Nursing News

Who Is Influencing Your Patients’ Health Behaviors?

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By Jennifer Larson, contributor

November 4, 2011 - Are patients more likely to listen to a clinician or a relative when making a decision that affects their health? The answer, based on a recent international survey, might surprise you.

During June and July, researchers from Edelman’s StrategyOne interviewed more than 15,000 adults in 12 countries, including 5,000 in the United States. They asked them a wide range of questions about their health-related attitudes and behaviors; the results were recently compiled and released as the Edelman Health Barometer 2011.

Both the international and U.S. respondents reported that friends and family tended to have the most positive influence on their lifestyle, including helping them make changes to improve their health. But health care providers weren’t too far behind, particularly for the U.S. respondents.

Additionally, health care providers seemed to enjoy a good reputation as health experts. Physicians topped the list of people considered to be the most credible sources of health-related information, cited by 88 percent, followed closely by pharmacists (81 percent) and nurses (77 percent). In this category, friends and family didn’t fare as well: they were cited by 55 percent of the respondents.

Friends’ and family’s influence

When people rely on their friends and family for health information, there is always some risk.

“There always is that concern that you would have somebody influencing that may not have the right information,” said Laura Linn, RN, MN, vice president and director of clinical and community networks for the Center for Health Transformation. “We have that fear that they may not have their facts right.”
But there is also a benefit to the phenomenon of people putting so much value on their relationships with their friends and family.

Family and friends can be a powerful reinforcement for positive behavior, noted Eileen Sullivan-Marx, Ph.D., CRNP, RN, who serves on the board of the American Academy of Nursing and oversees the University of Pennsylvania School of Nursing’s Living Independently for Elders (LIFE) program.

Patient Health Influencers
Eileen Sullivan-Marx, Ph.D., CRNP, RN, a board member of the American Academy of Nursing, believes that family members can be very influential in helping people implement positive behavioral changes.

“If change is going to occur, it has to occur with the approval of others around them,” she said.

For example, Sullivan-Marx worked with a geriatric mental health support program for veterans that originally started with sessions for the veterans but expanded to include the veterans’ wives.

“We got much more improvement in health education outcomes when we included the spouses in the teaching,” she said.

According to Sullivan-Marx, another example of the positive power of family is evident in the work of Loretta Sweet Jemmott, Ph.D., RN. Jemmott, the director of the Center for Health Disparities Research at UPenn, has conducted a great deal of research in the field of creating interventions to reduce HIV risk-associated sexual behaviors. One of her recent projects involved assessing the effect of several different types of group interventions with African-American teenage boys.

“It was always the work with the (boys’) mothers that was the most powerful,” Sullivan-Marx said.

Opportunities for nurses

In an 2009 article in the Online Journal of Issues in Nursing, Scott Paynton, Ph.D., wrote that nurses may not be perceived as having as much formal power as physicians and health care organizations, but they actually do possess a great deal of informal power.

And indeed, nurses have traditionally enjoyed a very good reputation among the American public.

Nurses repeatedly top the lists of the most trusted professionals; for example, nurses have received the top honors on the annual Gallup Honesty and Ethics survey for 11 straight years. The results of the 2010 Robert Wood Johnson Foundation report “Nursing Leadership from Bedside to Boardroom: Opinion Leaders’ Perceptions” showed that nurses are viewed as “key information providers” and “influencers of quality care.” And the 2011 Edelman survey also confirms that people believe that nurses are a trusted source of health information.

So nurses can definitely leverage that good will, said Katie Brewer, MSN, RN, senior policy analyst for the American Nurses Association. 

Patient Health Influencers
Katie Brewer, senior policy analyst for ANA, recommends nurses stay current on medical research findings so they are prepared to educate patients who may not have the right information.

“People know that nurses are out for their [patients’] best interests and really want to help people,” she said.

For example, nurses can use interactions with patients for educational purposes, to make sure that people are receiving the correct information and also understand it. They can listen to patients as they explain their concerns or fears, acknowledge those concerns and then gently provide the correct medical information to counter any misinformation. 

“You do need to be a skilled communicator, and nurses are pretty good at that,” Brewer said, citing the ANA’s immunization campaign ( as a resource for nurses who may want more information on communicating health information in an effective manner.

Paynton agreed.

“I think nurses would say they have been doing this for years,” said Paynton, who is now the interim associate dean for the College of Arts, Humanities and Social Sciences at Humboldt State University in Arcata, Calif. “These actions are core to nursing identity and performance.”

This could be especially relevant to one of the results of the Edelman survey; the survey noted that many respondents were unable to make positive health changes “stick” because of a lack of continual support from their support network, namely friends and family. Nurses can work with patients to make sure they have all the correct information, and they can also help patients find ways to get the support they need to make healthy changes to their lifestyles.

And there are additional steps that nurses can take to maximize their potential to be a positive influence.

“I think as a profession, we should be modeling healthy behaviors,” Linn said, adding that nurses haven’t always succeeded at this in the past.

Nurses can also be more visible online and in the community in their roles as nurses, Linn continued. They don’t stop being nurses when they take off their uniforms and go home at the end of a shift. People in their neighborhoods, schools and churches know they are nurses and want to hear what they have to say. They can use that advantage to make a positive difference.

Sullivan-Marx agreed and referred again to the nurse’s role as someone who is trusted, someone who is both an educator and patient advocate.

“It’s very important for nurses to make themselves visible as nurses in their community,” she said.

© 2011. AMN Healthcare, Inc. All Rights Reserved.