1. PATH TYPE® TEST APPLICATION
Supplemental report exploring utility of PATH Type assessment with
males, 40+ years in the U.K., Northeast, NHS
Prepared by
Frederick H. Navarro
President, PATH Institute Corporation
11321 Jacaranda Circle, Suite A
Fontana, CA 92337-1401, USA
Phone: 909-350-0400
Fax: 909-854-6800
Mobile: 909-835-5292
Toll Free: 800-501-7284 (PATH)
fnavarro@pathinstitute.com
www.pathinstitute.com
Directing health practice to
serve health priorities
PATH Institute Corporation
11321 Jacaranda Circle, Suite A
Fontana, CA 92337-1401 USA
Phone: (909-350-0400
Fax: (909) 854-6800
E-mail: info@pathinstitute.com

2. PATH Type® Test Application
Exploring utility of PATH Type assessment with males, 40+ years in
the U.K., Northeast, NHS
INTRODUCTION
This report provides a brief summary of the PATH Type results found for the 30 males, 40+ years
old in the U.K. Northeast NHS, interviewed in May of 2008.
PURPOSE
This research was carried out to evaluate the feasibility of using the PATH Type® methodology,
developed and validated in the U.S. and in the context of the U.S. health care market, within the
U.K. national health care system.
INITIAL FINDINGS
Results suggest that the PATH Type® methodology should be applicable in the U.K. Northeast, NHS,
and would likely function well throughout the U.K.’s various NHS regions. Even with a small, limited
sample like response patterns are identified along with the same demographic and socioeconomic
associations with the PATH Types as found in the U.S. If the PATH Type mix of subjects in this
sample were in fact representative of the men in the Northeast NHS area, these men, while likely
having higher rates of disease and health risk, would not demand for medical services resulting in
lower demand compared to other NHS areas. Suggested next steps are offered at the end of this
report.
KEY CONSIDERATIONS
It is critical to keep in mind that the dramatic variances in health risk prevalence, disease, and
health care demand linked to the PATH Type® model in the U.S. are found just by identifying the
consistent cognitive patterns that shape how people think about and prioritize health issues. It
suggests that working to change and promote the prevalence of various cognitive patterns of health
care thinking in a population could be a viable tactic to improving health with minimal medical
intervention.
PATH TYPE® RESULTS
Table 1 shows the distribution of participants within the patterns of health-behavior identified by the
PATH Type Model identified among the subjects interviewed with comparative distributions of males
found in larger studies within the U.S. General findings are:
o Three out of 30 subjects (10%) registered a secondary PATH Type. This is the same rate
found in the U.S.
REPORT

3. 2
o Consistent with the makeup of the sample, the PATH Types that appeared tend to be male
dominated in the U.S., with the exception of the one Naturalist
o An unassignment rate (P1=10) as high as 25% is consistent with other male-only studies
conducted in the U.S. (see Table 1)
o With the exception of the two PATH Type 8 (Independently Healthy) subjects and one the
PATH Type 9 (Naturalist), all other types represent subjects who are fairly uninvolved with
personal health issues and avoid seeking care. (All but five of the 30 males interviewed
somewhat or strongly agreed with the statement, “When it comes to my health, I rarely
plan ahead and just take things as whey come.” And nearly all of them either somewhat or
strongly agreed with the statement, “I only go to the doctor if I’m really sick or injured.”)
o The lower socioeconomic status of residents of the Northeast, NHS is consistent with the
higher rates of Types 2 (Traditionalist), 3 (Generic) and 10 (unassigned). All three types
are likewise associated with lower economic status in the U.S.
o While the initial assessment of subject health status did not follow expected trends (i.e.,
subjects initially rated their health good or very good), later self-disclosure by the subjects
revealed that more often than not subjects reported having many ailments or disease
issues suggesting that health status was actually lower than reported. Higher rates of
health risk factors or disease are commonly found among PATH Types 2 and 9.
Table 1: PATH Type Assessment Results with U.S. Comparisons
NESHA - Males Only PATH Type Breakdown
May-June 2008
PATH Types P1 Count % Count % Count % Count %
Clinic Cynic 1 3 10% 1 1% 1,086 2% 64 2%
Avoider 2 9 30% 8 8% 4,952 9% 94 3%
Generic 3 6 20% 19 19% 9,101 17% 582 16%
Traditionalist n 0 0% 2 2% 3,142 6% 71 2%
Family Centered 5 1 3% 10 10% 5,514 10% 567 15%
Loyalist n 0 0% 6 6% 4,411 8% 355 10%
Ready User n 0 0% 7 7% 5,478 10% 462 12%
Independently Healthy 8 2 7% 8 8% 3,122 6% 628 17%
Naturalist 9 1 3% 6 6% 4,394 8% 374 10%
Unassigned 10 8 27% 35 34% 13,785 25% 502 14%
Total 30 100% 102 100% 54,985 100% 3,699 100%
Test sample results
(A) On-line data
collection
Male Only PATH Type Distribution Examples
(B) National
tele+mail (C) Health plan-mail
.
PATH TYPE® ASSESSMENT RESPONSE PATTERNS
The response patterns to the PATH Type® assessment among the Northeast, NHS sample were
examined in an attempt to detect variance from the response patterns found in the U.S. Such
variances might signify lack of applicability, cultural differences in understanding, or other factors
related to the differences between the U.K. and U.S. health care systems. The responses for all
subjects in the Northeast, NHS sample are shown in Table 3 below. Overall, the response patterns
to the PATH Type® assessment do not appear to vary in any significant way from those in the U.S.,
with the exception of the cost/price related questions.

