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When Asked, Patients Tell: Disclosure of Sensitive Health-Risk Behaviors

Gerbert, Barbara PhD*; Bronstone, Amy PhD*; Pantilat, Steven MD†‡; McPhee, Stephen MD; Allerton, Michael MS§; Moe, James PhD*

Original Articles

Objectives. National health care organizations recommend routinely screening patients for behavioral health risks, the effectiveness of which depends on patients' willingness to disclose risky behaviors. This study aimed to determine if primary care patients' disclosures of potentially stigmatizing behaviors would be affected by (1) their expectation about whether or not their physician would see their disclosures and (2) the assessment method.

Methods. One thousand nine hundred fifty-two primary care patients completed a questionnaire assessing human immunodeficiency virus (HIV), alcohol, drug, domestic violence, tobacco, oral health, and seat belt risks; half were told their responses would be seen by the researcher and their physician and half were told that their responses would be seen by the researcher only. Patients were randomly assigned to one of five assessment methods: written, face-to-face, audio-based, computer-based, or video-based.

Results. Across all risk areas, patients did not disclose differently whether or not they believed their physician would see their disclosures. Technologically advanced assessment methods (audio, computer, and video) produced greater risk disclosure (4%-8% greater) than traditional methods in three of seven risk areas.

Conclusions. These findings suggest patients are not less willing to disclose health risks to a research assistant knowing that this information would be shared with their physician and that a number of assessment methods can effectively elicit patient disclosure. Potentially small increases in risk disclosure must be weighed against other factors, such as cost and convenience, in determining which method(s) to use in different health care settings.

*From the Division of Behavioral Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA.

From the Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA.

From the Program in Medical Ethics, Department of Medicine, University of California San Francisco, San Francisco, CA.

§From The Permanente Medical Group, Inc., Regional Offices, Oakland, California.

Supported by the National Institute of Mental Health (NIMH) Grant #1 R01 MH51006-04.

The abstract of this manuscript was presented at the Society of General Internal Medicine 21st Annual Meeting in Chicago, Illinois on April 25, 1998.

Address correspondence to: Barbara Gerbert, PhD, Professor and Chair, Division of Behavioral Sciences, UCSF, 601 Montgomery, Suite 810, San Francisco, California 94111; e-mail:

Received March 20, 1998; initial review completed May 11, 1998; accepted June 16, 1998.

© 1999 Lippincott Williams & Wilkins, Inc.