Re-examining the Role of Patients in Community-Based Interventions

  • Khary K. RiggEmail author
  • Amanda Sharp
  • Kyaien O. Conner
  • Kathleen A. Moore
Part of the International Perspectives on Social Policy, Administration, and Practice book series (IPSPAP)


In this Chapter, by Khary K. Rigg, Amanda Sharp, Kyaien O. Conner, and Kathleen A. Moore, examines how the patient-provider relationship has evolved over the years. Patients are now thought to play a central role in the provision of treatment, especially within the context of community-based interventions. In both theory and practice, the role of the patient is supposed to differ from traditional biomedical approaches to treatment with patient input introducing a new level of transparency and relevance into service provision. Specifically, patients are to play an increasingly active role in healthcare delivery and their backgrounds treated as central in any intervention. In short, a new form of participation between patient and provider is key to interventions that claim to be patient-centered and community-based. The current healthcare system, however, does not promote such participation, and obstacles to involving patients in their own care exist. The chapter traces the history of the patient-provider relationship and discusses the recent shift toward elevating the importance of persons receiving care. The authors also discuss obstacles to genuinely involving patients in their own treatment and make recommendations for how these barriers can be overcome. They conclude by discussing promising strategies for meaningfully involving patients in treatment, as well as how the role of patients in community-based care might be re-thought.


Patient-provider relationships Community-based interventions Healthcare delivery Treatment provision Patient-centered interventions 


  1. Allen, M. L., Lê Cook, B., Carson, N., Interian, A., La Roche, M., & Alegría, M. (2017). Patient-provider therapeutic alliance contributes to patient activation in community mental health clinics. Administration and Policy in Mental Health and Mental Health Services Research, 44(4), 431–440.CrossRefGoogle Scholar
  2. Andrews, J. O., Felton, G., Wewers, M. E., & Heath, J. (2004). Use of community health workers in research with ethnic minority women. Journal of Nursing Scholarship, 36(4), 358–365.CrossRefGoogle Scholar
  3. Balint, E. (1969a). The possibilities of patient-centred medicine. The Journal of the Royal College of General Practitioners, 17, 269e76.Google Scholar
  4. Balint, E. (1969b). The possibilities of patient-centered medicine. The Journal of the Royal College of General Practitioners, 17(82), 269.PubMedPubMedCentralGoogle Scholar
  5. Barber, J. P., Luborsky, L., Gallop, R., Crits-Christoph, P., Frank, A., Weiss, R. D., et al. (2001). Therapeutic alliance as a predictor of outcome and retention in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Journal of Consulting and Clinical Psychology, 69(1), 119.CrossRefGoogle Scholar
  6. Blumenthal, D., & McGinnis, J. M. (2015). Measuring vital signs: An IOM report on core metrics for health and health care progress. JAMA, 313(19), 1901–1902. Scholar
  7. Breuer, J., & Freud, S. (1955). Studies in hysteria. In The standard edition of the complete psychological works of Sigmund Freud (Vol. II). London, UK: Hogarth Press, Ltd..Google Scholar
  8. Butterworth, S. W., Linden, A., & McClay, W. (2007). Health coaching as an intervention in health management programs. Disease Management & Health Outcomes, 15(5), 299–307.,715,050-00004CrossRefGoogle Scholar