4. 3
PRICE/QUALITY CONCERN
Contrary to early expectations, subjects in the U.K. offered pretty much the full range of responses
to assessment measures related to price/cost/quality issues. While most responses did cluster in the
neutral response category, never more than half did; this means that many subjects still think
about price/quality issues even in a nationalized health care system.
Table 2: Response Patterns Related To Health Cost/Quality Issues
PATH Type assessment questions Strongly
agree
Somewhat
agree
Neutral Somewhat
disagree
Strongly
disagree
2. If doctors and hospitals advertised their
prices, I would certainly shop more by price
7 10 4 3 6
4. I have tried to save money by shopping
around for health
3 3 13 2 9
8. I only seek health from doctors or
therapists when I am really sick because
it is too expensive.
6 0 15 3 6
18. If doctors in my area charged different fees
I would never go to the lowest priced doctor.
6 6 10 7 1

5. 4
Table 3: Response patterns and PATH Type assignment
ID P1 P2 PRscores
1 1 11414 11135 15411 43444
2 1 41333 31311 45414 11445
3 1 10 44511 44334 45355 43555
4 2 23531 14354 25114 44325
5 2 34231 33344 25115 11525
6 2 15552 42542 15414 12345
7 2 23511 13155 45112 31255
8 2 21511 42345 14111 24535
9 2 31131 13535 14114 31515
10 2 32531 14355 35432 42345
11 2 31531 13555 34223 13335
12 2 33511 13151 15511 12234
13 3 45245 24554 25125 54255
14 3 10 45422 14542 45343 45535
15 3 2 44511 13345 25212 54345
16 3 54544 13552 55411 55535
17 3 44514 12343 25324 41345
18 3 44333 35243 14111 41135
19 5 42431 24325 44224 23434
20 8 44155 14242 55111 51215
21 8 21134 14355 35132 31355
22 9 44422 13234 44423 44445
23 10 24435 53354 45254 44224
24 10 45554 45145 52222 44445
25 10 23215 14343 25334 43324
26 10 45441 53145 25152 51223
27 10 55532 42134 34324 33244
28 10 25515 23325 25154 21434
29 10 34535 33333 55234 51334
30 10 32434 43343 45234 53345
PRscores = PATH Type response scores (1=strongly disagree, 5=strongly agree)
P1=primary PATH Type
P2=secondary PATH Type
A key indicator of attentiveness
to the PATH Type assessment
questions is “somewhat” or
“strong” agreement with the last
statement of I make my own
health care decisions. Ninety
percent of U.S. residents, both
males and females, strongly or
somewhat agree with this
statement. The fact that U.K.
males precisely mirrored this
trend is another strong
confirmation of the applicability
of the methodology in the U.K.

6. 5
IMPORTANT PATH TYPE® TRENDS IN U.S.
A wider application of the PATH Type® methodology in the U.K. should reveal that several PATH
Type® cognitive patterns pull along higher rates of health risk (Chart 2) or disease (Chart 3), while
other cognitive patterns pull along lower rates. Note that this increased or decreased prevalence is
identified by the cognitive patterns themselves and not some other demographic or physical health
assessment measure. This insight into the power of cognitive drivers is not identified by any
database driven methodology, financial records system or health risk assessment focused
assessments available today. The PATH Type® methodology is the only tool that reveals this ever
present, yet unseen influence shaping health outcomes.
Chart 1: National Mix of PATH Types in the U.S.
Chart 2: Prevalence of Health Risk Factors by PATH Type®
Health Risk Conditions and PATH Types
Sach/Scarborough HealthPlus, 2001, N=93,400
0.0%
50.0%
100.0%
150.0%
200.0%
250.0%
300.0%
350.0%
Avoiders
Traditionalist
N
aturalist
R
eady
User
C
linic
Cynics
Fam
ily
CenteredG
enericLoyalist
Independently
Healthy
%exceed100duetomultipleresponse
Poor attention to nutrition
Low physical activity
Migraines
Weight Problem
Chronic back pain
Depression
Smoking (4+ days per week
Sleeping Problems
High Cholesterol
Hypertension
Avoider
6%
Generic
15%
Traditionalist
6%
Family
Centered
14%
Loyalist
8%
Ready User
15%
Independently
Healthy
12%
Naturalist
9%
Unassigned
11%
Clinic Cynic
4%

