Patient Education and Counseling

Editorial Board

2010-02-01

EACH Page

2010-02-01

AACH Page

2010-02-01

Time to establish national standards and certification for health care interpreters

Alicia Fernandez, Yael Schenker — 2010-02-01

In the 2000 Census 18 million adults, 8.4% of the U.S. adult population, reported speaking English less than very well. In many other countries as well there are sizable minorities with less than perfect proficiency in the majority language. While patients and clinicians routinely navigate language barriers under less than ideal circumstances, in the best of cases a professional interpreter is used . Two of the studies in this issue of Patient Education and Counseling offer fascinating glimpses into the dynamics of interpreted interactions, while a third reviews a novel curriculum for teaching clinicians about interpreter use. These articles highlight the need for national standards and certification of healthcare interpreters to improve the clarity and consistency of communication across language barriers. Such national standards may be needed in many different countries, but the present editorial will view this issue from a U.S. perspective.

Tsunami

Ruth Kannai — 2009-07-21

Abstract: Tsunami is a fictionalized, based on the true story of a mother and baby patients who attended my rural clinic for 12 months and disappeared. (All personal identifiers have been removed.)It is a story of a family physician trying to establish trust relationship with a young mother, that her past history and living conditions make it almost impossible for her to raise a baby. The narrative describes the struggle of the clinic staff to help the mother to keep a safe and healthy environment for her baby, and their failure to maintain open communication and support for the young mother, until the inevitable end.

Developing communication skills in pharmacy: A systematic review of the use of simulated patient methods

2009-08-17

Abstract: Objective: To review the literature relating to the use of simulated patient methods to enhance communication skills of pharmacists.Methodology: We searched Embase, Lilacs, Medline, Scielo, and Scopus databases between 1980 and 2008, using “communication skills”, “patient counseling” and “pharmacist” as keywords. This search was then further refined by using “simulated patients”, “pseudo-customer”, “standardized patients”, and “mystery shoppers” as additional keywords.Results: The initial search identified 241 published studies. Once further refined, 15 studies met inclusion criteria.Conclusion: The majority of studies had an assessment focus aimed at documenting counseling behavior of practicing pharmacists, rather than an educational focus aimed at equipping pharmacists with effective communication skills. In instances where simulated patient methods were used for educational purposes, little regard was given to the role of performance and corrective feedback in shaping communication behavior of pharmacists. The majority of studies failed to describe the competencies and skills being investigated in relation to communication in the practice of pharmacy.Practice implications: Simulated patient methods provide pharmacy educators with a tool for implementing communication skills in the practice of pharmacy and will serve as a basis for implementing communication skills development programs at the College of Pharmacy of the Federal University of Sergipe in Brazil.

The importance of teaching clinicians when and how to work with interpreters

Elizabeth A. Jacobs, Lisa C. Diamond, Lisa Stevak — 2009-12-28

Abstract: Objective: To describe the importance of teaching clinicians when and how to overcome language barriers in clinical practice, provide an example of a curriculum for teaching on this topic, and outline the critical issues that must be addressed in this type of teaching.Methods: We describe a 1.5h educational program for students in a large urban medical school as an example curriculum and how it impacted student responses on a 28-item questionnaire measuring their knowledge, attitudes and likelihood of future behaviour before and after the course. The course components are described and highlight the essential components that should be included in teaching about overcoming language barriers in clinical practice.Results: There were significant improvments in knowledge, attitudes, and reported likelihood of future behaviors after the educational program. Recommendations for essetential curricular components are made.Conclusion: Teaching clinicians about language barriers in health care and how to overcome them should be essential to all clinical curricula. Brief educational interventions can meet this need and should include a core set of essential teaching points as outlined.Practice implications: Teaching clinicians when and how to overcome language barriers in health care will help to reduce the impact of this barrier, make clinicians and interpreters’ jobs easier and more transparent, and improve patient care and satisfaction.

