How do family physicians communicate about cardiovascular risk? Frequencies and determinants of different communication formats

Background: Patients understand information about risk better if it is communicated in numerical or visual formats (e.g. graphs) compared to verbal qualifiers only. How frequently different communication formats are used in clinical primary care settings is unknown. Methods: We collected socioeconomic and patient understanding data using questionnaires and audio-recorded consultations about cardiovascular disease risk. The frequencies of the communication formats were calculated and multivariate regression analysis of associations between communication formats, patient and general practitioner characteristics, and patient subjective understanding was performed. Results: In 73% of 70 consultations, verbal qualifiers were used exclusively to communicate cardiovascular risk, compared to numerical (11%) and visual (16%) formats. Female GPs and female patient's gender were significantly associated with a higher use of verbal formats compared to visual formats (p = 0.001 and p = 0.039, respectively). Patient subjective understanding was significantly higher in visual counseling compared to verbal counseling (p = 0.001). Conclusions: Verbal qualifiers are the most often used communication format, though recommendations favor numerical and visual formats, with visual formats resulting in better understanding than others. Also, gender is associated with the choice of communication format. Barriers against numerical and visual communication formats among GPs and patients should be studied, including gender aspects. Adequate risk communication should be integrated into physicians' education

The Impact of Substance Use, Sexual Trauma, and Intimate Partner Violence on Sexual Risk Intervention Outcomes in Couples: A Randomized Trial

BACKGROUND: Few HIV prevention interventions focus on sexual risk reduction as mutual process determined by couple members, though risk behaviors are inter-dependent. PURPOSE: This trial examined the impact of substance use, history of sexual trauma and intimate partner violence on sexual risk associated with participation in a risk reduction intervention. METHODS: HIV sero-concordant and -discordant multicultural couples in Miami, Florida (n = 216) were randomized to group (n = 112) or individual (n = 104) couple-based interventions. RESULTS: Group intervention participants increased condom use in couples in which women had a history of sexual trauma (F(2,221) = 3.39, p = .036) and by partners of alcohol users. History of sexual trauma was a determinant of conflict resolution, predicting negative communication and intimate partner violence. CONCLUSIONS: Results emphasize the need for group sexual risk reduction interventions targeting sexual trauma, partner violence and substance use among HIV seroconcordant and discordant couples