  9. Campbell, B. K., Guydish, J., Le, T., Wells, E. A., & McCarty, D. (2015). The relationship of therapeutic alliance and treatment delivery fidelity with treatment retention in a multisite trial of twelve-step facilitation. Psychology of Addictive Behaviors, 29(1), 106.CrossRefGoogle Scholar
  10. Carey, T. A., & Mullan, R. J. (2007). Patients taking the lead. A naturalistic investigation of a patient led approach to treatment in primary care. Counselling Psychology Quarterly, 20(1), 27–40.CrossRefGoogle Scholar
  11. Carlson, J. W., Lyon, E., Walton, D., Foo, W. C., Sievers, A. C., Shulman, L. N., et al. (2010). Partners in pathology: A collaborative model to bring pathology to resource poor settings. The American Journal of Surgical Pathology, 34(1), 118–123.CrossRefGoogle Scholar
  12. Carpenter, K. M., Cheng, W. Y., Smith, J. L., Brooks, A. C., Amrhein, P. C., Wain, R. M., et al. (2012). “Old dogs” and new skills: How clinician characteristics relate to motivational interviewing skills before, during, and after training. Journal of Consulting and Clinical Psychology, 80(4), 560–573. Scholar
  13. Centers for Medicare & Medicaid Services. (2019). Hospital consumer assessment for healthcare providers and systems. Retrieved from
  14. Chaitoff, A., Sun, B., Windover, A., Bokar, D., Featherall, J., Rothberg, M. B., et al. (2017). Associations between physician empathy, physician characteristics, and standardized measures of patient experience. Academic Medicine, 92(10), 1464–1471. Scholar
  15. Chang, E. S., Simon, M., & Dong, X. (2012). Integrating cultural humility into health care professional education and training. Advances in Health Sciences Education, 17(2), 269–278.CrossRefGoogle Scholar
  16. Chapman, J. R., Norvell, D. C., Hermsmeyer, J. T., Bransford, R. J., DeVine, J., McGirt, M. J., et al. (2011). Evaluating common outcomes for measuring treatment success for chronic low back pain. Spine, 36, S54–S68.CrossRefGoogle Scholar
  17. Charon, R. (2001a). Narrative medicine: Form, function, and ethics. Annals of Internal Medicine, 134(1), 83–87.CrossRefGoogle Scholar
  18. Charon, R. (2001b). Narrative medicine; a model for empathy, reflection, profession, and trust. Journal of the American Medical Association, 286(15), 1897–1902.CrossRefGoogle Scholar
  19. Chéret, A., Durier, C., Noël, N., Bourdic, K., Legrand, C., D’Andréa, C., et al. (2018). Motivational interviewing training for medical students: A pilot pre-post feasibility study. Patient Education and Counseling, 101(11), 1934–1941. Scholar
  20. Cushing, A. (2016). History of the doctor–patient relationship. In Clinical communication in medicine (pp. 6–20). Chichester, UK: Wiley.Google Scholar
  21. Del Canale, S., Louis, D. Z., Maio, V., Wang, X., Rossi, G., Hojat, M., et al. (2012). The relationship between physician empathy and disease complications: An empirical study of primary care physicians and their diabetic patients in Parma, Italy. Academic Medicine, 87(9), 1243–1249. Scholar
  22. DePasse, J. W., & Lee, P. T. (2013). A model for ‘reverse innovation’ in health care. Globalization and Health, 9(1), 40–47.CrossRefGoogle Scholar
  23. DiRosa, L., Gupta, A. K., & DeBonis, S. (2017). Effectiveness of a clinically oriented motivational interviewing training program in increasing skills & changing perceptions. Osteopathic Family Physician, 9(3).Google Scholar
  24. Drobac, P. C., Basinga, P., Condo, J., Farmer, P. E., Finnegan, K. E., Hamon, J. K., et al. (2013). Comprehensive and integrated district health systems strengthening: The Rwanda Population Health Implementation and Training (PHIT) Partnership. BMC Health Services Research, 13(2), S5.CrossRefGoogle Scholar
  25. Edelstein, L. (1937). Greek medicine in its relation to religion and magic. Bulletin of the Institute of the History of Medicine, 5(3), 201–246.Google Scholar