Provider–interpreter collaboration in bilingual health care: Competitions of control over interpreter-mediated interactions

Elaine Hsieh — 2009-04-09

Abstract: Objective: This study examines (a) providers’ and interpreters’ perception of their competition in controlling the content and process of provider–patient interactions, and (b) the challenges to providers’ and interpreters’ collaboration in bilingual health care.Methods: I recruited 26 professional medical interpreters from 17 languages and 39 providers from 5 specialties to participate in in-depth interviews and focus groups. Grounded theory was used for data analysis to develop themes in areas where providers and interpreters compete and assert their expertise.Results: Providers and interpreters experience conflicts over their expertise and authority due to their practice in (a) adopting different speech conventions, (b) controlling the other's narratives, and (c) overstepping expertise and role boundaries.Conclusion: A successful bilingual medical encounter is dependent on the interpreters’ and providers’ ability (a) to understand, communicate, and negotiate their and others’ communicative strategies/goals and (b) be adaptive of and responsive to others’ management of the communicative process.Practice implications: Authority in bilingual health care should not be established through pre-existing categories or expertise but negotiated and coordinated during the interactive process, which would allow individuals to be adaptive to the issues emerged in the communicative process.

Experiences of Kurdish war-wounded refugees in communication with Swedish authorities through interpreter

Nabi Fatahi, Lena Nordholm, Bengt Mattsson, Mikael Hellström — 2009-04-20

Abstract: Objective: To study experiences of war-wounded Kurdish refugees with respect to cross-cultural communication through interpreters.Method: Semi-structured interviews were conducted with ten men, aged 31–42. Content analysis was used for analysis and interpretation of data.Result: War-wounded Kurdish refugees experienced a number of difficulties regarding communication through interpreters, mainly related to the insufficient language link to the Swedish authorities, particularly health care personnel. In many instances, interpreters were selected based on the immigrant's citizenship rather than mother tongue, leading to a more complex, tri-lingual interpretation situation. Differences in cultural background, fear, suspicion and lack of confidence in interpreters were addressed as other problems by the participants.Conclusion: Interpreter competence and patient confidence in the interpreter are essential for an adequate cross-cultural health communication. Assignment of interpreters should be based on knowledge of the patient's/client's mother tongue, rather than citizenship, and the outcome is improved by a common ethnic and cultural background of interpreter and patient/client. Our study should be considered as a pilot study, and the results should be validated in larger cohorts as well as in other ethnic and language groups.Practice implications: In order to minimize communication misunderstandings, complicated tri-lingual interpretation situations should be avoided. Interpreters should ideally be assigned according to patient's/client's mother tongue rather than citizenship. Interpreters’ competence and patient's/client's confidence in interpreter may have significant impact on communication outcome.

Strategies for distributing cancer screening decision aids in primary care

2009-08-10

Abstract: Objective: Decision aids (DAs) have been shown to facilitate shared decision making about cancer screening. However, little data exist on optimal strategies for dissemination. Our objective was to compare different decision aid distribution models.Methods: Eligible patients received video decision aids for prostate cancer (PSA) or colon cancer screening (CRC) through 4 distribution methods. Outcome measures included DA loans (N), % of eligible patients receiving DA, and patient and provider satisfaction.Results: Automatically mailing DAs to all age/gender appropriate patients led to near universal receipt by screening-eligible patients, but also led to ineligible patients receiving DAs. Three different elective (non-automatic) strategies led to low rates of receipt. Clinician satisfaction was higher when patients viewed the DA before the visit, and this model facilitated implementation of the screening choice. Regardless of timing or distribution method, patient satisfaction was high.Conclusions: An automatic DA distribution method is more effective than relying on individual initiative. Enabling patients to view the DA before the visit is preferred.Practice implications: Systematically offering DAs to all eligible patients before their appointments is the ideal strategy, but may be challenging to implement.

