Effective Patient-provider Communication Research Articles

Abstract C87: Provider characteristics and timely receipt of cancer screening: The role of communication and race/sex concordance between patients and providers

Abstract Background: Early detection through screening is an important predictor of cancer prognosis and can significantly improve quality of life, lower mortality and reduce treatment costs. Despite improved access, screening remains sub-optimal. Healthcare providers play a crucial role in promoting positive health behaviors by establishing trust through effective patient-provider interactions and communication. It is known that optimal alignment of race/ethnicity and sex between patients and providers as well as satisfaction with interaction with providers may encourage compliance with treatment. It remains unclear if concordance and patient's perceptions of quality of provider's communication influences utilization and adherence to cancer screening. This study's objectives are two-fold:1) To examine if race/ethnicity and sex concordance is associated with compliance for breast, cervical and colorectal cancer screening (CRC) and 2) To estimate the association between patients rating of their provider's communication and receipt of timely screening. Methods: Analyses data are adult respondents with a usual source of care (USC) identified from 2008-2013 Medical Expenditure Panel Survey. Sample sizes varied by services based on U.S. Preventive Services Task Force screening recommendations for breast, cervical and CRC. Concordance was categorized as no concordance, race only, sex only or dual concordance using respondents' report of their own and their providers' race/ethnicity and sex. Perceptions of provider's communication were measured on four dimensions; how often USC 1) asked about prescription medications and treatments from other doctors, 2) showed respect for medical, traditional and alternative treatments that the person wants, 3) involved in making decisions between treatments, 4) presented and explained all options. Separate multivariate logistic regressions were conducted for each cancer screening to examine association with concordance and each communication behavior individually. Results: Women with female providers were more likely to report adherence to mammography [Odds Ratio (OR) = 1.8, 95% confidence interval (CI): 1.3, 2.4; p<0.001] and PAP tests [OR = 1.5, 95% CI: 1.3, 2.0; p=0.006]. Neither sex nor dual concordance was associated with CRC screening. Race concordance alone was not statistically associated with any cancer screening. Women who perceived USC to involve in decision making or asked about treatments from other doctors were more likely to report timely mammograms [OR = 1.2, 95% CI: 1.0, 1.4; p=0.04 and OR = 1.5, 95% CI: 1.2,1.7; p<0.001 respectively] and cervical cancer screening [OR = 1.2, 95% CI: 1.03, 1.4; p=0.02 and OR = 1.3, 95% CI: 1.09,1.6; p=0.005 respectively]. However, only one communication behavior of being asked about treatments was associated with timely CRC screening [OR = 1.2, 95% CI: 1.02, 1.3; p=0.02]. Subgroup analysis indicated that positive perceptions of communication were associated with higher likelihood of reporting all cancer screening among racial and ethnic minorities. Conclusions: Association between sex concordance with breast and cervical cancer screening suggests that either female providers are more likely to recommend them because of better attunement to female preventive needs or patients are more comfortable receiving them from female providers. Results on communication patterns indicate that both measures that were significant, were related to providers' soliciting response from patients which may encourage patient activation and facilitate receipt of cancer screening especially among racial and ethnic minorities. Thus, greater patient involvement and encouraging dialogue with patients can be an important platform for promotion of disease prevention. Healthcare providers play a crucial role in mitigating disparities in cancer screening and should consider interpersonal communication with their patients as an effective instrument to promote timely screening. Note: This abstract was not presented at the conference. Citation Format: Anushree M. Vichare. Provider characteristics and timely receipt of cancer screening: The role of communication and race/sex concordance between patients and providers. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C87.

“Life Support”: A Play about Palliative Care (FR476)

