as
well as ‘Met Expectations’. SSCP matrix and the inverse of the
Table 3.2
Coef?cients: Non-Information seekers and satisfaction with the doctors wrt. consultation time.
Model Unstandardized coef?cients Standardized coef?cients T stat Signi?cance P value
B Std. Error Beta B
1 (Constant) 9.034 .367 24.586 .000
Waiting time .044 .094 .018 .465 .642
Time spent À.195 .075 À.112 À2.601 .010
REGR factor score 1 for Receptive Communication style .611 .081 .325 7.536 .000
REGR factor score 2 Expressive Communication style 1.092 .070 .621 15.656 .000
Dependent Variable: satisfaction_provider.
Selecting only cases that are Non-information seekers ¼ 1.00.
Table 4
Independent samples test.
Seek information N Mean Std. Deviation
Satisfaction with
the provider
1 380 8.8842 1.67938
2 246 8.2642 2.34723
Levene's test for
equality of variances
t-test for equality of means
F Sig. t df Sig.
(2-tailed)
Mean
difference
Std. Error
difference
95% con?dence interval
of the difference
Lower Upper
Satisfaction with
the provider
Equal variances
assumed
31.066 .000 3.848 624 .000 .61998 .16111 .30359 .93637
Equal variances
not assumed
3.590 405.500 .000 .61998 .17268 .28052 .95944
Table 5
Difference in satisfaction levels between high information seekers and non-information seekers with communication factors using the ANOVA test.
Sn. Variables p-value High IS vs. Low IS level of satisfaction
with the doctor (for both groups)
1 Response to query on phone .000 Both average
2 Response to query in person .001 Both high
3 Promoted feeling of cure and relief .000 Both high
4 Possessed technical expertise .000 Both high
5 Demonstrated empathy and understanding .000 Difference is signi?cant
6 Gave time to the patient .000 Difference is signi?cant
7 Assisted patient in deciding a course of action .000 Both high
8 Gave emotional support .000 Both low
9 Did not interrupt .000 Both high
10 Made eye contact .000 Both high
11 Asked probing questions .000 Difference is signi?cant
12 Responded to queries satisfactorily .000 Difference is signi?cant
13 Clari?ed doubts .000 Difference is signi?cant
14 Made Informal remarks to ease tension .003 Both poor
15 Decision making support .000 Both poor
16 Understood the conversation .411 Both high
17 Paraphrased concerns of the patient .001 Difference is signi?cant
18 Reduced the patients' fear .000 Difference is signi?cant
19 Advised future course of action patiently .000 Both high
20 Used simple language .870 Difference is signi?cant
21 Provided additional information .000 Both low
P. Mehra / Asia Paci?c Management Review 20 (2015) 293e303 298
error SSCP matrix were used to compute the statistics in the
multivariate tests table. The multivariate tests table displayed
four tests of signi?cance for each model effect (See Tables 7.1 and
7.2).
Table 7.3 depicts the Multivariate tests. The multivariate tests
table displays four tests of signi?cance for each model effect. The
Wilks Lambda for the predictor is closer to 0 than to 1 and hence
the most signi?cant predictor. In the model, except for expressive
Table 6
Patient gender and comparison of information seekers and noneseekers.
Parameters Mean score of
information
seekers
Comments Mean score of
Non information
seekers
Comments
1 Doctor in?uenced me Difference is signi?cant. Females are more
favorably in?uenced by the provider than the
males.
Males are more favorably in?uenced by the
provider than the females. Mean Female 8.9657 8.0116
Mean Male 9.1756 8.4667
2 I will recommend
the doctors to others
Both would recommend the provider to others.
Difference is not signi?cant.
Males would recommend the provider more
than the females
Mean Female 8.8229 8.2093
Mean Male 8.9659 9.2056
3 The doctor ful?lled
my expectations
Expectations of males ful?lled more than the
females though the difference is not stat
signi?cant
Expectations of males ful?lled more than the
females
Mean Female 8.5886 8.0814
Mean Male 8.8878 8.7000
4 I am satis?ed with
the doctor
Male patients are more satis?ed than the female
patients, and the difference is signi?cant.
Female patients report lower satisfaction than
the male patients
Mean Female 8.7257 7.7907
Mean Male 9.0195 8.6785
5 Waiting time in the clinic Reasonable waiting time for both male and
female patients though females had to wait
more
Was somewhat less to acceptable for both the
male as well as female patients. Mean Female 3.1143 2.8023
Mean Male 3.0732 2.7675
6 Time spent in the clinic On an average female patient got to spend more
time with the doctor than the male patients.
Both report less time spent in consultation.
Females spent more time with the doctor than
males.
Mean Female
a
3.3829 2.9419
Mean Male 2.9415 2.4563
7 I prefer targeted messages
from the clinic on mobile
phone or on my email
Mode Female
a
Mode Male
Mode is 1 would like to receive targeted messages from
the clinic
Mode is 2 would not like to receive
targeted messages from the clinic
8 Experience on
perception of query
handling by the
doctor on phone
Neutral (neither favorable nor unfavorable)
with respect to the query handling of the doctor
on phone. No signi?cant difference in response
Experience of both groups was unfavorable to
neutral (neither favorable nor unfavorable)
with respect to the query handling of the doctor
on phone.
Mean Female
a
3.3314 2.8140
Mean Male 3.3610 2.7484
9 Experience on perception
of query handling by the
doctor at the clinic
Experience of both groups was somewhat
favorable with respect to the query handling of
the doctor in person. No signi?cant difference in
response
Experience of both groups was somewhat
favorable with respect to the query handling of
the doctor in person
Mean Female
a
4.5771 4.2209
Mean Male 4.5024 4.3677
10 Experience on perception
of cure and relief in the clinic
Experience of both groups was quite favorable
No signi?cant difference in response
Experience of both groups was somewhat
favorable
Mean Female
a
4.4629 4.2093
Mean Male 4.4585 4.2129
11 Experience on perception
of the medical competency
of the doctor
Experience of both groups was quite favorable
No signi?cant difference in response
Experience of both groups was somewhat
favorable
Mean Female
a
4.6914 4.5465
Mean Male 4.5317 4.2129
12 Experience on perception
of Empathy and understanding
demonstrated by the doctor
Experience of both groups was quite favorable
No signi?cant difference in response
Experience of both groups was somewhat
favorable
Mean Female
a
4.2686 3.9535
Mean Male 4.2146 4.0000
13 Experience on perception
of the support provided by
the doctor in decision making/
course of future action
Experience of both groups was quite favorable
No signi?cant difference in response
Experience of both groups was somewhat
favorable
Mean Female
a
4.7429 4.5349
Mean Male 4.5854 4.2968
Note: Scale is from 1e11; 1: Totally Disagree to À11: Totally agree.
a
On a 5-point scale.
Table 7.1
Results of the GLMmultivariate analysis and contrast test results: Between-subjects
factors.
N
Gender 1 260
2 245
Seek information 1 322
2 183
P. Mehra / Asia Paci?c Management Review 20 (2015) 293e303 299
communication skills, Hotelling trace is nearly equal to Roy's largest
root as well as the Pillai's trace indicating the remaining predictors
do not contribute much to the model (See Table 7.3).
Findings indicate that except for the predictor ‘ receptive
communication skills’ of the doctor, the signi?cance values of the
rest of the main effects, the predictors, are more than .05, which
proves that the effects do not contribute to the model, and any
relationship is purely by chance.
This is validated by the signi?cance of the Box's M test which is
.000, suggesting that the assumptions are not met, and thus the
model results are suspect. To con?rmthe ?ndings a Levene test was
conducted where a separate test was performed for each depen-
dent variable. The p value for met expectations and overall
satisfaction (.364 and .450) was greater than .10, so there was no
reason to believe that the equal variances assumption is violated for
this variable (See Tables 7.4 and 7.5).
Table 7.6 displays the hypothesis and error sum-of-squares and
cross-products (SSCP) matrices for testing model effects. Since
there are two dependent variables, each matrix has two columns
and two rows for testing the signi?cance of factor 1.4.
The matrix associated with rest of the factors (such as 2.3, 2.4
and 1.4 and 2.4 etc.) in the table is the hypothesis matrix for testing
the signi?cance of factor 2.3, 2.4 etc., and the matrix VAR1.4*-
VAR1.14 is used for testing their interaction effect. The error matrix
is used in testing each effect. In analogy to the test for models with
one dependent variable, the “ratio” of the hypothesis SSCP matrix
to the error matrix is used to evaluate the effect of interest (See
Table 7.6).