The theory of planned behaviour in a randomized trial of a decision aid on cardiovascular risk prevention

2009-08-10

Abstract: Objective: To assess the feasibility and outcome of measuring the theory of planned behaviour (TPB) in patients receiving routine counselling versus counselling with a decision aid (DA) during primary care consultation on cardiovascular risk prevention.Methods: A DA was developed, based on models of shared decision-making (SDM) and the TPB. We evaluated the impact of the intervention in a randomized controlled trial. Main outcomes were previously reported. To assess the intermediate social cognitive processes and our theoretical framework, we evaluated the impact of the intervention on a TPB scale.Results: The TPB scale showed satisfactory measurement properties. Factor analysis (main component analysis, confirmatory model) could mostly replicate the assumptions of the model. 44% of variance of the behavioural intention to adhere to the decision after counselling was explained in linear regression models. Of the TPB components, only attitude towards the decision and moral norm were significantly more positive in the intervention. No difference was found with regard to intention to adhere to the decision. High risk resulted in higher values of the TPB components in both groups.Conclusion: Most DAs are developed and tested without explicitly referring to a theoretical model of psychosocial processes. The TPB may serve as a useful theoretical framework.Practice Implications: Trials on DAs demonstrate positive effects on psychological outcomes of patients without leading to better objective health results. Our study might contribute to an explanation: DAs might not cause stronger adherence to decisions even though one's attitude towards the decision becomes more positive.

Developing a dyadic OPTION scale to measure perceptions of shared decision making

Emma Melbourne, Kate Sinclair, Marie-Anne Durand, France Légaré, Glyn Elwyn — 2009-08-03

Abstract: Objective: Our aim was to develop a measurement which enables research into the interdependent nature of clinical encounters. The prime objective was to develop an instrument capable of assessing the extent to which patients have been involved in (shared) decision making from two viewpoints—that of the patient and the clinician.Methods: To develop an initial ‘dyadic OPTION’ instrument, the twelve original third-person items were drafted in passive, first person plural forms. Using this version initially, three rounds of cognitive debriefing interviews were held. These were audio-recorded and analysed at the end of each round and the results used to revise the dyadic OPTION scale.Results: It was possible to modify the observer OPTION instrument into an instrument for completion by both clinicians and patients after a dyadic interaction. Cognitive debriefing revealed five areas of interpretative difficulty. Each item of the observer OPTION scale underwent modification in order to develop a dyadic version of the scale.Conclusions: The dyadic OPTION scale is acceptable and comprehensible by both clinicians and public respondents. Cognitive debriefing adapted and refined an existing scale and provided confidence that the core constructs of the scale (perceived involvement in decisions making) were understood.Practice implications: Further validation of the dyadic OPTION scale is required prior to its use in research settings.

Burnout prevention: A review of intervention programs

Wendy L. Awa, Martina Plaumann, Ulla Walter — 2009-05-21

Abstract: Objective: To evaluate the effectiveness of intervention programs at the workplace or elsewhere aimed at preventing burnout, a leading cause of work related mental health impairment.Methods: A systematic search of burnout intervention studies was conducted in the databases Medline, PsycINFO and PSYNDEX from 1995 to 2007. Data was also extracted from papers found through a hand search.Results: A total of 25 primary intervention studies were reviewed. Seventeen (68%) were person-directed interventions, 2 (8%) were organization-directed and 6 (24%) were a combination of both interventions types. Eighty percent of all programs led to a reduction in burnout. Person-directed interventions reduced burnout in the short term (6 months or less), while a combination of both person- and organization-directed interventions had longer lasting positive effects (12 months and over). In all cases, positive intervention effects diminished in the course of time.Conclusion: Intervention programs against burnout are beneficial and can be enhanced with refresher courses. Better implemented programs including both person- and organization-directed measures should be offered and evaluated.Practice implications: A combination of both intervention types should be further investigated, optimized and practiced. Institutions should recognize the need for and make burnout intervention programs available to employees.

A self-referral preventive intervention for burnout among Norwegian nurses: One-year follow-up study

