Patterns of Adapting to Health (PATH), Health Status, and Type 2 Diabetes. In a sample of over 4,000 commercial health plan members, the “patterns of adapting to health” explained differences in perceived health status among Type 2 diabetic and non-diabetic members.
The Patterns of Adapting to Health (PATH). The "patterns of adapting to health" are nine emergent patterns found within adult populations all over the United States. The patterns are formed by the interaction of multiple health-related responses to common health-related contexts. These contexts include response to perceived illness, family health, health information present in the environment, local health care providers, care seeking, cost pressure, attention to food consumption, expression of physical activity, and so on. The adaptive health behavior of the majority of adults within any population tend to conform to one of these nine patterns. There is no evidence that adults choose the pattern their adaptive health behavior will follow. Their own unique preferences and innate abilities in response to their health-related environment "draw" their behavior into one of these patterns.
Health Status and Diabetes Type 2. Consistent with other published research, in this sample the members with Type 2 diabetes reported significantly lower perceived health status when contrasted against non-diabetic members, confirming the negative impact that Type 2 diabetes has on how adults perceive their health.
The PATH Influence. However, this negative impact was not uniform among Type 2 diabetics. The PATH members followed had pretty much the same impact on perceived health whether members were diabetic or non-diabetic. Members conforming to Patterns 3, 4, and 8 reported higher perceived health status in both member populations in contrast to those members who conformed to Patterns 1, 2, 5, and 9. In fact, Type 2 diabetics dominated by Pattern 8 reported had higher health status than non-diabetics dominated by Pattern 2.
Conclusion. Based on this study, the negative impact of Type 2 diabetes on health status is not uniform across a diabetic population. The PATH underlying adult adaptive behavior has a significant impact on either alleviating or worsening the impacts of Type 2 diabetes on health. In fact, the PATH can create a situation where the health status of diabetics (Pattern 8) is superior to the health status of non-diabetics (Pattern 2).
Health literacy is a key social determinant of health. Those people who are more health literate tend to have better health, better health outcomes, and are better able to manage health issues.
Motivation to Seek Health Information
The motivation to seek health information has been recognized as a critical piece to meeting the goal of increased health literacy. Different issues may motivate the seeking of health information. One person may seek health information motivated by a desire to promote good health. Another person might seek health information to learn about a specific health problem he or she is dealing with. Someone else might seek health information for a friend or family member suffering from a health issue. Someone else might seek health information out of general interest.
Other people, however, may be rarely motivated to seek health information. A lack of interest in health, to learn about health, or to seek health information for others is certainly a part of the essential “capacity” to obtain health information contributing to disparities in health literacy.
Motivation to Seek Health Information and Health Behavior Patterns. The Patterns of Adapting to Health (PATH) show that the seeking of health information in support of health is linked to deeper patterns of health-related behavior. The primary consumers of health information are dominated by adults conforming to three patterns of health behavior: Pattern 7, Pattern 8, and Pattern 9. Drastically lower levels of health information seeking are associated with adults dominated by Pattern 1 and Pattern 2.
Health Literacy and the Problem of Motivation. Higher and lower levels of health literacy are not necessarily linked to access or exposure to health information, but to the motivation to seek it. The Patterns of Adapting to Health show that the motivation to seek and evaluate health information does not exist in isolation, but is linked to deeper more complex patterns of health behavior within a population. This suggests that adequate levels of health literacy are heavily influenced by complex patterns of health behavior where health information is available.
A person’s likelihood of shopping and comparing health care providers and insurers to save money is strongly and reliably predicted by their level of conformity to the Patterns of Adapting to Health (PATH).
Three separate studies from 2003, 2012, and 2017 show that as adult health behavior increasingly conforms to Patterns 2, 4, and 7 their tendency to ignore the cost implications of health care has remained strong in spite of increasing costs. Adults conforming to these patterns of adapting to health appear to be unaffected by the rising costs of health care with no change in their tendency to ignore the cost implications of their care.
However, as adults conform to Pattern 3, health care shopping behavior has gotten stronger. Adults conforming to this pattern of adapting to health showed greater attention to the cost of health care and increasing shopping behavior as the cost of health care increased between 2003 and 2017.
Interestingly, adult’s conforming to Patterns 4 and 7 are the most frequent seekers of health care and generate the greatest medical expenditures. The health care demand associated with these two patterns can’t be discounted as a factor, even if only a minor one, supporting continued health care cost inflation.
Social Determinants of Health vs. Health Behavior Patterns. The availability of healthy food is a key social determinant of health. Sufficient household income is another social determinant which contributes to, among other things, the ability to afford and acquire healthier food.
Household Income and Healthy Eating. In a sample of over 2,000 adult interviews the relationship between household income and healthy eating was supported: Higher household incomes were linked to increased the odds of healthy eating. This supports the social determinant argument that the ability to afford healthier food is a key factor in shaping its consumption.
Patterns of Adapting to Health and Healthy Eating. In the same analysis, the Patterns of Adapting to Health (PATH) explained much greater variation in the odds of healthy eating compared to household income. Further, after controlling for household income, the PATH also identified adults with significantly lower odds of healthy eating irrespective of income effects.
Beyond Social Determinants. While social determinants of health such as household income are certainly relevant to health, the conformity of adult health behavior to identifiable patterns may explain more variation in health outside the context of social determinants.
Frederick H. Navarro, PhD.