•Identify factors that lead to effective patient-provider communication.•Discuss how complex psychosocial issues affect patient care.•Reflect on a patient’s journey through illness. For this session, we propose a unique educational strategy: combining live theater with a talkback/reflective exercise. First, we will perform “Life Support”, a 90-minute play about palliative care. “Life Support” tells the story of a complicated patient who transitions to hospice. After the play, attendees will have an opportunity to debrief through a facilitated discussion. Goals of this session are: to teach communication skills, promote self-reflection, and highlight complex psychosocial issues. According to the literature, theater can enhance empathy [1], improve case presentation skills [2], and facilitate discussions about “hot button” issues [3]. For example, at AAHPM 2016, Ms. Elaine Magree presented a play about the AIDS crisis. The play “Life Support”, by Madeline Leong, was presented at Johns Hopkins Hospital in April 2016. It received substantial press and excellent reviews. Technical requirements are simple. For more information about the play, please contact the primary author. In “Life Support”, the characters participate in several goals of care discussions, including a discussion of Advance Directives and what it means to receive hospice care. These topics are especially relevant given the known benefit of early palliative care and advance care planning and the public’s frequent misconception of these phrases. During the talkback, attendees will discuss the patient-provider communication in the play. Attendees will also have the option to fill out a one-page survey about the play. The purpose of the reflective exercise is to act as an interactive adjunct to the inherent educational value of the play. Yasmina Reza wrote, “Theater is a mirror.” In this session, we hope to use theater as a mirror to demonstrate the nuances of patient-provider communication and the importance of the words we choose and how we speak them. We also hope to create a unique educational experience that contributes to clinician wellness and burnout prevention.

Health Literacy Tool Shed: A Source for Validated Health Literacy Instruments

ABSTRACTAssessing patients for health literacy levels can be an important tool in effective provider-patient communication and positive health care outcomes. A number of different assessment tools are available to health care providers and researchers. The Health Literacy Tool Shed is a convenient searchable database of validated health literacy instruments. Instruments can be searched by alphabetic title list, context, domain measured, and administration time, among others. Results include a description of the tool, references, and score validation criteria. Tools may be freely available online or may be requested from the creator of the evaluation instrument.

Primary care providers' cancer genetic testing-related knowledge, attitudes, and communication behaviors: A systematic review and research agenda.

Primary care providers (PCPs) can play a critical role in helping patients receive the preventive health benefits of cancer genetic risk information. Thus, the objective of this systematic review was to identify studies of US PCPs' knowledge, attitudes, and communication-related behaviors regarding genetic tests that could inform risk-stratification approaches for breast, colorectal, and prostate cancer screening in order to describe current findings and research gaps. We conducted a systematic search of six electronic databases to identify peer-reviewed empirical articles relating to US PCPs and genetic testing for breast, colorectal, or prostate cancer published in English from 2008 to 2016. We reviewed these data and used narrative synthesis methods to integrate findings into a descriptive summary and identify research needs. We identified 27 relevant articles. Most focused on genetic testing for breast cancer (23/27) and colorectal cancer risk (12/27); only one study examined testing for prostate cancer risk. Most articles addressed descriptive research questions (24/27). Many studies (24/27) documented PCPs' knowledge, often concluding that providers' knowledge was incomplete. Studies commonly (11/27) examined PCPs' attitudes. Across studies, PCPs expressed some concerns about ethical, legal, and social implications of testing. Attitudes about the utility of clinical genetic testing, including for targeted cancer screening, were generally favorable; PCPs were more skeptical of direct-to-consumer testing. Relatively fewer studies (9/27) examined PCPs' communication practices regarding cancer genetic testing. This review indicates a need for investigators to move beyond descriptive research questions related to PCPs' knowledge and attitudes about cancer genetic testing. Research is needed to address important gaps regarding the development, testing, and implementation of innovative interventions and educational programs that can improve PCPs' genetic testing knowledge, assuage concerns about the appropriateness of cancer genetic testing, and promote open and effective patient-provider communication about genetic risk and genetic testing.

Interventions to Manage Uncertainty and Fear of Recurrence in Female Breast Cancer Survivors: A Review of the Literature.

Fear of cancer recurrence (FCR) is one of the largest unmet needs in the breast cancer survivor population. This review addresses this unmet need with the question. The purpose of this article is to better understand potential interventions to manage FCR when caring for breast cancer survivors. Databases used were PubMed, CINAHL®, Google Scholar, EMBASE, and Scopus. Articles published in English from 2009-2014 with female breast cancer survivors and interventions that address FCR as an endpoint or outcome measure or objectively illustrate an improvement in FCR were included. One hundred ninety-eight articles were initially identified in this literature review search. Upon detailed review of content for relevance, seven articles met criteria to be included in this review. This literature review provided current evidence of published interventions to manage uncertainty in the female breast cancer survivor population, as well as future research recommendations. Interventions surrounding being mindful, managing uncertainty, having more effective patient-provider communication, and handling stress through counseling are options for managing FCR.

Providing Nutritional Care in the Office Practice: Teams, Tools, and Techniques.