Karin E. Isaksson Rø, Tore Gude, Reidar Tyssen, Olaf G. Aasland — 2009-08-05

Abstract: Objective: Burnout among nurses is an issue of concern, and preventive interventions are important to implement and evaluate. This study investigated levels and predictors of change in burnout dimensions after an intervention for help-seeking nurses.Methods: Nurses participating in a self-referral, counseling intervention, from 2004 to 2006 in Norway, were followed with self-reporting assessments. One-year follow-up was completed by 160/172 (93%, 155 women and 5 men).Results: Mean level of emotional exhaustion (one dimension of burnout, scale 1–5) was significantly reduced from 2.87 (SD 0.79) to 2.52 (SD 0.8), t=5.3, p<0.001, to the level found in a representative sample of Norwegian nurses. The proportion of nurses seeking psychotherapy increased after the intervention, from 17.0% (25/147) to 34% (50/147), p<0.001. Less reduction in emotional exhaustion was independently predicted by reporting a work-related conflict (β −0.53 (SE 0.13), p<0.001) or by getting a period of sick leave (β −0.28 (SE 0.12), p<0.05) after the intervention.Conclusions: A short-term preventive intervention could contribute to reduction of emotional exhaustion in nurses. Work-related conflict and sick leave after the intervention were negatively associated with this reduction.Practice implications: Preventive interventions to reduce burnout for nurses should be considered, as well as programs for preventing or handling conflicts at work.

Encouraging patients with depressive symptoms to seek care: A mixed methods approach to message development

2009-08-12

Abstract: Objective: To assess the message preferences of individuals affected by depression as part of a project that will evaluate interventions to encourage at-risk patients to talk to their physicians about depression.Methods: Adaptive Conjoint Analysis (ACA) of 32 messages defined by 10 message attributes. Messages were developed based on input from three focus groups comprised of individuals with a personal and/or family history of depression, then tested using volunteers from an Internet health community. In an online conjoint survey, 249 respondents with depression rated their liking of the messages constructed for each attribute. They were then presented with two message sets and rated their preferences. Preference utilities were generated using hierarchical Bayes estimation.Results: The optimal communication approach described both psychological and physical symptoms of depression, recognized multiple treatment options, offered lifetime prevalence data, noted that depression can affect anyone, and acknowledged that finding an effective treatment can take time.Conclusion: Individuals with depression respond differently to depression care messages, underscoring the need for careful message development and evaluation.Practice implications: ACA, used in conjunction with focus groups, is a promising approach for developing and testing messages in the formative research stage of intervention development.

Training GP's to use a minimal intervention for stress-related mental disorders with sick leave (MISS): Effects on performance: Results of the MISS project; a cluster-randomised controlled trial [ISRCTN43779641]

2009-08-03

Abstract: Objective: To study the effects of a brief patient-stress management training on the performance of general practitioners (GPs).Methods: After training in the Minimal Intervention for Stress-related mental disorders with Sick leave (MISS), the performance of 24 GPs was compared with the usual care provided by 22 GPs. Outcome measures in this intervention were: assignment of a diagnosis, taking an activating approach and monitoring the symptoms.Results: Twenty-three GPs completed the training. Outcomes showed that the training added to a psychosocial diagnosis. Other skills (using a questionnaire to make a diagnosis, handing out information leaflets and monitoring the symptoms) were to some extent improved by the training.Conclusion: The result indicates limited adherence of GPs to the MISS. Only a few components of the training were actually applied after the training, and there is still ample room for improvement.Practice implications: More than the current 11h of training are probably needed to change the behaviour of GPs in general. Within educational programmes more attention should be given to the implementation of new behaviour, particularly when it concerns the treatment of patients with stress-related problems.

‘It's not my job. I’m the patient not the doctor’: Patient perspectives on medicines management in the treatment of schizophrenia

Derek C. Stewart, Geraldine B. Anthony, Rosemary Chesson — 2009-08-10

Abstract: Objectives: Medicines management plays a key role in schizophrenia treatment. Objectives were to investigate the feasibility of undertaking in-depth research involving in-patients with a diagnosis of schizophrenia and to determine patients’ views and experiences of medicines management.Methods: Research was carried out in the forensic ward of a psychiatric hospital and two rehabilitation settings in north-east Scotland. A qualitative methodology was adopted incorporating semi-structured interviews. Full text transcripts were produced and analysed.Results: Fifteen of 16 patients approached were willing to participate. Ages ranged from 27 to 70 years and they had been prescribed antipsychotics from six months to 27 years. Nearly everyone was aware of their medication regimen. Most relied on staff for information, but this was supplemented by learning from other patients’ experiences. Most were happy to leave decisions to staff and few sought any role in shared decision making.Conclusion: The research demonstrated the feasibility of undertaking qualitative work with patients with schizophrenia. Findings indicated that it should not be assumed that all patients want to take responsibility for their medications.Practice implications: Patients’ reluctance to assume responsibility needs to be explored and patients’ wishes taken into account when planning future medicine related education.