  26. Elliott, R., Bohart, A. C., Watson, J. C., & Greenberg, L. S. (2011). Empathy. Psychotherapy (Chicago, Ill.), 48(1), 43–49. Scholar
  27. Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136.CrossRefGoogle Scholar
  28. Epstein, R. M., Franks, P., Fiscella, K., Shields, C. G., Meldrum, S. C., Kravitz, R. L., et al. (2005). Measuring patient-centered communication in patient-physician consultations: Theoretical and practical issues. Social Science and Medicine, 61(7), 1516–1528. Scholar
  29. Fajt, M. L., & Wenzel, S. E. (2015). Asthma phenotypes and the use of biologic medications in asthma and allergic disease: The next steps toward personalized care. Journal of Allergy and Clinical Immunology, 135(2), 299–310.CrossRefGoogle Scholar
  30. Furin, J. J., Farmer, P., Wolf, M., Levy, B., Judd, A., Paternek, M., et al. (2006). A novel training model to address health problems in poor and underserved populations. Journal of Health Care for the Poor and Underserved, 17(1), 17–24.CrossRefGoogle Scholar
  31. Heidbreder, E. (1945). Toward a dynamic psychology of cognition. Psychological Review, 52(1), 1.CrossRefGoogle Scholar
  32. Hellin, T. (2002). The physician–patient relationship: Recent developments and changes. Haemophilia, 8(3), 450–454.CrossRefGoogle Scholar
  33. Herrin, J., Mockaitis, K. G., & Hines, S. (2018). HCAHPS scores and community factors. American Journal of Medical Quality, 33(5), 461–471. Scholar
  34. Hibbard, J. H., Greene, J., & Tusler, M. (2009). Improving the outcomes of disease management by tailoring care to the patient’s level of activation. American Journal of Managed Care, 15(6), 353–360.PubMedGoogle Scholar
  35. Hibbard, J. H., Stockard, J., Mahoney, E. R., & Tusler, M. (2004). Development of the Patient Activation Measure (PAM): Conceptualizing and measuring activation in patients and consumers. Health Services Research, 39(4 Pt 1), 1005–1026.CrossRefGoogle Scholar
  36. Hojat, M., Louis, D. Z., Markham, F. W., Wender, R., Rabinowitz, C., & Gonnella, J. S. (2011). Physicians’ empathy and clinical outcomes for diabetic patients. Academic Medicine, 86(3), 359–364. Scholar
  37. Jewson, N. K. (1976). Disappearance of the sickman from medical cosmologies 1770–1870. Sociology, 10, 225e44.Google Scholar
  38. Johnson, D. M., & Russell, R. S. (2015). SEM of service quality to predict overall patient satisfaction in medical clinics: A case study. Quality Management Journal, 22(4), 18–36. Scholar
  39. Kaba, R., & Sooriakumaran, P. (2007). The evolution of the doctor-patient relationship. International Journal of Surgery, 5(1), 57–65.CrossRefGoogle Scholar
  40. Kangovi, S., Mitra, N., Norton, L., et al. (2018). Effect of community health worker support on clinical outcomes of low-income patients across primary care facilities: A randomized clinical trial. JAMA Internal Medicine, 178(12), 1635–1643. Scholar
  41. Katigbak, C., Van Devanter, N., Islam, N., & Trinh-Shevrin, C. (2015). Partners in health: A conceptual framework for the role of community health workers in facilitating patients’ adoption of healthy behaviors. American Journal of Public Health, 105(5), 872–880.CrossRefGoogle Scholar
  42. Kaufman, B. G., Spivack, B. S., Stearns, S. C., Song, P. H., & O’Brien, E. C. (2019). Impact of accountable care organizations on utilization, care, and outcomes: A systematic review. Medical Care Research and Review, 76(3), 255–290.CrossRefGoogle Scholar
  43. Kovacs, P. J., Bellin, M. H., & Fauri, D. P. (2006). Family-centered care: A resource for social work in end-of-life and palliative care. Journal of Social Work in End-of-Life & Palliative Care, 2(1), 13–27.CrossRefGoogle Scholar