Provision of dietary counseling in the office setting is enhanced by using team-based care and electronic tools. Effective provider-patient communication is essential for fostering behavior change: the key component of lifestyle medicine. The principles of communication and behavior change are skill-based and grounded in scientific theories and models. Motivational interviewing and shared decision making, a collaboration process between patients and their providers to reach agreement about a health decision, is an important process in counseling. The stages of change, self-determination, health belief model, social cognitive model, theory of planned behavior, and cognitive behavioral therapy are used in the counseling process.

Creating a Professional Ladder for Interpreters for Improvement of Care

Children's Hospital Los Angeles (CHLA), a metropolitan academic medical center, recognized limitations in how the professional interpreters from the Diversity Services Department were used to support effective patient-provider communication across the organization. Given the importance of mitigating language and communication barriers, CHLA sought to minimize clinical and structural barriers to health care for limited English proficiency populations through a comprehensive restructuring of the Diversity Services Department. This approach entailed a new delivery model for hospital language assistance and cultural consultancy resources. The intervention focused on restructuring the Diversity Services Department, redefining priorities, reallocating resources, and redefining the roles of the language staff positions in the department. The language staff role was redesigned to fit a four-level professional career ladder modeled after the professional career ladders commonly used in hospitals for the RN role and other professional disciplines. The approach involved creating new levels of language specialist, each with progressive requirements for performance, leadership, and accountability for patient care outcomes. Language staff in the inpatient, clinic, and emergency department settings worked alongside nurses, physicians, and other disciplines to care for a specific set of patients. The result of this work was a positive culture change resulting in service efficiencies, care improvements, and improved access to language services. A professional career ladder for language staff contributed to improving the quality and access of language services and advancing the interpreting profession by incorporating care coordination support, vital document translation, and cultural consultancy.

Psychometrics of shared decision making and communication as patient centered measures for two language groups.

Shared decision making (SDM) and effective patient-provider communication are key and interrelated elements of patient-centered care that impact health and behavioral health outcomes. Measurement of SDM and communication from the patient's perspective is necessary in order to ensure that health care systems and individual providers are responsive to patient views. However, there is a void of research addressing the psychometric properties of these measures with diverse patients, including non-English speakers, and in the context of behavioral health encounters. This study evaluated the psychometric properties of 2 patient-centered outcome measures, the Shared Decision-Making Questionnaire-9 (SDM-Q) and the Kim Alliance Scale-Communication subscale (KAS-CM), in a sample of 239 English and Spanish-speaking behavioral health patients. One dominant factor was found for each scale and this structure was used to examine whether there was measurement invariance across the 2 language groups. One SDM-Q item was inconsistent with the configural invariance comparison and was removed. The remaining SDM-Q items exhibited strong invariance, meaning that item loadings and item means were similar across the 2 groups. The KAS-CM items had limited variability, with most respondents indicating high communication levels, and the invariance analysis was done on binary versions of the items. These had metric invariance (loadings the same over groups) but several items violated the strong invariance test. In both groups, the SDM-Q had high internal consistency, whereas the KAS-CM was only adequate. These findings help interpret results for individual patients, taking into account cultural and linguistic differences in how patients perceive SDM and patient-provider communication. (PsycINFO Database Record

Developing an mHealth framework to improve diabetes self-management.

The need for improved diabetes care outcomes is paramount. Each year, 1.6 million cases are diagnosed with type 2 diabetes and as of 2006; diabetes was the seventh leading cause of death in the United States. Moreover, the financial burden associated with diabetes was estimated to be $174 billion in 2007. Studies show that effective patient-provider communication (PPC) improves diabetes self-care, diabetes outcomes, or both. There has been significant number of studies aimed at improving diabetes care through different telehealth technologies such as patient web portals. However, to the best of our knowledge, there has been limited amount of research done exploring the use of mobile technologies to improve diabetes care.

Instructor and Dental Student Perceptions of Clinical Communication Skills via Structured Assessments

The aim of this study was to use structured assessments to assess dental students' clinical communication skills exhibited during patient appointments. Fourth-year dental students (n=55) at the University of Alabama at Birmingham evaluated their own interpersonal skills in a clinical setting utilizing the Four Habits Coding Scheme. An instructor also assessed student-patient clinical communication. These assessments were used to identify perceived strengths and weaknesses in students' clinical communication. Both instructor assessments and student self-assessments pinpointed the following clinical communication skills as effective the most often: patient greeting, avoidance of jargon, and non-verbal behavior. There was also relative agreement between instructor assessments and student self-assessments regarding clinical communication skills that were rated as not effective most frequently: ensuring patient comprehension, identification of patient feelings, and exploration of barriers to treatment. These resulted pointed to strengths and weaknesses in the portion of the curriculum designed to prepare students for effective provider-patient communication. These results may suggest a need for the school's current behavioral science curriculum to better address discussion of potential treatment barriers and patient feelings as well as techniques to ensure patient comprehension.