Facing uncertainty as a medical student—A qualitative study of their reflective learning diaries and writings on specific themes during the first clinical year

M.K. Nevalainen, T. Mantyranta, K.H. Pitkala — 2009-09-23

Abstract: Objective: Tolerance of uncertainty related to the complex work is a major dimension of general practitioner's (GP) profession. Strategies for managing uncertainty have been studied among GPs but less is known about how medical students develop tolerance of uncertainty during their studies. The aim of this study was to investigate how the medical students experience uncertainty during their first clinical years and how their feelings develop with time as they progress from the 3rd year to the 4th year.Methods: The material consisted of 22 students’ reflective learning diaries and writings on specific themes collected during the 3rd and 4th year of their medical studies. The analysis was performed using thematic content analysis. In this article we present the results related to the theme of uncertainty.Results: Uncertainty is a major cause of mental strain for medical students, particularly fear of making mistakes. Main themes related to facing uncertainty and found in the diaries and writings were insecurity of professional skills, own credibility, facing with the inexactness of medicine, fear of making mistakes, coping with responsibility, and tolerating oneself as incomplete and accepting oneself as a good-enough doctor-to-be. Common steps of development towards tolerance of uncertainty were found in diaries over a one-year time period as the students progressed in their clinical studies.Conclusions: Reflective writing showed to be an effective means for the students of both expressing and dealing with uncertainty, both with the difficult and the pleasant feelings and the experiences the students had with their first patient contacts. It also gave some of them the means of self-reflection which they afterwards found worthwhile.Practice implications: Reflective writing is powerful tool which medical students could use to facilitate their maturation process what comes to uncertainty during their first clinical year.

Adaptive Conjoint Analysis as individual preference assessment tool: Feasibility through the internet and reliability of preferences

2009-07-08

Abstract: Objective: Patient values are not routinely assessed in clinical practice. Adaptive Conjoint Analysis (ACA) is increasingly applied in studies assessing treatment preferences, and could provide a means to routinely assess individual patients’ treatment preferences.Methods: An ACA-questionnaire was administered three times (7–10 days apart) to 98 long-term rectal cancer survivors either on a portable computer or through internet, to assess whether (a) responses differ according to administration mode, (b) relative importances of rectal cancer treatment outcomes (survival, local control, incontinence, sexual problems) consolidate over time, (c) ACA-outcomes are sufficiently reliable (ICC) for use in individual decision-making. We also evaluated patients’ acceptance of ACA.Results: Mode did not affect ACA-completion or evaluation. Importance scores did not consolidate over time. ICCs were poor for sexual problems and fair for the other outcomes, and were at least equal or higher from first to second retest. Most participants valued completing the ACA-questionnaire and learning their results.Conclusion: Values did not show consolidation over time. ACA-derived preferences should not determine which treatment patients should choose.Practice implications: Findings extend ACA-validation studies to the health care setting and suggest that ACA-questionnaires might be appreciated as adjuncts to treatment decision-making in newly diagnosed patients.

Women's experiences of health visitor delivered listening visits as a treatment for postnatal depression: A qualitative study

Katrina M. Turner, Carolyn Chew-Graham, Liz Folkes, Deborah Sharp — 2009-07-02

Abstract: Objective: To explore women's experiences of health visitor delivered listening visits as a treatment for postnatal depression.Methods: In-depth interviews with 22 women who had received listening visits as a treatment for postnatal depression.Results: All the women reported the visits as beneficial, although many of them had required additional intervention to manage their symptoms. Women who had a previous history of depression and women whose depression was not attributed to events in the postnatal period perceived the listening visits to be less beneficial. Receiving visits from a research health visitor, rather than their practice health visitor, was felt to be advantageous.Conclusion: Women with postnatal depression may report listening visits as helpful but insufficient to manage their depression. The extent to which women report listening visits as beneficial appears to be linked to the causes of their depression, the way in which the visits are delivered and by whom.Practice implications: Practitioners managing women with postnatal depression should discuss possible causes and previous episodes of depression before suggesting listening visits as a treatment. They need to explain what the visits will entail, ensure that additional types of treatment remain available and encourage women to utilise other forms of support.