Table 7.7 displays results for each contrast. Simple contrasts
using the ?rst level of ‘Gender’ as the reference category were
speci?ed. Thus, one contrast compares the second level to the ?rst
level; that is, the effect of male gender to the effect of female
gender. The contrast estimates showthat, on average, male patients
were less satis?ed than female patients. Expectations of male pa-
tients were met less in comparison to female patients. Since the
signi?cance value for gender is more than .05, it is concluded that
this difference is due to chance for both the variables.
In Table 7.8, Simple contrasts using the ?rst level of ‘Information
seeking’ as the reference category were speci?ed. Thus, one
contrast compares the second level to the ?rst level; that is, the
effect of non-information seeker to the effect of high information
seeker. The contrast estimates show that, on average, non-
information seeking patients were less satis?ed than high infor-
mation seeking. Expectations of non-information seeking patients
were met less in comparison to high information seeking patients.
Since the signi?cance value for information seeking is more than
.05, it is concluded that this difference is due to chance for both the
variables (See Tables 7.7 and 7.8).
The model indicates that more than any other factor, the quality
of the doctors' receptive skills result in greater patient satisfaction.
The model indicates that the non-information seeking patients
tend to be more dissatis?ed than high information seeking patients.
They also have greater expectations from the doctor that have not
been met.
The following conclusions have been drawn with respect to the
hypotheses:
Table 7.2
Results of the GLM multivariate analysis and contrast test results: Descriptive statistics.
Gender Type of Information seeking behaviour Mean Std. Deviation N
Ful?lled expectations 1 S 8.3861 1.60701 158
NS 7.4314 1.92693 102
Total 8.0115 1.79764 260
2 S 8.5000 1.36341 164
NS 7.6543 1.45911 81
Total 8.2204 1.44871 245
Total S 8.4441 1.48669 322
NS 7.5301 1.73456 183
Total 8.1129 1.63940 505
Satisfaction with the doctor 1 S 8.5316 1.57071 158
NS 7.5294 1.91247 102
Total 8.1385 1.77826 260
2 S 8.6341 1.34768 164
NS 7.9012 1.51332 81
Total 8.3918 1.44345 245
Total S 8.5839 1.45999 322
NS 7.6940 1.75234 183
Total 8.2614 1.62782 505
Note: 1-Male; 2-Female/S: Seeker. NS: Non-Seeker.
Table 7.3
Results of the GLM multivariate analysis and contrast test results: Multivariate tests.
Effect Sig.
Intercept Pillai's Trace .000
Wilks' Lambda .000
Hotelling's Trace .000
Roy's Largest Root .000
Wilks' Lambda .192
Hotelling's Trace .192
Roy's Largest Root .192
Hotelling's Trace .175
Roy's Largest Root .175
FAC1_4 Pillai's Trace .001
Wilks' Lambda .001
Hotelling's Trace .001
Roy's Largest Root .001
FAC2_4 Pillai's Trace .474
Wilks' Lambda .474
Hotelling's Trace .474
Roy's Largest Root .474
VAR1.4 Pillai's Trace .527
Wilks' Lambda .527
Hotelling's Trace .527
Roy's Largest Root .527
VAR1.14 Pillai's Trace .165
Wilks' Lambda .165
Hotelling's Trace .165
Roy's Largest Root .165
VAR1.4*VAR1.14 Pillai's Trace .241
Wilks' Lambda .241
Hotelling's Trace .241
Roy's Largest Root .241
Exact statistic.
P. Mehra / Asia Paci?c Management Review 20 (2015) 293e303 300
Hypothesis 1. The communication style of the doctor (receptive
or expressive) does not impact the patient satisfaction with the
quality of information
Conclusion: The receptiveness of the doctor is an important
factor in patient satisfaction; hence this hypothesis is partially
rejected.
Hypothesis 2. Non-Information seekers (patients who do not
seek health care information actively) are satis?ed with the
communication style of the doctor
Conclusion: Non information seekers/less information seekers
are not satis?ed with the communication style of the doctor; hence
this hypothesis is rejected.
Hypothesis 3. Longer interaction time may be necessary for pa-
tients to perceive that that the doctor is supportive towards infor-
mation sharing communication behaviors
Conclusion: This hypothesis is rejected. The impact of waiting
time and consultation time is not signi?cant at .05 con?dence
interval.
Hypothesis 4. Gender wise there is no difference between the less
educated, low income, the highly educated, and, the high income
patients, in the desire to seek more information
Conclusion: There is a difference. Males (educated or other-
wise; high and low income wise) seek less information than fe-
males; also more literate and working female patients tend to
seek greater information from the doctor. Thus this hypothesis is
rejected.
5. Discussion
The above ?ndings indicate that the receptive communication
skills of the doctor, such as listening, query handling (in person),
response to queries, and clari?cation of doubts are important var-
iables that affect satisfaction with primary care. Waiting time and
consultation length are important variables that contribute to the
model, but their effects are not signi?cant. The study indicates that
patients with greater consultation length would recommend the
doctor more than those with decreased consultation length.
Table 7.4
Results of the GLM multivariate analysis and
contrast test results: Box's test of equality of
covariance matrices.
a
Box's M 46.180
F 5.090
df1 9
df2 1.075E6
Sig. .000
Tests the null hypothesis that the observed
covariance matrices of the dependent variables
are equal across groups.
a
Design: Intercept þ FAC1_4 þ FAC2_4
þ VAR1.4 þ VAR1.14 þ VAR1.4*VAR1.14.
Table 7.5
Results of the GLM multivariate analysis and contrast test results: Levene's test of
equality of error variances.
F df1 df2 Sig.
Ful?lled expectations of the patient 1.065 3 501 .364
Satisfaction .883 3 501 .450
Tests the null hypothesis that the error variance of the dependent variable is equal
across groups.
Design: intercept þ fac1_3 þ fac2_3 þ fac3_3 þ fac1_4 þ fac2_4 þ var1.4 þ var1.14
þ var1.4*var1.14.
Table 7.6
Results of the GLM multivariate analysis and contrast test results: Between-subjects SSCP matrix.
Ful?lled expectations Satisfaction provider
Hypothesis Intercept Ful?lled expectations 8253.742 8369.566
Satisfaction provider 8369.566 8487.017
FAC1_4 (receptive communication skills) Ful?lled expectations 10.490 11.679
Satisfaction provider 11.679 13.004
FAC2_4 (expressive/directive communication skill) Ful?lled expectations 1.321 1.264
Satisfaction provider 1.264 1.210
VAR1.4 (Gender) Ful?lled expectations .036 .158
Satisfaction provider .158 .693
VAR1.14 (Information seeking behavior) Ful?lled expectations 2.040 .802
Satisfaction provider .802 .315
VAR1.4*VAR1.14 Ful?lled expectations .419 .966
Satisfaction provider .966 2.226
Error Ful?lled expectations 444.022 389.738
Satisfaction provider 389.738 518.925
Based on Type III Sum of Squares.
Table 7.7
Results of the GLM multivariate analysis and contrast test results: Contrast results (K Matrix).
Gender simple contrast Dependent Variable
Ful?lled expectations Satisfaction provider
Level 1 vs. Level 2 Contrast Estimate À.018 À.078
Hypothesized Value 0 0
Difference (Estimate e Hypothesized) À.018 À.078
Std. Error .089 .096
Sig. .841 .416
95% Con?dence Interval for Difference Lower Bound À.193 À.268
Upper Bound .157 .111
Reference category ¼ 2.
P. Mehra / Asia Paci?c Management Review 20 (2015) 293e303 301
Classifying patients into information seekers and non-seekers
gave direction to the study. Analysis reveals, that as compared to
the female patients, more male patients fell into the category of
non-information seekers.
Both male and female non-information seekers record satis-
faction on most communication dimensions. However, female non-
information seekers record lower satisfaction overall, as well as
unmet expectations, in comparison to the male non-information
seeking patients. Apart from recording lower satisfaction and un-
met expectations, the female non-information seeking patients
would recommend the doctor less than the male non-information
seeking patients.
This implies two things: Firstly, the non-information seeking
patients are perhaps indifferent to the doctors' communication
skills or the lack of it. This may hold true for the male patients.