Published Issues

To describe the changing dynamics of patient-provider communication with proposals for optimizing this important relationship.Current research, national programs and guidelines from the National Cancer Institute, the Commission on Cancer, the Institute of Medicine, and the Oncology Nursing Society.There are important opportunities to apply evidence-based strategies to optimize patient-provider communication that will result in improved health outcomes.Oncology nurses across all areas of practice, including clinical care, research, and education, can play a significant role in achieving the goal of positive health outcomes by addressing challenges that inhibit effective patient-provider communication.

Patient-Provider Communication: the Rise of Patient Engagement.

To describe the changing dynamics of patient-provider communication with proposals for optimizing this important relationship. Current research, national programs and guidelines from the National Cancer Institute, the Commission on Cancer, the Institute of Medicine, and the Oncology Nursing Society. There are important opportunities to apply evidence-based strategies to optimize patient-provider communication that will result in improved health outcomes. Oncology nurses across all areas of practice, including clinical care, research, and education, can play a significant role in achieving the goal of positive health outcomes by addressing challenges that inhibit effective patient-provider communication.

Attachment Theory as a Model of Doctor–Patient Interaction

Individuals' attachment styles have been traced throughout the life span, informing our understanding of long‐standing interpersonal patterns and self‐care habits. Recent scholarship has identified direct and indirect mechanisms through which attachment theory may impact individuals' health outcomes, with specific emphasis on endocrine and behavioral responses to stress. This article reviews extant literature on medical patients' attachment styles and also proposes a new line of research: an investigation of the interaction between patients' and providers' attachment styles. As medical establishments place more emphasis on effective patient–provider communication, attachment theory serves as an apt framework for clarifying, measuring, and training medical personnel in the advancement of patient‐centered care.

Barriers to communication between HIV care providers (HCPs) and women living with HIV about child bearing: A qualitative study

ObjectivesIn the context of HIV clinical care, open discussion regarding sexual health and reproductive plans has become increasingly relevant. The aim of this paper is to explore barriers to communication between providers and women living with HIV regarding childbearing. MethodsIn-depth interviews (IDIs) were conducted with 48 HIV infected women receiving ART at 7 different HIV clinics providing comprehensive HIV care services in four districts in Uganda, between July and August 2012. All women were aware of their HIV diagnosis prior to pregnancy or had given birth while living with HIV. ResultsFour themes emerged describing barriers to communication, from the HIV-positive women’s point of view: (i) provider indifference or opposition to childbearing post HIV diagnosis, (ii) anticipation of negative response from provider, (iii) provider’s emphasis on ‘scientific’ facts, (iv) ‘accidental pregnancy’. ConclusionExisting evidence regarding effective provider-patient communication should be considered for its application for reproductive counseling among HIV infected women. Practice implicationsThese data demonstrate the need for current counseling guidelines to explore approaches that encourage open, non-judgmental, non-directive discussions with HIV positive individuals around their reproductive desires and intentions in a health care setting

Barriers to effective communication between veterans with chronic kidney disease and their healthcare providers: Table 1.

BackgroundMany patients with chronic kidney disease (CKD) have insufficient knowledge about CKD, which is associated with poorer health outcomes. Effective patient–provider communication can improve CKD patients' knowledge, thereby augmenting their participation in self-care practices. However, barriers to addressing CKD patients' information needs have not been previously characterized.MethodsAdults with an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2 or on chronic dialysis or with a kidney transplant were recruited from a Department of Veterans Affairs (VA) nephrology clinic. Semi-structured telephone interviews were conducted to assess patients' CKD information needs and demographic characteristics. A qualitative approach was used to analyze interview transcripts and identify themes pertaining to communication dynamics.ResultsThirty-two patients participated. The mean age of participants was 63 years; most were male (94%) and non-Hispanic white (53%). CKD severity groups represented included CKD-3 (eGFR 30–59 mL/min/1.73 m2; 34%), CKD-4 (eGFR 15–29 mL/min/1.73 m2; 25%), CKD-5 (eGFR <15 mL/min/1.73 m2; 16%), end-stage kidney disease on dialysis (13%) and kidney transplant recipients (12%). Several key themes emerged about barriers to patient–provider communication based on patients' reported care at both VA and non-VA facilities, including patients perceived their role as a ‘listener’, reported limited CKD knowledge, did not understand physicians' explanations and were dissatisfied with the patient–provider relationship.ConclusionsSeveral barriers to patient–provider communication prevent patients from meeting their information needs and perpetuate patient passivity. Future research should evaluate whether interventions that empower CKD patients to actively participate in their care increase knowledge and improve health outcomes.