Development and preliminary evaluation of a cognitive behavioural approach to fatigue management in people with multiple sclerosis

2009-08-10

Abstract: Objectives: (i) To develop a group-based intervention for the management of multiple sclerosis (MS) fatigue incorporating energy effectiveness and cognitive behavioural approaches and (ii) to undertake a process and preliminary evaluation.Methods: Drawing upon a literature search, a local model of good practice and the views of service users and health professionals, a manualised group-based fatigue management programme was developed, designed to be delivered by health professionals. A process and preliminary outcome evaluation was undertaken. Sixteen participants attended across two iterations. Participant feedback, obtained via a focus group and evaluation questionnaires, was used to refine the programme. Outcomes were collected pre- and post-programme (including fatigue severity, quality of life, self-efficacy).Results: Focus group feedback suggested the programme was well received, reflected in high attendance and positive ratings on evaluation questionnaires. At follow-up, despite the small sample size, there were significant improvements in perceived self-efficacy for managing fatigue.Conclusion: An evidence-based fatigue management intervention has been developed and preliminary findings look promising. In the next phase we will examine whether the programme transfers satisfactorily to other centres and collect data in preparation for a randomised controlled trial (RCT).Practice implications: Implications for practice will emerge when the results of our RCT are published.

The relationship between nurses’ religiosity and willingness to let patients control the conversation about end-of-life care

Stephanie A. Christopher — 2009-07-02

Abstract: Objective: The study attempts to examine the relationship between nurses’ religious beliefs and how nurses communicate with patients.Method: An online census survey was administered to graduate students in the School of Nursing at a Midwestern university. The survey was designed to measure: relational control, as measured by the subscales of dominance and task orientation in Burgoon and Hale's scale of relational communication; clinician empathy, as measured by the Jefferson scale of clinician empathy; and intrinsic and extrinsic religiosity, whether religious views are held for deep personal reasons or social reasons, as measured by the Maltby and Lewis scale. Data were analyzed using multiple regressions and one-way ANOVAs.Results: Intrinsic religiosity and empathy were both associated with the willingness to relinquish relational control in certain, specific contexts, such as end-of-life care.Conclusion: Nurses who scored higher on a scale of intrinsic religious beliefs were more willing to let patients take control of conversations about end-of-life care.Practice implications: A nurse's religious beliefs can enhance the clinical experience without the nurse trying to impose his or her beliefs on the patient, as the nurse works to make sure the patient's religious beliefs are upheld.

The Coping with Caregiving Group Program for Chinese caregivers of patients with Alzheimer's disease in Hong Kong

2009-07-21

Abstract: Objective: This pilot study evaluated the effectiveness of Coping with Caregiving (CWC) psychoeducational program for Chinese family caregivers of patients with Alzheimer's disease in Hong Kong.Method: Twenty-seven female primary caregivers were randomized to join the treatment group or wait-list control group. The caregivers in the treatment group participated in 13 weekly training sessions which taught specific cognitive–behavioral strategies to handle caregiving stress.Results: As compared to the wait-list control group, caregivers completing the CWC program demonstrated a significant increase in their self-efficacy for controlling their upsetting thoughts and handling disruptive behaviors of the care recipients. They also reported a significant increase in the use of both problem-focused and emotion-focused coping strategies.Conclusion: These findings suggested that cognitive–behavioral programs can be effective in improving the resourcefulness of Chinese caregivers of persons with dementia in Hong Kong.Practice implications: Future CWC programs will have to enhance participants’ ability to differentiate among various coping skills and to use situation-appropriate strategies.

Shared decision making coding systems: How do they compare in the oncology context?