Secondly, though female non-information seeking patients are
satis?ed on nearly all communication dimensions, they express
dissatisfaction with primary care and meeting of expectations.
A study of the demographic information of the non-information
seeking patients presents further insights. In the survey, a large
majority of the non-information seekers were rural, illiterate to
semi-literate, and belonging to lowincome households. It might be
so that they come to the clinic with minimal or no expectations;
they consider the doctor as authoritative and controlling and fear to
challenge the doctors' authority. At the same time, if more
consultation time was given, the non-information seeking patients
could be encouraged to share their concerns with the doctor. The
high information seeking patients were more literate, urban, and
?nancially well off. Older male patients are greater information
seekers than younger male patients.
The assumption that Indian women are hesitant to seek infor-
mation from the doctor is unfounded; more males than females
were non-information seekers. Results show that as female pa-
tients become more educated and self-dependent, they come with
enhanced expectations to the clinic. These expectations have to be
met. The information non-seeking female patients record lower
satisfaction with the primary care in the clinic. They would also
recommend the doctor less than their male counterparts. Though
satis?ed on the communication dimensions, they report low
satisfaction with the consultation time which, in turn, affects their
overall satisfaction. This implies the following: female patients
come with expectations to the clinic; and, need encouragement
(and time) from the doctor to articulate their concerns.
Patients in general were not disappointed with the information
that they received from the doctor. In fact patients adapted to the
communication style of the doctor, rather than vice versa, in their
efforts to solicit information from the doctor. Both the information
seeking as well as non-seeking groups expressed dissatisfaction
with the doctors' decision making support or the lack of it.
There is nothing to indicate in this study that information
seeking is greatly affected by the type of illness-chronic or life
threatening. We conclude that information seeking is an attitude or
a predisposition that is dependent less on the socio-demographic
variables (such as gender) and situational variables (waiting time,
consultation time) and more on communication variables (partic-
ularly the doctor's receptive skills). In other words the doctor is not
communicating as well as he/she should be. In a medically under-
served nation, such as India, this probably holds true since the
doctor is indeed hard pressed for time. The doctors often sidetrack
the important role of communication in diagnosis and prognosis.
The lack of purposeful information seeking clearly creates
challenges for health communicators. This aspect is outside the
purview of the current research; suf?ce to state that such a cate-
gory of patients exists in the country. However, further studies can
be taken in this direction especially nowthat organized health care
is getting requisite attention in India.
Patients are gradually becoming internet pro?cient and have a
desire to know more about their ailment. The study strongly rec-
ommends doctors to encourage patients, especially reticent male
and female patients, to articulate their concerns. Doctors also need
to view health care as a service by valuing the ‘service paradigm’, a
philosophy where the customers' needs are to be given the utmost
priority. Effective communication practices can go a long way to
create, maintain, and build a loyal patient base. Another important
recommendation pertains to promoting communication skills
training in the medical curricula. Periodical assessment of these
skills for further certi?cation would also help promoting this
valuable skill amongst doctors.
The WHO Western Paci?c Regional Strategy 2010 states that
health systems in low- and middle-income countries (LMICs) ‘can
be strengthened using Public Health Cadre (PHC) values as core
principles’. A review article by Rule et al. (2014) investigated the
effectiveness of PHC interventions in LMICs and concluded that
there was a lack of consistency for the assessment of effectiveness
of health care programs. In India, the previous national government
had backed the creation of a Public Health Cadre in the 12th Five-
year Plan. The present government is also conscious of closing
the health care gaps in India. However, more needs to be done.
There needs to be a consistent approach to assess organized health
care in India involving the doctor, the patient and the facility so that
the health systems can be strengthened to serve all the segments of
the society. People-centeredness, community protection, and
participation require that doctors effectively communicate with the
stakeholders.
6. Limitations
The research is not without its limitations. The ?rst relates to the
duration of the study. This being a cross sectional study, the ?nd-
ings can be accused of being subjective and generalized. Secondly
the researcher only made assumptions as to why the patients were
information seekers and non-seekers-perhaps a deeper
Table 7.8
Results of the GLM multivariate analysis and contrast test results: Contrast results (K Matrix).
Seek_information simple contrast
a
Dependent Variable
Ful?lled expectations Satisfaction provider
Level 1 vs. Level 2 Contrast Estimate À.150 À.059
Hypothesized Value 0 0
Difference (Estimate e Hypothesized) À.150 À.059
Std. Error .100 .108
Sig. .132 .583
95% Con?dence Interval for Difference Lower Bound À.346 À.270
Upper Bound .045 .152
a
Reference category ¼ 2.
P. Mehra / Asia Paci?c Management Review 20 (2015) 293e303 302
psychological study is required to supplement the research as to
why some patients prefer not to seek any information from the
doctor. In the third place, a cultural approach could have been
conducted to investigate the impact of cultural differences with
respect to information seeking behavior of patients. Future re-
searchers could explore that dimension taking a cue from the
present research.
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P. Mehra / Asia Paci?c Management Review 20 (2015) 293e303 303
doc_832629933.pdf
Patients seek health related information from the doctor to seek assurance, to help them to decide on the
future course of action, or, for the sake of knowledge. The information seeking behavior of patients is
dependent on a number of factors, such as, the doctors' communication style, gender, consultation time,
and, direct waiting time, amongst others. This study investigates differences in behavior between information
seeking patients and non-information seeking patients in outpatient clinics in India, which is a
medically underserved nation. Results show that differences exist in the satisfaction level of information
seekers and non-seekers in that the non-seekers were less satisfied. Information-seeking behavior of
patients was found to be related to both situational variables and socio-demographic characteristics.
Information seeking patients in India were inhibited by the expressive (also known as the controlling
style of the doctors). The assumption that Indian women are hesitant to seek information from the doctor
is unfounded; more males than females were non-information seekers in the doctorepatient interaction.
The research recommends a socio-structural approach to address the health care issues in India.
Face to face information seeking behavior of patients and impact on in-clinic
satisfaction
Payal Mehra
Department of Communication, Indian Institute of Management, Lucknow, India
a r t i c l e i n f o
Article history:
Received 24 February 2014
Accepted 28 May 2015
Available online 29 November 2015
Keywords:
Patient satisfaction
Information seekers and non seekers
Gender
Socio-demographic factors
GLM multivariate
a b s t r a c t
Patients seek health related information from the doctor to seek assurance, to help them to decide on the
future course of action, or, for the sake of knowledge. The information seeking behavior of patients is
dependent on a number of factors, such as, the doctors' communication style, gender, consultation time,
and, direct waiting time, amongst others. This study investigates differences in behavior between in-
formation seeking patients and non-information seeking patients in outpatient clinics in India, which is a
medically underserved nation. Results show that differences exist in the satisfaction level of information
seekers and non-seekers in that the non-seekers were less satis?ed. Information-seeking behavior of
patients was found to be related to both situational variables and socio-demographic characteristics.
Information seeking patients in India were inhibited by the expressive (also known as the controlling
style of the doctors). The assumption that Indian women are hesitant to seek information from the doctor
is unfounded; more males than females were non-information seekers in the doctorepatient interaction.
The research recommends a socio-structural approach to address the health care issues in India.
© 2015 College of Management, National Cheng Kung University. Production and hosting by Elsevier
Taiwan LLC. All rights reserved.
1. Introduction
Health related communication and information are important in
assisting patients cope with illnesses. Diagnosis often results in
anxiety that can be remedied by information. People, however,
differ in the amount of information they want, and this is re?ected
in their efforts to solicit the same.
Patient question asking is not only a method of information
seeking, but also a means of patient participation in the medical
dialogue (Roter, 1984). Lack of purposeful information seeking
creates challenges, not only for doctors, but also for health com-
municators, commissioned to design health related messages for
appropriate channels for this group of audience (Askelson, Campo,
& Carter, 2011). Many researchers such as Roter (1983), Sleath,
Roter, Chewning, and Svarstad (1999), and McKenzie (2002) have
analyzed the question asking behavior of the patients; however,
they have focused more on the actions of the doctor than that of the
patients. Also, very few studies have segregated patients on the
basis of their information seeking behavior. Consequently, research
is limited on patient satisfaction with the doctor and information
seeking behaviors in medical interactions.