  44. Lehmann, U., & Sanders, D. (2007). Community health workers: What do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. University of the Western Cape. Evidence and Information for Policy, Department of Human Resources for Health Geneva.Google Scholar
  45. Lewin, S. A., Dick, J., Pond, P., Zwarenstein, M., Aja, G., van Wyk, B., et al. (2005). Lay health workers in primary and community health care. The Cochrane Database of Systematic Reviews, 25(1), CD004015. ISSN 1469-493X.. Scholar
  46. Linden, A., Butterworth, S. W., & Prochaska, J. O. (2010). Motivational interviewing-based health coaching as a chronic care intervention. Journal of Evaluation in Clinical Practice, 16(1), 166–174. Scholar
  47. Lindenauer, P. K., Lagu, T., Ross, J. S., Pekow, P. S., Shatz, A., Hannon, N., et al. (2014). Attitudes of hospital leaders toward publicly reported measures of health care quality. JAMA Internal Medicine, 174(12), 1904–1911. Scholar
  48. Mafi, J. N., Gerard, M., Chimowitz, H., Anselmo, M., Delbanco, T., & Walker, J. (2018). Patients contributing to their doctors’ notes: Insights from expert interviews. Annals of Internal Medicine, 168, 302–305. Scholar
  49. Manary, M. P., Boulding, W., Staelin, R., & Glickman, S. W. (2013). The patient experience and health outcomes. New England Journal of Medicine, 368(3), 201–203. Scholar
  50. Matalon, A. (2008). Person centered care or public health improvement. BMJ, 337, 1355.CrossRefGoogle Scholar
  51. McDaniel, S. H., & Fogarty, C. T. (2009). What primary care psychology has to offer the patient-centered medical home. Professional Psychology: Research and Practice, 40(5), 483.CrossRefGoogle Scholar
  52. Metzl, J. M., & Hansen, H. (2014). Structural competency: Theorizing a new medical engagement with stigma and inequality. Social Science & Medicine, 103, 126–133.CrossRefGoogle Scholar
  53. Miller, B. F., Ross, K. M., Davis, M. M., Melek, S. P., Kathol, R., & Gordon, P. (2017). Payment reform in the patient-centered medical home: Enabling and sustaining integrated behavioral health care. American Psychologist, 72(1), 55–68. Scholar
  54. Miller, S. (2009). Cultural humility is the first step to becoming global care providers. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 38(1), 92–93.CrossRefGoogle Scholar
  55. Miller, W. R., Yahne, C. E., Moyers, T. B., Martinez, J., & Pirritano, M. (2004). A randomized trial of methods to help clinicians learn motivational interviewing. Journal of Consulting and Clinical Psychology, 72(6), 1050.CrossRefGoogle Scholar
  56. Moyers, T. B. (2014). The relationship in motivational interviewing. Psychotherapy (Chicago, Ill.), 51(3), 358–363. Scholar
  57. Murphy, J. W. (2015). Primary health care and narrative medicine. The Permanente Journal, 19(4), 90.PubMedPubMedCentralGoogle Scholar
  58. Neumann, M., Edelhäuser, F., Tauschel, D., Fischer, M. R., Wirtz, M., Woopen, C., et al. (2011). Empathy decline and its reasons: A systematic review of studies with medical students and residents. Academic Medicine, 86(8), 996–1009.CrossRefGoogle Scholar
  59. Noordman, J., van der Weijden, T., & van Dulmen, S. (2012). Communication-related behavior change techniques used in face-to-face lifestyle interventions in primary care: A systematic review of the literature. Patient Education and Counseling, 89(2), 227–244. Scholar
  60. Olaniran, A., Smith, H., Unkels, R., Bar-Zeev, S., & van den Broek, N. (2017). Who is a community health worker? - a systematic review of definitions. Global Health Action, 10(1), 1272223.CrossRefGoogle Scholar
  61. OpenNotes. (2017). The next step for OpenNotes is OurNotes. Retrieved from
  62. Parsons, T. (1951). The social system. New York, NY: Free Press.Google Scholar