7. 6
Chart 3: Disease Prevalence and PATH Type®
Reported Disease Conditions
by PATH Type
Sachs/Scarborough HealthPlus USA Survey, 2000, N=61,000
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
120.0%
140.0%
R
eady
User
TraditionalistN
aturalistG
enericLoyalist
C
linic
Cynics
Fam
ily
CenteredAvoider
Independently
Healthy
%exceed100duetomultipleresponses
Dermatitis
Osteoporosis
Respiratory conditions
Arthritis/ rhematism
Alzheimer's
Chronic Allergies
Heart Disease
All Cancers
Skin Cancer
Breast Cancer
Kidney Disease
The impact of the cognitive patterns and disease prevalence in the U.S. becomes evident in Chart 4
below. Identified only by revealing the patterns of health care thinking detected by the PATH Type®
methodology, the cognitive patterns of health related thinking explain a variance in both disease
and demand of $238 billion dollars a year.
Chart 4: Estimated Rate of National Health Care Spending by PATH Type®
$50
$81
$110 $115
$139 $143 $145
$184
$219
$288
$0
$50
$100
$150
$200
$250
$300
SpendPerYear(inbillions)
Clinic Cynic
Avoider
Traditionalist
Loyalist
Naturalist
Unassigned
Independently Healthy
Family Centered
Generic
Ready User
Medical Spending (in billions) Per U.S. Adult
Population

8. 7
In the above chart, it is important to note that both the Generic and Ready User types represent the
same number of people (see Chart 1), yet the Ready User types generates $68 billion more in
medical spending per year. Also, the Avoider and Traditionalist types represent the same number of
people, yet Traditionalist type adults generate $29 billion more per year. It is critical to keep in
mind that these dramatic variances in health care demand are identified just by assessing how
people think about and prioritize health issues in the PATH Type® model framework. It also
suggests that working to change the cognitive patterns of health care thinking could be both a
viable tactic to improve health and reduce medical care consumption. For example, it’s estimated
that a one percent (1%) drop in the PATH Type 7 (Ready User) prevalence in favor of a one percent
(1%) increase in the prevalence of PATH Type 8 (Independently Healthy) would improve health
along with an expected reduction in health care spending of about $5 billion per year.
NEXT STEPS: SUGGESTIONS FOR FURTHER RESEARCH
Given the research outcomes, there is every indication the PATH Type® methodology can be
effectively used in the U.K. While similar small studies like the current one can be applied in other
NHS areas to further validate the applicability, if necessary, the PATH Institute Corporation suggests
more substantive quantitative research as the next phase if and when the Northeast and/or other
NHS areas decide to further PATH Type® research.
Step 1: Quantitative Study and Baseline
o Conduct a larger, quantitative study of 10,000 adults throughout the U.K. NHS areas using
the PATH Type® assessment as the first measure.
o All adults completing the PATH Type® assessment should have their data linked to their
medical record information (i.e., use of prescription medications, hospitalizations,
outpatient procedures, visits to MDs, visits to specialists, plus monetary outlay in each
category). This data will be analyzed using various multivariate procedures to explore and
validate the demand and diagnostic trends for PATH Types as found in the U.S. and confirm
or not that they can be extended to the U.K.
o Supplement the PATH Type® assessment with standard health risk assessment variables
and other measures to assess disease state prevalence (e.g., heart disease, diabetes,
cancer) across the PATH Types.
Step 2: Intervention Study 1
o Select a subsample of the 2,000 subjects from the PATH Type identified patterns associated
with the highest health risk or disease.
o Train four health coach/nurse/physician counselors in the PATH Voice Clinical Interventions
(12 hours of training per clinician).
o Assign these four counselors to interact with half of the 2,000 subsample (i.e., case load of
250:1) for 6 months with the goal of improving their engagement in desirable health
behaviors
o Assign two non-PATH trained counselors to intervene with the other half of the subsample
using standard interventions and without the benefit of PATH Type® insights
o After six months, evaluate impact
SPECIAL THANKS
The PATH Institute Corporation wishes to thank Claire Riley, Strategic Head of Communications,
Northeast Strategic Health Authority, U.K., for supporting this research. Special thanks goes to
Lorna Johnson, Lindum Research, U.K., for organizing and managing this research effort, the

9. 8
Northeast data collection, subsequent analysis, and very cordial dealings with the PATH Institute
Corporation “across the pond”.