This research addresses these issues in the context of India,
which is a medically underserved nation. Most of the quali?ed
health workers are concentrated in the urban areas; migration of
Indian doctors has further strained the system (Kanchanachitra
et al., 2011). The current doctorepopulation ratio is abysmally
low, at approximately 1:2000. According to latest reports, about
3000 doctors have migrated abroad in the past three years. The
Planning Commission's high-level expert group (HLEG) predicts
that India would take at least 17 more years to achieve the World
Health Organization's recommended norm of one doctor per 1000
people (Source: Press Information Bureau, Government of India
Ministry of Health and Family Welfare press release. 2013: visit.http://pib.nic.in/newsite/PrintRelease.aspx?relid¼77859).
The current study examines gender wise differences in infor-
mation seeking behaviors because, in typical Indian families, roles
are de?ned by age and gender. Indian society is patriarchal with
communication patterns ?owing fromthe top to the bottom. Indian
women are expected to assume household responsibilities, rear
children and defer to the authority of men; as such only fewwomen
feel empowered to seek responses from doctors, and that too, from
a male doctor. India also has a sharp rural urban divide; close to 70
E-mail address: [email protected].
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Kung University.
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Asia Paci?c Management Review 20 (2015) 293e303
percent of the country's population is rural with little or no access
to medical facilities. Most of the rural populace is illiterate or semi-
literate. There are language differences also between different rural
as well urban areas. All these factors can potentially escalate
communication issues between the doctor and the patient.
In this context, the following research questions assume rele-
vance: What is the information seeking behavior of patients in
primary care and how does it impact in clinic satisfaction? What
are the socio-demographic characteristics of the high information
seekers and non-information seekers? Are high health care infor-
mation seekers more satis?ed with the communication skills of the
doctor in comparison to the non-information seekers? Are there
any gender-wise differences between the perceptions of the high
information seekers vis- a-vis the information non-seekers?
2. Literature review
2.1. Health information seeking behavior of patients
Most studies underline that health information seeking
behavior is a positive behavior. Patients seek information to aid
them in medical decision making, for the sake of reassurance or,
simply to gain knowledge. Generally patients rely on traditional
sources of health information such as magazines, doctors, televi-
sion and books (Gollop, 1997; Maibach, Weber, Massett, Hancock, &
Price, 2006; Tu & Hargraves, 2003), however, non-traditional
sources of health information (such as the Internet) are also get-
ting popular.
Patients differ in their approach to seek information from the
doctors. There are those that seek much information from the
doctor (the high information seekers), yet others do not seek any
information from the doctor (the non-information seekers). In
terms of in-clinic satisfaction, there appears to be a gap with
respect to the differences between satisfaction levels of both high,
and low information seekers (Morey, 2007).
Research has noted that the desire for information is especially
higher amongst patients suffering from life threatening diseases,
than for chronic diseases (Blanchard, Labrecque, Ruckdeschel, &
Blanchard, 1988; Molleman et al., 1984; Newall, Gadd, &
Priestman, 1987; Reynolds, Sanson-Fisher, Poole, Harker, & Byrne,
1981; Sutherland et al., 1989). With the paternalistic role of the
doctors replaced by shared decision making, patients now actively
seek information to make more informed decisions (Beinkeiser &
Benkeiser, 1990; Brock & Wartman, 1990; Siminoff & Fetting,
1991; Sutherland et al., 1989).
Information seeking (by both the patient and the doctor), is both
a predictor and an outcome (Hernsel, Leshner, & Logan, 2010). As a
predictor, active health information seeking may bring about
greater therapeutic effects such as improvement in management of
stress and other health improvement measures (Shim, Kelly, &
Hornik, 2006; Van der Molen, 1999). As a variable that impacts
on the outcomes, the need to seek health information can be
dependent on socio demographic variables, media preferences, and
individual differences (Hensel et al., 2010).
Ramanadhan and Viswanath (2006) classify information
seeking behavior as ‘seekers’ and ‘non-seekers’ with the latter likely
to have lower incomes, less education and lower health con-
sciousness. Some studies point out that information seeking is an
‘uncommon behavior’ (Morris, Rooney, Wray, & Kreuter, 2009;
Neiderdeppe et al., 2007). In reality, patients might be merely
‘scanners’ rather than ‘seekers’ of information.
Doctors often misread the patients' desire for more information
(Waitzkin, 1991). Tidwell and Sias (2005) suggest that traits or
personality plays an important role in information seeking
behavior. Dutta-Bergman (2004) also classi?es channels as active
and passive, and conclude that the health conscious patients prefer
the active channels whereas the less health conscious people
gravitate towards passive channels.
2.2. Information seeking and communication behaviors
Instrumental (cure or task focused) and affective (care or socio-
emotional) communication behaviors have both been found to in-
?uence patients' perception of doctors (Blanchard et al., 1983; Hall,
Roter, & Katz, 1987; Hall, Roter, & Katz, 1988; Roter, Hall, & Katz,
1987). It may also impact the information seeking behavior of pa-
tients. Instrumental utterances include: giving information, asking
questions, advising, giving directions, discussing test results, future
course of treatment, and the like. Affective utterances include:
openness, empathy, reducing anxiety, showing concern, verbal
support, and addressing patients' by name (Blanchard et al., 1983).
Buller and Buller (1987) report that patients' information
seeking behavior is largely determined by the communication style
of the doctor (controlling or af?liate). In a typical doctorepatient
encounter, the contribution of the doctor is about 60 percent while
that of the patient is 40 percent. The use of language-both
nonverbal as well as verbal-may also hinder or promote doctor
patient communication (though research is limited on this theme).
Doctors tend to easily switch fromthe normal everyday language to
the medical language, and reverse, to in?uence the patients (Roter,
Hall, & Katz, 1988).
2.3. Health outcome: satisfaction
Research by Levinson and Chaumeton (1999) demonstrates, that
effective communication enhances patient recall of information,
generates compliance, yields satisfaction, creates psychological
well-being, and results in improved biomedical outcomes. Patient
outcomes de?ned in research include satisfaction, compliance,
recall, recovery, and knowledge.
By far the most widely used outcome variable is perhaps patient
satisfaction. Satisfaction is the cognitive and affective evaluation
based on the personal experience across all service episodes within
the relationship (Davis-Sramek, Droge, Mentzer, & Myers, 2009).
Older studies, as early as 1965, reveal that empathy demonstrated
by the doctors was proportionately related to patient satisfaction.
This view is supported in later research by Jensen (1981), Pantell,
Stewart, Dias, Wells, and Ross (1982) and Friedman, Di Matteo,
and Taranta (1980). Similarly, Street and Wiemann (1987) found
that involved, expressive physicians had more satis?ed patients.
Conversely, satisfaction was perceived to be low when the doctors
used too much jargon, were too curt in their responses to the
concerns and queries of patients, and spent too little a time
consulting them. Studies by Hall, Roter, and Rand (1981), Lane
(1983), Lavin (1983), and Street and Wiemann (1987) found that
patients were dissatis?ed with controlling and assertive doctors.
Buller and Buller used the measure of the physician's commu-
nication ability to evaluate the health care, rather than the level and
quality of medical information provided by him/her. Accordingly,
patients who expressed satisfaction with the communication style
of the doctors, were more satis?ed with the health care they
received. They concluded that patients who perceived that their
doctor's style was af?liative, were more satis?ed with the quality of
health care than when the doctor used the af?liative and non-
controlling style when interacting with patients. Their report also
noted that the average waiting time of patients in their survey was
about 25 min and each patient spent approximately 21 min or so
consulting with the physician.
The research review suggests that communication behaviors
have been found to in?uence patients' perception of doctors and
P. Mehra / Asia Paci?c Management Review 20 (2015) 293e303 294
the manner of information seeking. The task was to investigate
whether the communication style of doctors inhibited the quality
of information seeking behavior of patients. In this context the ?rst
null hypothesis is as below:
Hypothesis 1. The communication style of the doctor that is
whether they are receptive or expressive (controlling), does not
impact the patient satisfaction with the quality of information
sharing by doctors
2.4. Socio-demographic variables
Studies have investigated doctor characteristics, such as socio-
demographic (gender, age) and personality variables (communi-
cation styles, information giving, expression of empathy and non-
verbal behavior) and their impact on satisfaction and compliance.
However, patient characteristics (information seeking, gender, age)
also impacts the in clinic interaction between the doctor and the
patient. Cartwright and Anderson (1981) found that older re-
spondents expected less information from their doctor and
consequently sought less information.