  63. Rigg, K. K., & Murphy, J. W. (2013). Storylines as a neglected tool for mental health service providers and researchers. International Journal of Mental Health and Addiction, 11(4), 431–440.CrossRefGoogle Scholar
  64. Rigg, K. K., & Wilson, G. (2013). Can patient-physician race concordance improve health outcomes for African-American HIV patients? Evidence, insights, and implications. In M. S. Harris (Ed.), African-American perspectives: Family dynamics, healthcare issues, and the role of ethnic identity (pp. 155–168). New York, NY: Nova Science Publishers.Google Scholar
  65. Rogers, C. R. (1961). On becoming a person: A therapist’s view of psychotherapy. Boston, MA: Houghton Mifflin.Google Scholar
  66. Rogers, C. R., Stevens, B., Gendlin, E. T., Shlien, J. M., & Van Dusen, W. (1967). Person to person: The problem of being human: A new trend in psychology (p. 56). Lafayette, CA: Real People Press.Google Scholar
  67. Saver, B. G., Martin, S. A., Adler, R. N., Candib, L. M., Deligiannidis, K. E., Golding, J., et al. (2015). Care that matters: Quality measurement and health care. PLoS Medicine, 12(11), e1001902. Scholar
  68. Smith, R. C., Dwamena, F. C., Grover, M., Coffey, J., & Frankel, R. M. (2011). Behaviorally defined patient-centered communication--a narrative review of the literature. Journal of General Internal Medicine, 26(2), 185–191. Scholar
  69. Srinivasan, D., & Desai, N. R. (2017). The impact of the transition from volume to value on heart failure care: Implications of novel payment models and quality improvement initiatives. Journal of Cardiac Failure, 23(8), 615–620. Scholar
  70. Szasz, T., & Hollender, M. (1956). A contribution to the philosophy of medicine: The basic model of the doctor-patient relationship. Archives of Internal Medicine, 97, 585e92.Google Scholar
  71. Szasz, T. S., Knoff, W. F., & Hollender, M. H. (1958). The doctor-patient relationship and its historical context. American Journal of Psychiatry, 115(6), 522–528.CrossRefGoogle Scholar
  72. Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117–125.CrossRefGoogle Scholar
  73. Tilahun, D., Hanlon, C., Araya, M., Davey, B., Hoekstra, R. A., & Fekadu, A. (2017). Training needs and perspectives of community health workers in relation to integrating child mental health care into primary health care in a rural setting in sub-Saharan Africa: A mixed methods study. International Journal of Mental Health Systems, 11(1), 15.CrossRefGoogle Scholar
  74. Timbie, J. W., Bogart, A., Damberg, C. L., Elliott, M. N., Haas, A., Gaillot, S. J., et al. (2017). Medicare advantage and fee-for-service performance on clinical quality and patient experience measures: Comparisons from three large states. Health Services Research, 52(6), 2038–2060. Scholar
  75. Tsai, T. C., Orav, E. J., & Jha, A. K. (2015). Patient satisfaction and quality of surgical care in US hospitals. Annals of Surgery, 261(1), 2–8. Scholar
  76. Unützer, J., Schoenbaum, M., Katon, W. J., Fan, M.-Y., Pincus, H. A., Hogan, D., et al. (2009). Healthcare costs associated with depression in medically ill fee-for-service medicare participants. Journal of the American Geriatrics Society, 57(3), 506–510. Scholar
  77. World Health Organization. (2006). Working together for health: The World Health Report. Retrieved at
  78. Zolnierek, K. B., & Dimatteo, M. R. (2009). Physician communication and patient adherence. Medical Care, 47(8), 826–834.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Khary K. Rigg
    • 1
    Email author
  • Amanda Sharp
    • 1
  • Kyaien O. Conner
    • 1
  • Kathleen A. Moore
    • 1
  1. 1.Department of Mental Health Law & PolicyUniversity of South FloridaTampaUSA

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