What to Do When Your Patient Doesn’t Speak English

You have accessThe ASHA LeaderOn the Pulse1 Nov 2014What to Do When Your Patient Doesn’t Speak EnglishPatients are entitled to quality speech-language, swallowing and hearing services, no matter what languages they speak. Here’s how to provide them. Gennith Johnson, andMCD, CCC-SLP Claudia SaadMS, CCC-SLP Gennith Johnson Google Scholar More articles by this author , MCD, CCC-SLP and Claudia Saad Google Scholar More articles by this author , MS, CCC-SLP https://doi.org/10.1044/leader.OTP.19112014.28 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In An acute-level hospital admits a 67-year-old Haitian man who shows slurred speech and right-sided weakness. He speaks some French but is fluent in Haitian Creole, common to his region of Haiti. A nurse administers a swallow screening in the emergency room—which he fails—but the patient cannot answer standard admission questions because of the language barrier. Hospital staff consult the speech-language pathologist to complete a dysphagia evaluation, because the nurse is hesitant to administer oral medications. What should an English-speaking SLP do in this situation? Place the patient on medical hold until he can describe his problem? Proceed with a swallowing evaluation by giving the patient food and drink? Use an English communication board to explain the process of the swallow evaluation? Request a Haitian Creole interpreter to aid communication between the patient and the SLP during the evaluation? Our patient represents many people in the United States who speak a language other than English, and for whom providing quality health care can be a challenge. But SLPs and audiologists have a responsibility to provide appropriate services to people with communication or swallowing disorders who may not be proficient speakers of English. To guide practice, the Joint Commission—an accrediting organization that certifies more than 20,500 health care organizations and programs in the United States—developed a set of patient-centered communication standards for hospitals in July 2012. The standards guide clinicians on addressing all patients’ communication needs, and outline qualifications for interpreters and translators. The standards are part of a larger initiative, “Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals”, that focuses on effective communication and culturally competent care. Failure to meet these requirements could result in a loss of accreditation. According to the Joint Commission, “No longer considered to be simply a patient’s right, effective communication is now accepted as an essential component of quality care and patient safety.” Using an interpreter is the best option; ASHA’s Practice Portal provides guidance for collaborating with interpreters. You can also tap these resources to facilitate communication with non-English-speaking patients: Numerous apps and online translation sites provide immediate translation, but use them with caution: They are not always accurate. Smartphone technology can facilitate carryover and recall of strategies and techniques. For example, with a smartphone one can record spoken and video-signed clinical recommendations. Consider using Communication Access Realtime Translation (CART, or Computer Assisted Realtime) on site or remotely for patients who are deaf or hard of hearing, in addition to a sign interpreter. CART transcribes and instantaneously captions spoken language to relay messages. Let’s return to our 67-year-old Haitian patient with the language barrier. Which option is the right one according to the Joint Commission? Requesting a Haitian Creole interpreter to assist with the evaluation is the only correct answer. Hospitals accredited by the Joint Commission are required to provide language interpreting and translation services. These services can be in-person or via telephone or video. Language interpreters should demonstrate not only language proficiency, but have qualifications that are typically met through education, training and experience. Hospitals may employ language interpreters or contract out for these services; SLPs can request an interpreter through nursing or social services. Trained bilingual hospital staff may also be a viable option. Research shows that effective patient-provider communication is essential to patient safety as well as to better treatment outcomes. For more on using interpreters… ASHA Issues in Ethics: Cultural and Linguistic Competence further outlines the importance of providing culturally competent care that ensures access to services via an interpreter when needed. ASHA’s Code of Ethics also supports the use of interpreters when working with patients who do not speak English. Author Notes Gennith Johnson, MCD, CCC-SLP, is ASHA associate director of health care services. [email protected] Claudia Saad, MS, CCC-SLP, is ASHA director of multicultural education. [email protected] Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 19Issue 11November 2014 Get Permissions Add to your Mendeley library History Published in print: Nov 1, 2014 Metrics Current downloads: 8,677 Topicsasha-topicsleader_do_tagasha-article-typesleader-topicsCopyright & Permissions© 2014 American Speech-Language-Hearing AssociationLoading ...