Research by Turk-Charles, Meyerowitz, and Gatz (1997) vali-
dates this. According to them, information seeking is too narrowly
de?ned and needs to include other sources of information, besides
face to face interaction with the doctor in the clinic. These include
traditional media such as brochures, the newspaper and television,
as well as the new media such as email, internet, blogs, etc. Their
study reveals the extent to which individual characteristics of the
patients (type of disease: acute, chronic or life threatening; and
stage of the illness) have the potential to affect howdoctors interact
with their patients.
Older patients tend to seek more information (Jenkins,
Fallow?eld, & Saul, 2001). Their ?nding indicates that situa-
tional factors (such as a longer interaction time) may be neces-
sary for patients to perceive that the doctor is supportive towards
information sharing communication behaviors. Older patients are
more prone to anxiety and have many questions to ask once they
perceive that the doctor is giving more time to the interaction
and is supportive to information seeking communication behav-
iors. Thus research suggests that patient attitudes became
important in predicting information-seeking behavior only when
the doctorepatient interaction was a longer one (19 min or
more).
This appears to suggest that more than the attitude of the pa-
tient (active information seeking or inactive information seeking),
it is the situational factors that impact the quality of face to face
information seeking. The doctor might have too many patients to
attend or may be unwilling to disclose much. This leads to the
following two hypotheses below (Fig. 1):
Hypothesis 2. Lowinformation seekers (patients who do not seek
health care information actively) are satis?ed with the communi-
cation style of the doctor
Hypothesis 3. Longer interaction time may be necessary for pa-
tients to perceive that that the doctor is supportive towards infor-
mation sharing communication behaviors and the null hypothesis
Hypothesis 4. Gender wise there is no difference between the less
educated, low income, the highly educated patients, and the high
income patients in the desire to seek more information
3. Procedures
3.1. Setting
This cross sectional study was conducted in three major cities of
IndiaeLucknow, Kanpur, and New Delhi. Using strati?ed random
sampling, a structured questionnaire was used to collect data from
525 patients visiting 33 private clinics and two public hospitals in
Lucknow over a period of eight months. In Delhi and Kanpur, data
was collected from 121 patients from seven private clinics. The
cronbach's alpha for 55 questionnaire items was .913 (overall) and
.921 for construct related to 22 communication variables. Data was
analyzed using the SPSS v16 (See Tables 1.1 and 1.2).
4. Findings
4.1. Sources of information for patients
Interpersonal sources, mass media and magazines, constituted
relevant sources of health related information. About 61 percent of
the interviewed patients said that they actively sought out infor-
mation fromthe doctors during a face to face medical encounter. 24
percent of the sample said that they relied primarily on doctors to
provide relevant health information in the clinic (brochures, post-
ers etc.). Only 3 percent sought health information from the
internet. About 68 percent of the patients said that they would
prefer targeted information from the clinic.
4.2. Communication skills
A factor analysis reveals two communication styles of doctors as
perceived by the patients- Receptive and Expressive Communica-
tion skills (See Tables 2.1 and 2.2).
The KMO and Bartlett test is signi?cant with a sampling ade-
quacy of .881. This indicates that the test is reliable. The analysis
clubbed the variables into two most important communication
behaviors expected from Doctors- Receptive skills and Expressive
High
Information
Seekers
Non
Information
Seekers
Sasfacon with
communicaon
factors
Overall sasfacon with the primary
care at the clinic
Expectaons met
Covariates
1. Communicaon factors
2. In?uence factors
Fixed factors:
Gender, Type of informaon
seeker
Fig. 1. The research model.
P. Mehra / Asia Paci?c Management Review 20 (2015) 293e303 295
Table 1.1
Demographic details of Lucknow (Sample size 505: In %).
1.1. Age group in years 20e25 26e30 31e40 41e55 >55
9.8 19 23.8 25.2 21.6
1.2. Visit for this problem First time Second time Third time Many times
13.1 17.8 18.2 50.9
1.3. Did you know the provider before? Yes Referred by someone
48.7 51.3
1.4. Gender Male Female
51.3 48.7
1.5. Category Rural Urban
26.3 73.7
1.6. Purpose of visit Acute Chronic Injury Emergency
39 50.3 6.7 4.0
1.7. Doctor on email Yes No
2 97.3
1.8. Waiting time Very less Somewhat less Acceptable Delayed Highly delayed
.8 14.7 71.1 9.7 3.8
1.9. Time spent with the doctor (APPROX) 25 min
11.5 6.9 31.3 48.7 .2
1.10. Location of clinic Very near Close by Some distance Large distance Far away
2.8 17.4 38.8 18.2 22.8
1.11. Income High Middle Low
5.7 56 38.2
1.12. Employment Private Public Self Employed
22.4 20.8 56.4
1.13. Education Literate Semi-literate Illiterate
64.2 19.6 16.2
1.14. Do you actively seek health care information? Yes No
63.8 36.2
1.15. If yes to above, where do you MAINLY access health related information? Doctors clinic TV/Radio Internet All of the above None of the above
17.2 30.1 3.8 13.9 35
1.16. Do you prefer targeted messages by the clinic itself? Yes No
64.7 35.3
Table 1.2
Demographic details of N. Delhi and Kanpur (Sample size 121) (In %).
1.1. Age group in years 20e25 26e30 31e40 41e55 >55
16.5 43.8 24.8 8.3 6.6
1.2. Visit for this problem First time Second time Third time Many times
16.5 12.4 4.1 66.9
1.3. Did you know the provider before? Yes Referred by someone
95.1 4.9
1.4. Gender Male Female
85.1 14.9
1.5. Category Rural Urban
.8 99.2
1.6. Purpose of visit Acute Chronic Injury Emergency
65.3 22.3 5 7.4
1.7. Doctor on email Yes No
.8 99.2
1.8. Waiting time Very less Somewhat less Acceptable Delayed Highly delayed
5.8 23.1 52.9 18.2 0
1.9. Time spent with the doctor (APPROX) 25 min
15.7 75.2 6.6 2.5 0
1.10. Location of clinic Very near Close by Some distance Large distance Far away
17.4 39.7 18.2 24.8 0
1.11. Income High Middle Low
59.5 38.8 1.7
1.12. Employment Private Public Self Employed
75.2 23.1 1.7
1.13. Education Literate Semi-literate Illiterate
100
1.14. Do you actively seek health care information? Yes No
47.9 52.1
1.15. If yes to above, where do you MAINLY access
health related information?
Doctors clinic TV/Radio Internet All of the above None of the above
39.7 2.5 5.8
1.16. Do you prefer targeted messages by the clinic itself? Yes No
47.1 1.8
1.17. Overall experience Unfavorable Favorable
8.3 92.7
P. Mehra / Asia Paci?c Management Review 20 (2015) 293e303 296
skills, accounting for 65% variance. The default correlation method
was applied for the factor analysis. It produces the default prin-
cipal components analysis of variables. Those with eigenvalues
greater than 1 (the default criterion for extraction) are rotated
using varimax rotation (the default). The default is the number of
eigenvalues greater than mineigen .500 speci?ed for the analysis.
A simple regression run on the high information seeking pa-
tients' perception of doctors' communication style and satisfaction
with primary care shows, that communication style-both receptive
and expressive-is positively associated with satisfaction. The
impact of consultation time and waiting time are signi?cant, but
only at 10 percent con?dence interval (R square is .537). Longer
consultation time is desirable but not a guarantee of satisfaction
with primary care.
Results of the regression run on the low information seeking
patients (R square is .612) show that waiting time and consultation
time do not signi?cantly affect satisfaction level with the primary
care. Consultation time is found to be inversely related to satis-
faction level in the low information seeking group (See Tables 3.1
and 3.2 and also Table 4).
Results of the Anova show that the high information seeking
patients differ signi?cantly at .05 signi?cance level from the low
information seeking in their overall satisfaction level with the
health services provided at the clinic (See Table 5).
The Anova was applied to statistically compare the differences in
the response of the high and the non-information seekers with
respect to the communication skills of the doctor. The groups' differ
signi?cantly at .05 level of signi?cance with respect to demon-
stration of empathy, time given to the patient; response to queries,
clari?cation of doubts, indulging in informal chat, reducing fear,
providing additional information, and advising future course of
action (low information seeking patients are less satis?ed-see
Table 6).
