A multilevel longitudinal study of patient-physician communication in later life proactive health behaviors

Patient-physician relationships are central to effective healthcare, yet the role of older adults' proactive health behaviors in shaping trust in communication remains unclear. Guided by the health care partnership model and communication accommodation theory, this study examined the association between proactive health behaviors and trust in physician communication over time, and whether perceived physician caring and partnership moderate this association.

Data were drawn from a three-wave longitudinal survey of 292 community-dwelling older adults in Miami, Florida (M = 76.4 years, SD = 7.9), and analyzed using multilevel modeling to capture both within-person and between-person effects.

Results indicated that higher proactive health behaviors were associated with lower trust in physician communication at both within-person (B = -0.20, p < .001) and between-person levels (B = -0.33, p < .001). Perceived caring from the physician mitigated this negative association at within-person (B = 0.32, p < .001) and between-person levels (B = 0.15, p < .001). In contrast, perceived partnership moderated the association only at the between-person level (B = 0.11, p < .001).

These findings underscore that the association between proactive behaviors and trust in physician communication is context dependent. Physician caring and partnership can mitigate the negative association between proactivity and trust. The study highlights the unique perspectives of older adults, emphasizing the importance of fostering physician receptiveness, recognizing patients' proactive health behaviors, and collaborative communication to support effective patient-centered care.