Issue Highlights

Issue Highlights

Barriers and facilitators to self-care communication during medical appointments in the United States for adults with type 2 diabetes

Diabetes self-care is challenging and requires effective patient-provider communication to achieve optimal treatment outcomes. This study explored perceptions of barriers and facilitators to diabetes self-care communication during medical appointments. Qualitative study using in-depth interviews with a semistructured interview guide. Thirty-four patients with type 2 diabetes and 19 physicians who treat type 2 diabetes. Physicians described some patients as reluctant to discuss their self-care behaviors primarily because of fear of being judged, guilt, and shame. Similarly, patients described reluctant communication resulting from fear of being judged and shame, particularly shame surrounding food intake and weight. Physicians and patients recommended trust, nonjudgmental acceptance, open/honest communication, and providing patients hope for living with diabetes as important factors for improving self-care communication. Further, patients stressed the clinical benefits of physicians directly addressing poor self-care behaviors while physicians described having few strategies to address these difficulties. Physician-patient self-care communication barriers included patients' reluctance to discuss self-care behaviors and physicians' perceptions of few options to address this reluctance. Treatment recommendations stressed the importance of establishing trusting, nonjudgmental and open patient-provider communication for optimal diabetes treatment. Medical education is needed to improve physicians' strategies for addressing self-care communication during medical appointments.

Adherence to colorectal cancer and polyps screening recommendations among filipino-americans.

This cross-sectional study explored the perceptions and behaviors toward colorectal cancer screening and the predictors of adherence to colorectal cancer and polyps screening recommendations among Filipino-Americans. A total of 188 participants were recruited from community churches in southern California from September to November 2011. About half of the participants were found to be adherent to the screening recommendations. Multivariate logistic regression analysis revealed the following significant predictors of adherence: having a relative with colon or rectal cancer (odds ratio [OR] = 6.17), having heard of fecal occult blood test (OR = 4.58), strong agreement with benefit of screening in reducing worry about cancer (OR = 2.81), age ≥ 65 years (OR = 2.64) and very easy communication with providers (OR = 2.43). Patient awareness of colorectal cancer screening and its benefits through effective patient-provider communication were significant modifiable predictors of adherence to colorectal cancer and polyps screening recommendations. Nurses could have a major impact in improving screening behaviors through patient education in increasing patient awareness and benefits of cancer screening.

Pregnant Women’s Perceptions of Patient-Provider Communication for Health Behavior Change during Pregnancy

Aim: The primary aim of the project was to conduct focus groups with pregnant women to examine their perceptions on patient and health care provider (HCP) communication during prenatal visits pertaining to health behavioral change. In particular, to determine what types of communication facilitate or prevent patient engagement and adherence to certain health behaviors related to smoking cessation, engagement in physical activity, healthy eating and healthy weight gain, and stress management. Methods: Participants were recruited from the obstetric and midwifery clinics at the University of Colorado Hospital. Twenty-four pregnant, English-speaking women between the ages of 18 and 46 years old, the majority of which had full health insurance coverage, participated in one of three focus groups that were conducted. The transcripts were coded for themes and patterns. Results identified numerous current practices of HCPs, facilitators and barriers in care, and patient recommendations related to effective patient-provider communication. Results: Overall many women received basic information about most health behaviors (i.e. healthy eating, physical activity, and smoking cessation) with the exception of stress management from their HCPs via their introductory information packet. However, typically there was no follow-up beyond receipt of the packet. As a result, women sought information online from numerous sources. Unfortunately, this information often conflicted with HCP provided information, as did the information provided from multiple HCPs in group care settings. A major facilitator of behavioral change pertained to building trust and rapport as it directly enhanced the perceived quality of patient-provider communication on prenatal health behaviors. Across all behaviors, women voiced the need for available resources that were credible and referenced by their HCPs. Conclusions: These findings provide a better understanding of what facilitates and prevents women from engaging in healthy behaviors during their pregnancy, in addition to improving patient and provider communication.