4.3. Analysis by gender
Among the 363 male patients and 263 female patients, 205 and
177 patients respectively were high information seekers. The in
clinic experience of both groups was neutral (neither favorable nor
unfavorable) with respect to the query handling of the doctor on
phone. Experience of both groups-the active information seekers
and the non-information seekers-was only ‘somewhat favorable’
with respect to the query handling of the doctor in person. Expe-
rience of both groups was quite favorable on the perception of the
medical competency of the doctor, empathy, and understanding
demonstrated by the doctor in assisting the patients to decide the
future course of action. Again, the difference in responses was not
signi?cant at .05 signi?cance level. Males were more favorably
in?uenced by the provider than the females, though the difference
was not signi?cant at 95% con?dence interval.
In the current study, more female patients reported that they
would recommend the doctor. The male patients reported greater
expectation ful?llment though the difference was not statistically
Table 2.1
Factor analysis on patient satisfaction with the communication skills of the doctor:
KMO and Bartlett's Test.
KaisereMeyereOlkin measure of sampling adequacy .881
Bartlett's test of sphericity Approx. Chi-Square 3582.585
df 91
Sig. .000
Table 2.2
Rotated component matrix.
Communication skills of the doctor as perceived by the patients Component
1 2
Emotional support À.115 .816
Rarely interrupted .705 .321
Eye contact .816 .159
Probing questions .119 .412
Responded queries .430 .602
Clari?ed doubts .459 .505
Informal remarks À.094 .721
Decision-making .301 .649
Understood conversation .697 À.201
Paraphrased concerns .514 .497
Reduced fear .436 .580
Advised future action .429 .579
Simple language .554 À.125
Additional information .161 .699
Extraction method: principal component analysis.
Rotation method: varimax with Kaiser normalization.
Rotation converged in 3 iterations.
Table 3.1
Coef?cients: High Information seekers and satisfaction with the doctors wrt. the time spent at the clinic.
Model Unstandardized coef?cients Standardized coef?cients T stat Signi?cance P value
B Std. Error Beta B
1 (Constant) 8.561 .505 16.952 .000
Waiting time .185 .156 .049 1.181 .239
Time spent À.034 .098 À.017 À.351 .726
REGR factor score 1 Expressive Communication Style .755 .101 .359 7.479 .000
REGR factor score 2 Receptive Communication Style 1.612 .098 .665 16.428 .000
Dependent Variable: satisfaction_provider.
Selecting only cases that are high information seekers ¼ 2.00.
P. Mehra / Asia Paci?c Management Review 20 (2015) 293e303 297
signi?cant at .05 signi?cance level. Female patients reported lower
satisfaction than the male patients and the difference was signi?-
cant. The waiting time was somewhat less to acceptable for both
the male as well as female patients. Both groups report less time
spent on consultation, even as female patients reported greater
consultation time. Both males and female patients report that they
preferred the doctor over popular health care messages. Both
groups were unanimous in their opinion that they would not like to
receive targeted messages from the clinic in the form of short
messaging services or chats. Both groups were satis?ed with
respect to the perception of cure and relief, medical competency of
the doctor, support provided by the doctor in deciding the future
course of action, and the empathy demonstrated by the doctor in
the clinic.
4.4. Testing the model
Using the GLM Multivariate procedure, the values of multiple
dependent scale variables were modeled, based on their re-
lationships to categorical and scale predictors. The 2 Â 2 matrix in
the table is the hypothesis matrix for testing the signi?cance of all
independent variables (regression scores of satisfaction with the
communication skills of the doctor) on ‘Overall Satisfaction’ as
well as ‘Met Expectations’. SSCP matrix and the inverse of the
Table 3.2
Coef?cients: Non-Information seekers and satisfaction with the doctors wrt. consultation time.
Model Unstandardized coef?cients Standardized coef?cients T stat Signi?cance P value
B Std. Error Beta B
1 (Constant) 9.034 .367 24.586 .000
Waiting time .044 .094 .018 .465 .642
Time spent À.195 .075 À.112 À2.601 .010
REGR factor score 1 for Receptive Communication style .611 .081 .325 7.536 .000
REGR factor score 2 Expressive Communication style 1.092 .070 .621 15.656 .000
Dependent Variable: satisfaction_provider.
Selecting only cases that are Non-information seekers ¼ 1.00.
Table 4
Independent samples test.
Seek information N Mean Std. Deviation
Satisfaction with
the provider
1 380 8.8842 1.67938
2 246 8.2642 2.34723
Levene's test for
equality of variances
t-test for equality of means
F Sig. t df Sig.
(2-tailed)
Mean
difference
Std. Error
difference
95% con?dence interval
of the difference
Lower Upper
Satisfaction with
the provider
Equal variances
assumed
31.066 .000 3.848 624 .000 .61998 .16111 .30359 .93637
Equal variances
not assumed
3.590 405.500 .000 .61998 .17268 .28052 .95944
Table 5
Difference in satisfaction levels between high information seekers and non-information seekers with communication factors using the ANOVA test.
Sn. Variables p-value High IS vs. Low IS level of satisfaction
with the doctor (for both groups)
1 Response to query on phone .000 Both average
2 Response to query in person .001 Both high
3 Promoted feeling of cure and relief .000 Both high
4 Possessed technical expertise .000 Both high
5 Demonstrated empathy and understanding .000 Difference is signi?cant
6 Gave time to the patient .000 Difference is signi?cant
7 Assisted patient in deciding a course of action .000 Both high
8 Gave emotional support .000 Both low
9 Did not interrupt .000 Both high
10 Made eye contact .000 Both high
11 Asked probing questions .000 Difference is signi?cant
12 Responded to queries satisfactorily .000 Difference is signi?cant
13 Clari?ed doubts .000 Difference is signi?cant
14 Made Informal remarks to ease tension .003 Both poor
15 Decision making support .000 Both poor
16 Understood the conversation .411 Both high
17 Paraphrased concerns of the patient .001 Difference is signi?cant
18 Reduced the patients' fear .000 Difference is signi?cant
19 Advised future course of action patiently .000 Both high
20 Used simple language .870 Difference is signi?cant
21 Provided additional information .000 Both low
P. Mehra / Asia Paci?c Management Review 20 (2015) 293e303 298
error SSCP matrix were used to compute the statistics in the
multivariate tests table. The multivariate tests table displayed
four tests of signi?cance for each model effect (See Tables 7.1 and
7.2).
Table 7.3 depicts the Multivariate tests. The multivariate tests
table displays four tests of signi?cance for each model effect. The
Wilks Lambda for the predictor is closer to 0 than to 1 and hence
the most signi?cant predictor. In the model, except for expressive
Table 6
Patient gender and comparison of information seekers and noneseekers.
Parameters Mean score of
information
seekers
Comments Mean score of
Non information
seekers
Comments
1 Doctor in?uenced me Difference is signi?cant. Females are more
favorably in?uenced by the provider than the
males.
Males are more favorably in?uenced by the
provider than the females. Mean Female 8.9657 8.0116
Mean Male 9.1756 8.4667
2 I will recommend
the doctors to others
Both would recommend the provider to others.
Difference is not signi?cant.
Males would recommend the provider more
than the females
Mean Female 8.8229 8.2093
Mean Male 8.9659 9.2056
3 The doctor ful?lled
my expectations
Expectations of males ful?lled more than the
females though the difference is not stat
signi?cant
Expectations of males ful?lled more than the
females
Mean Female 8.5886 8.0814
Mean Male 8.8878 8.7000
4 I am satis?ed with
the doctor
Male patients are more satis?ed than the female
patients, and the difference is signi?cant.
Female patients report lower satisfaction than
the male patients
Mean Female 8.7257 7.7907
Mean Male 9.0195 8.6785
5 Waiting time in the clinic Reasonable waiting time for both male and
female patients though females had to wait
more
Was somewhat less to acceptable for both the
male as well as female patients. Mean Female 3.1143 2.8023
Mean Male 3.0732 2.7675
6 Time spent in the clinic On an average female patient got to spend more
time with the doctor than the male patients.
Both report less time spent in consultation.
Females spent more time with the doctor than
males.