2009-08-03

Abstract: Objective: The current study aimed to evaluate three coding systems which have been used to assess shared decision making in oncology consultations (OPTION, Decision Support Analysis Tool (DSAT) and Decision Analysis System for Oncology (DAS-O)): (i) comparing their ability to identify competencies of shared decision making, and (ii) determining their ability to predict patient outcomes in a single data set.Method: Twenty oncologists from Australia and New Zealand participated in the IBCSG Trial 33-03. The consultations of 55 women with early stage breast cancer were audio-taped, transcribed and then coded using the OPTION, DAS-O and DSAT coding systems by three different raters. Women completed the questionnaires 2 weeks and 4 months after their consultation.Results: DAS-O was strongly correlated with OPTION (r=0.73). DSAT was moderately correlated with DAS-O and OPTION (r<0.6). Decisional satisfaction and satisfaction with doctor SDM skills were significantly correlated with OPTION (r=0.39 and 0.42 respectively) and the latter variable was correlated with DAS-O (r=0.40). These relationships persisted in multiple linear regression analyses.Conclusions: OPTION may be the most efficient and sensitive coding system for research purposes; however, DSAT appeared to document behaviours reducing decisional conflict and both DSAT and DAS-O offer more detailed feedback to doctors.Practice implications: Optimal coding system will depend on research goals and training purposes.

The role of self-efficacy in dental patients’ brushing and flossing: Testing an extended Health Belief Model

Maria E. Buglar, Katherine M. White, Natalie G. Robinson — 2009-07-29

Abstract: Objective: In an effort to examine the decreasing oral health trend of Australian dental patients, the Health Belief Model (HBM) was utilised to understand the beliefs underlying brushing and flossing self-care. The HBM states that perception of severity and susceptibility to inaction and an estimate of the barriers and benefits of behavioural performance influence people's health behaviours. Self-efficacy, confidence in one's ability to perform oral self-care, was also examined.Methods: In dental waiting rooms, a community sample (N=92) of dental patients completed a questionnaire assessing HBM variables and self-efficacy, as well as their performance of the oral hygiene behaviours of brushing and flossing.Results: Partial support only was found for the HBM with barriers emerging as the sole HBM factor influencing brushing and flossing behaviours. Self-efficacy significantly predicted both oral hygiene behaviours also.Conclusion: Support was found for the control factors, specifically a consideration of barriers and self-efficacy, in the context of understanding dental patients’ oral hygiene decisions.Practice implications: Dental professionals should encourage patients’ self-confidence to brush and floss at recommended levels and discuss strategies that combat barriers to performance, rather than emphasising the risks of inaction or the benefits of oral self-care.

2010-02-01

Patient Education and Counseling

Editorial Board

EACH Page

AACH Page

Time to establish national standards and certification for health care interpreters

Tsunami

Developing communication skills in pharmacy: A systematic review of the use of simulated patient methods

The importance of teaching clinicians when and how to work with interpreters

Provider–interpreter collaboration in bilingual health care: Competitions of control over interpreter-mediated interactions

Experiences of Kurdish war-wounded refugees in communication with Swedish authorities through interpreter

Strategies for distributing cancer screening decision aids in primary care

The theory of planned behaviour in a randomized trial of a decision aid on cardiovascular risk prevention

Developing a dyadic OPTION scale to measure perceptions of shared decision making

Burnout prevention: A review of intervention programs

A self-referral preventive intervention for burnout among Norwegian nurses: One-year follow-up study

Encouraging patients with depressive symptoms to seek care: A mixed methods approach to message development

Training GP's to use a minimal intervention for stress-related mental disorders with sick leave (MISS): Effects on performance: Results of the MISS project; a cluster-randomised controlled trial [ISRCTN43779641]

‘It's not my job. I’m the patient not the doctor’: Patient perspectives on medicines management in the treatment of schizophrenia

Facing uncertainty as a medical student—A qualitative study of their reflective learning diaries and writings on specific themes during the first clinical year

Adaptive Conjoint Analysis as individual preference assessment tool: Feasibility through the internet and reliability of preferences

Women's experiences of health visitor delivered listening visits as a treatment for postnatal depression: A qualitative study

Development and preliminary evaluation of a cognitive behavioural approach to fatigue management in people with multiple sclerosis

The relationship between nurses’ religiosity and willingness to let patients control the conversation about end-of-life care

The Coping with Caregiving Group Program for Chinese caregivers of patients with Alzheimer's disease in Hong Kong

Shared decision making coding systems: How do they compare in the oncology context?

The role of self-efficacy in dental patients’ brushing and flossing: Testing an extended Health Belief Model

Contents