Development of the CoMac Adherence Descriptor™: a linguistically-based survey for segmenting patients on their worldviews

Abstract

Nonadherence to prescribed medication and healthy behaviors is a pressing health care issue. Much research has been conducted in this area under a variety of labels, such as compliance, disease management and, most recently, adherence. However, the complex factors related to predicting and, more importantly, understanding and explaining adherence, have nevertheless remained elusive. However, through an in-depth linguistic analysis of patient talk, the International Center for Intercultural Communication (ICIC) at Indiana University has produced a psycholinguistic coding system that uses patients’ own language to cluster them into distinct groups based on their worldviews. ICIC’s studies have shown, for example, that patients reveal their fundamental perceptions about themselves and their environment in their life narratives; clustering of individual patients based on these different perceptions is possible via the use of differential language in survey questions, and differential language can be used to tailor messages for individual patients in a manner that these individuals prefer over generically worded communication. In grant-funded research, an interdisciplinary team of researchers at the ICIC reviewed the literature and identified three basic psychosocial tenets related to adherence: control orientation, based on locus of control research; agency, based on self-efficacy; and affect or attitude and emotion. These three constructs were selected because, in the published literature, they have been consistently found to be connected to patient adherence. Based on this research, a survey, the CoMac Descriptor™ was developed. This report shows that The Descriptor™ questions and responses are valid and reliable in segmenting patients across psychosocial constructs, which will have positive implications for health care providers and patients.

<p>Implementing person-centered communication in diabetes care: a new tool for diabetes care professionals</p>

“…The research identified linguistic indicators in the way patients talk that include agency (high/takes charge, low/does not take charge), affect (positive/upbeat, negative/downbeat), and control orientation (internal/looks to self for directions, external/looks to others for directions). The linguistic features of these three well-studied psychosocial constructs related to type 2 diabetes mellitus self-management and adherence were subsequently applied to the development of a survey questionnaire, the CoMac Descriptor 9. The 12-question survey has a reading level at the sixth-grade level.…”

“…In the present study, we report a pilot implementation of an innovative language-centered communication tool, the CoMac Communication System. The CoMac System starts with the inherent assumption that language of the patient reveals his/her beliefs, worldviews, and orientation to self-management 5–9. Through understanding the person’s orientation through language, this approach provides the clinician with tools for individualized advice and person-centered communication.…”

Variation in medication adherence across patient behavioral segments: a multi-country study in hypertension

“…The CoMac Descriptor™ for hypertension was originally developed using the language of US patients gathered in interviews. 25 The online instrument was linguistically based in two senses. First, it was created from lengthy interviews of patients, and second, the actual language of the patients who had been classified as belonging to different domains was used to craft response options in the questions.…”