Mean Female
a
3.3829 2.9419
Mean Male 2.9415 2.4563
7 I prefer targeted messages
from the clinic on mobile
phone or on my email
Mode Female
a
Mode Male
Mode is 1 would like to receive targeted messages from
the clinic
Mode is 2 would not like to receive
targeted messages from the clinic
8 Experience on
perception of query
handling by the
doctor on phone
Neutral (neither favorable nor unfavorable)
with respect to the query handling of the doctor
on phone. No signi?cant difference in response
Experience of both groups was unfavorable to
neutral (neither favorable nor unfavorable)
with respect to the query handling of the doctor
on phone.
Mean Female
a
3.3314 2.8140
Mean Male 3.3610 2.7484
9 Experience on perception
of query handling by the
doctor at the clinic
Experience of both groups was somewhat
favorable with respect to the query handling of
the doctor in person. No signi?cant difference in
response
Experience of both groups was somewhat
favorable with respect to the query handling of
the doctor in person
Mean Female
a
4.5771 4.2209
Mean Male 4.5024 4.3677
10 Experience on perception
of cure and relief in the clinic
Experience of both groups was quite favorable
No signi?cant difference in response
Experience of both groups was somewhat
favorable
Mean Female
a
4.4629 4.2093
Mean Male 4.4585 4.2129
11 Experience on perception
of the medical competency
of the doctor
Experience of both groups was quite favorable
No signi?cant difference in response
Experience of both groups was somewhat
favorable
Mean Female
a
4.6914 4.5465
Mean Male 4.5317 4.2129
12 Experience on perception
of Empathy and understanding
demonstrated by the doctor
Experience of both groups was quite favorable
No signi?cant difference in response
Experience of both groups was somewhat
favorable
Mean Female
a
4.2686 3.9535
Mean Male 4.2146 4.0000
13 Experience on perception
of the support provided by
the doctor in decision making/
course of future action
Experience of both groups was quite favorable
No signi?cant difference in response
Experience of both groups was somewhat
favorable
Mean Female
a
4.7429 4.5349
Mean Male 4.5854 4.2968
Note: Scale is from 1e11; 1: Totally Disagree to À11: Totally agree.
a
On a 5-point scale.
Table 7.1
Results of the GLMmultivariate analysis and contrast test results: Between-subjects
factors.
N
Gender 1 260
2 245
Seek information 1 322
2 183
P. Mehra / Asia Paci?c Management Review 20 (2015) 293e303 299
communication skills, Hotelling trace is nearly equal to Roy's largest
root as well as the Pillai's trace indicating the remaining predictors
do not contribute much to the model (See Table 7.3).
Findings indicate that except for the predictor ‘ receptive
communication skills’ of the doctor, the signi?cance values of the
rest of the main effects, the predictors, are more than .05, which
proves that the effects do not contribute to the model, and any
relationship is purely by chance.
This is validated by the signi?cance of the Box's M test which is
.000, suggesting that the assumptions are not met, and thus the
model results are suspect. To con?rmthe ?ndings a Levene test was
conducted where a separate test was performed for each depen-
dent variable. The p value for met expectations and overall
satisfaction (.364 and .450) was greater than .10, so there was no
reason to believe that the equal variances assumption is violated for
this variable (See Tables 7.4 and 7.5).
Table 7.6 displays the hypothesis and error sum-of-squares and
cross-products (SSCP) matrices for testing model effects. Since
there are two dependent variables, each matrix has two columns
and two rows for testing the signi?cance of factor 1.4.
The matrix associated with rest of the factors (such as 2.3, 2.4
and 1.4 and 2.4 etc.) in the table is the hypothesis matrix for testing
the signi?cance of factor 2.3, 2.4 etc., and the matrix VAR1.4*-
VAR1.14 is used for testing their interaction effect. The error matrix
is used in testing each effect. In analogy to the test for models with
one dependent variable, the “ratio” of the hypothesis SSCP matrix
to the error matrix is used to evaluate the effect of interest (See
Table 7.6).
Table 7.7 displays results for each contrast. Simple contrasts
using the ?rst level of ‘Gender’ as the reference category were
speci?ed. Thus, one contrast compares the second level to the ?rst
level; that is, the effect of male gender to the effect of female
gender. The contrast estimates showthat, on average, male patients
were less satis?ed than female patients. Expectations of male pa-
tients were met less in comparison to female patients. Since the
signi?cance value for gender is more than .05, it is concluded that
this difference is due to chance for both the variables.
In Table 7.8, Simple contrasts using the ?rst level of ‘Information
seeking’ as the reference category were speci?ed. Thus, one
contrast compares the second level to the ?rst level; that is, the
effect of non-information seeker to the effect of high information
seeker. The contrast estimates show that, on average, non-
information seeking patients were less satis?ed than high infor-
mation seeking. Expectations of non-information seeking patients
were met less in comparison to high information seeking patients.
Since the signi?cance value for information seeking is more than
.05, it is concluded that this difference is due to chance for both the
variables (See Tables 7.7 and 7.8).
The model indicates that more than any other factor, the quality
of the doctors' receptive skills result in greater patient satisfaction.
The model indicates that the non-information seeking patients
tend to be more dissatis?ed than high information seeking patients.
They also have greater expectations from the doctor that have not
been met.
The following conclusions have been drawn with respect to the
hypotheses:
Table 7.2
Results of the GLM multivariate analysis and contrast test results: Descriptive statistics.
Gender Type of Information seeking behaviour Mean Std. Deviation N
Ful?lled expectations 1 S 8.3861 1.60701 158
NS 7.4314 1.92693 102
Total 8.0115 1.79764 260
2 S 8.5000 1.36341 164
NS 7.6543 1.45911 81
Total 8.2204 1.44871 245
Total S 8.4441 1.48669 322
NS 7.5301 1.73456 183
Total 8.1129 1.63940 505
Satisfaction with the doctor 1 S 8.5316 1.57071 158
NS 7.5294 1.91247 102
Total 8.1385 1.77826 260
2 S 8.6341 1.34768 164
NS 7.9012 1.51332 81
Total 8.3918 1.44345 245
Total S 8.5839 1.45999 322
NS 7.6940 1.75234 183
Total 8.2614 1.62782 505
Note: 1-Male; 2-Female/S: Seeker. NS: Non-Seeker.
Table 7.3
Results of the GLM multivariate analysis and contrast test results: Multivariate tests.
Effect Sig.
Intercept Pillai's Trace .000
Wilks' Lambda .000
Hotelling's Trace .000
Roy's Largest Root .000
Wilks' Lambda .192
Hotelling's Trace .192
Roy's Largest Root .192
Hotelling's Trace .175
Roy's Largest Root .175
FAC1_4 Pillai's Trace .001
Wilks' Lambda .001
Hotelling's Trace .001
Roy's Largest Root .001
FAC2_4 Pillai's Trace .474
Wilks' Lambda .474
Hotelling's Trace .474
Roy's Largest Root .474
VAR1.4 Pillai's Trace .527
Wilks' Lambda .527
Hotelling's Trace .527
Roy's Largest Root .527
VAR1.14 Pillai's Trace .165
Wilks' Lambda .165
Hotelling's Trace .165
Roy's Largest Root .165
VAR1.4*VAR1.14 Pillai's Trace .241
Wilks' Lambda .241
Hotelling's Trace .241
Roy's Largest Root .241
Exact statistic.
P. Mehra / Asia Paci?c Management Review 20 (2015) 293e303 300
Hypothesis 1. The communication style of the doctor (receptive
or expressive) does not impact the patient satisfaction with the
quality of information
Conclusion: The receptiveness of the doctor is an important
factor in patient satisfaction; hence this hypothesis is partially
rejected.
Hypothesis 2. Non-Information seekers (patients who do not
seek health care information actively) are satis?ed with the
communication style of the doctor
Conclusion: Non information seekers/less information seekers
are not satis?ed with the communication style of the doctor; hence
this hypothesis is rejected.
Hypothesis 3. Longer interaction time may be necessary for pa-
tients to perceive that that the doctor is supportive towards infor-
mation sharing communication behaviors
Conclusion: This hypothesis is rejected. The impact of waiting
time and consultation time is not signi?cant at .05 con?dence
interval.
Hypothesis 4. Gender wise there is no difference between the less
educated, low income, the highly educated, and, the high income
patients, in the desire to seek more information
Conclusion: There is a difference. Males (educated or other-
wise; high and low income wise) seek less information than fe-
males; also more literate and working female patients tend to
seek greater information from the doctor. Thus this hypothesis is
rejected.
