“It’s just some numbers”: using cognitive informational styles theory to understand behaviour and expectations in relation to blood test monitoring for long term conditions

Problem

Annual monitoring blood tests assess long term condition [LTC] disease progression, treatment response and associated diseases. Patients with LTCs who want to be more involved in their health. Drawing upon the patient activation and cognitive informational styles theory we wanted to better understand patient and healthcare professional behaviour, views and beliefs in relation to blood test monitoring for long term conditions.

Approach

As part of the Optimal Testing study we conducted qualitative in-depth-interviews. A topic guide was developed with PPI input. Patients and clinicians were purposively sampled from 4 GP practices, representing a range in social deprivation scores, patient list size and location (rural/urban). Interviews were conducted with patients living with Type 2 Diabetes , hypertension or chronic kidney disease (N=21); and with a range of health care professionals [HCP], including GPs, nurses, health care assistants, practice pharmacists and phlebotomists (N=21). Informed consent was taken for each interview. Interviews were recorded, transcribed verbatim and uploaded into NVIVO software.Reflexive thematic analysis was conducted. HCP and patient transcripts were coded separately and sequentially, before comparative analysis across clinician/patient coding. Theoretical codes were introduced after inductive coding had been completed as a way of developing the analytic insights of the thematically coded data. Drawing upon informational style theories, codes were created for ‘monitors’ (those who actively seek out information) and ‘blunters’ (those who avoid information) and applied across the patient data set. Patterns were explored between deductive theoretical coding and inductive thematic coding.

Findings

We developed a typology of patient blunter and monitor characteristics and identified four key patient behaviour patterns in this typology: seeking out information about tests/test results, making blood test appointments, asking questions about tests/test results during or after a consultation, and attending appointments. Our results explore the links between paternalism and blunter or monitor behaviours; clinicians descriptions of monitor type behaviours; clinicians descriptions of blunter type behaviour; psycho-social explanations for monitor versus blunter behaviours; differences between HCP role and views of blunter and monitor behaviours; factors that may reinforce blunter style behaviour; the use of coercion versus better information to manage blunter style preferences.

Consequences

LTC blood test information needs to be presented in a way that turns numeracy (the ability of patients to understand blood test numbers) into a form of illness knowledge. It is only then that we are more likely to see blood test result communication leading to improved patient outcomes. Using the monitor/blunter typology has helped us to better understand patient preferences for information and the way this interacts with clinician behaviours and attitudes, which will inform our development of an intervention aimed at improving communication.