5. Discussion
The above ?ndings indicate that the receptive communication
skills of the doctor, such as listening, query handling (in person),
response to queries, and clari?cation of doubts are important var-
iables that affect satisfaction with primary care. Waiting time and
consultation length are important variables that contribute to the
model, but their effects are not signi?cant. The study indicates that
patients with greater consultation length would recommend the
doctor more than those with decreased consultation length.
Table 7.4
Results of the GLM multivariate analysis and
contrast test results: Box's test of equality of
covariance matrices.
a
Box's M 46.180
F 5.090
df1 9
df2 1.075E6
Sig. .000
Tests the null hypothesis that the observed
covariance matrices of the dependent variables
are equal across groups.
a
Design: Intercept þ FAC1_4 þ FAC2_4
þ VAR1.4 þ VAR1.14 þ VAR1.4*VAR1.14.
Table 7.5
Results of the GLM multivariate analysis and contrast test results: Levene's test of
equality of error variances.
F df1 df2 Sig.
Ful?lled expectations of the patient 1.065 3 501 .364
Satisfaction .883 3 501 .450
Tests the null hypothesis that the error variance of the dependent variable is equal
across groups.
Design: intercept þ fac1_3 þ fac2_3 þ fac3_3 þ fac1_4 þ fac2_4 þ var1.4 þ var1.14
þ var1.4*var1.14.
Table 7.6
Results of the GLM multivariate analysis and contrast test results: Between-subjects SSCP matrix.
Ful?lled expectations Satisfaction provider
Hypothesis Intercept Ful?lled expectations 8253.742 8369.566
Satisfaction provider 8369.566 8487.017
FAC1_4 (receptive communication skills) Ful?lled expectations 10.490 11.679
Satisfaction provider 11.679 13.004
FAC2_4 (expressive/directive communication skill) Ful?lled expectations 1.321 1.264
Satisfaction provider 1.264 1.210
VAR1.4 (Gender) Ful?lled expectations .036 .158
Satisfaction provider .158 .693
VAR1.14 (Information seeking behavior) Ful?lled expectations 2.040 .802
Satisfaction provider .802 .315
VAR1.4*VAR1.14 Ful?lled expectations .419 .966
Satisfaction provider .966 2.226
Error Ful?lled expectations 444.022 389.738
Satisfaction provider 389.738 518.925
Based on Type III Sum of Squares.
Table 7.7
Results of the GLM multivariate analysis and contrast test results: Contrast results (K Matrix).
Gender simple contrast Dependent Variable
Ful?lled expectations Satisfaction provider
Level 1 vs. Level 2 Contrast Estimate À.018 À.078
Hypothesized Value 0 0
Difference (Estimate e Hypothesized) À.018 À.078
Std. Error .089 .096
Sig. .841 .416
95% Con?dence Interval for Difference Lower Bound À.193 À.268
Upper Bound .157 .111
Reference category ¼ 2.
P. Mehra / Asia Paci?c Management Review 20 (2015) 293e303 301
Classifying patients into information seekers and non-seekers
gave direction to the study. Analysis reveals, that as compared to
the female patients, more male patients fell into the category of
non-information seekers.
Both male and female non-information seekers record satis-
faction on most communication dimensions. However, female non-
information seekers record lower satisfaction overall, as well as
unmet expectations, in comparison to the male non-information
seeking patients. Apart from recording lower satisfaction and un-
met expectations, the female non-information seeking patients
would recommend the doctor less than the male non-information
seeking patients.
This implies two things: Firstly, the non-information seeking
patients are perhaps indifferent to the doctors' communication
skills or the lack of it. This may hold true for the male patients.
Secondly, though female non-information seeking patients are
satis?ed on nearly all communication dimensions, they express
dissatisfaction with primary care and meeting of expectations.
A study of the demographic information of the non-information
seeking patients presents further insights. In the survey, a large
majority of the non-information seekers were rural, illiterate to
semi-literate, and belonging to lowincome households. It might be
so that they come to the clinic with minimal or no expectations;
they consider the doctor as authoritative and controlling and fear to
challenge the doctors' authority. At the same time, if more
consultation time was given, the non-information seeking patients
could be encouraged to share their concerns with the doctor. The
high information seeking patients were more literate, urban, and
?nancially well off. Older male patients are greater information
seekers than younger male patients.
The assumption that Indian women are hesitant to seek infor-
mation from the doctor is unfounded; more males than females
were non-information seekers. Results show that as female pa-
tients become more educated and self-dependent, they come with
enhanced expectations to the clinic. These expectations have to be
met. The information non-seeking female patients record lower
satisfaction with the primary care in the clinic. They would also
recommend the doctor less than their male counterparts. Though
satis?ed on the communication dimensions, they report low
satisfaction with the consultation time which, in turn, affects their
overall satisfaction. This implies the following: female patients
come with expectations to the clinic; and, need encouragement
(and time) from the doctor to articulate their concerns.
Patients in general were not disappointed with the information
that they received from the doctor. In fact patients adapted to the
communication style of the doctor, rather than vice versa, in their
efforts to solicit information from the doctor. Both the information
seeking as well as non-seeking groups expressed dissatisfaction
with the doctors' decision making support or the lack of it.
There is nothing to indicate in this study that information
seeking is greatly affected by the type of illness-chronic or life
threatening. We conclude that information seeking is an attitude or
a predisposition that is dependent less on the socio-demographic
variables (such as gender) and situational variables (waiting time,
consultation time) and more on communication variables (partic-
ularly the doctor's receptive skills). In other words the doctor is not
communicating as well as he/she should be. In a medically under-
served nation, such as India, this probably holds true since the
doctor is indeed hard pressed for time. The doctors often sidetrack
the important role of communication in diagnosis and prognosis.
The lack of purposeful information seeking clearly creates
challenges for health communicators. This aspect is outside the
purview of the current research; suf?ce to state that such a cate-
gory of patients exists in the country. However, further studies can
be taken in this direction especially nowthat organized health care
is getting requisite attention in India.
Patients are gradually becoming internet pro?cient and have a
desire to know more about their ailment. The study strongly rec-
ommends doctors to encourage patients, especially reticent male
and female patients, to articulate their concerns. Doctors also need
to view health care as a service by valuing the ‘service paradigm’, a
philosophy where the customers' needs are to be given the utmost
priority. Effective communication practices can go a long way to
create, maintain, and build a loyal patient base. Another important
recommendation pertains to promoting communication skills
training in the medical curricula. Periodical assessment of these
skills for further certi?cation would also help promoting this
valuable skill amongst doctors.
The WHO Western Paci?c Regional Strategy 2010 states that
health systems in low- and middle-income countries (LMICs) ‘can
be strengthened using Public Health Cadre (PHC) values as core
principles’. A review article by Rule et al. (2014) investigated the
effectiveness of PHC interventions in LMICs and concluded that
there was a lack of consistency for the assessment of effectiveness
of health care programs. In India, the previous national government
had backed the creation of a Public Health Cadre in the 12th Five-
year Plan. The present government is also conscious of closing
the health care gaps in India. However, more needs to be done.
There needs to be a consistent approach to assess organized health
care in India involving the doctor, the patient and the facility so that
the health systems can be strengthened to serve all the segments of
the society. People-centeredness, community protection, and
participation require that doctors effectively communicate with the
stakeholders.
6. Limitations
The research is not without its limitations. The ?rst relates to the
duration of the study. This being a cross sectional study, the ?nd-
ings can be accused of being subjective and generalized. Secondly
the researcher only made assumptions as to why the patients were
information seekers and non-seekers-perhaps a deeper
Table 7.8
Results of the GLM multivariate analysis and contrast test results: Contrast results (K Matrix).
Seek_information simple contrast
a
Dependent Variable
Ful?lled expectations Satisfaction provider
Level 1 vs. Level 2 Contrast Estimate À.150 À.059
Hypothesized Value 0 0
Difference (Estimate e Hypothesized) À.150 À.059
Std. Error .100 .108
Sig. .132 .583
95% Con?dence Interval for Difference Lower Bound À.346 À.270
Upper Bound .045 .152
a
Reference category ¼ 2.
P. Mehra / Asia Paci?c Management Review 20 (2015) 293e303 302
psychological study is required to supplement the research as to
why some patients prefer not to seek any information from the
doctor. In the third place, a cultural approach could have been
conducted to investigate the impact of cultural differences with
respect to information seeking behavior of patients. Future re-
searchers could explore that dimension taking a cue from the
present research.
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