Graduate School of Medicine University of Wollongong 1 Do doctors have a role in Public Health Education? (A study of people’s attitudes and responses to the presentation of health education by a doctor.) Dr Helen Rienits General Practitioner Senior Lecturer Clinical Skills Graduate School of Medicine, University of Wollongong

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Objectives: Should doctors do public health education? Where do people turn to for health information? How much do people learn in a health talk? Does the advice given get remembered and implemented? What do people think of doctors as educators? What factors inhibit effective health education by doctors? 3

Summary of study participants: (n=391) Age groupsEducation levels 4

Should doctors do public health education ? Some argue that preventive health education is not the doctor’s role. [1] Perhaps doctors have a vested interest in keeping people sick? Garland Report – Aging population and rise in preventable illness rates. Preventive HE has become the responsibility of all health professionals Many studies show the enormous credibility doctors have and this should be utilised to the maximum. 5

Where do people turn to for health information and how do doctors rank? [2,3,4,5,6] 6

How much do people learn in a health talk? Health knowledge of the subject was tested before and after the talk with 9 simple T/F/DK statements (Doctors sometimes assume that 100% of the advice they give is clearly understood and remembered.) The average improvement of scores was 29.2% (16.1%-48.0%) Analysis of surveys by non English mother tongue speakers showed no significant difference. Analysis of surveys completed by those with < HSC education showed a significant reduction in improvement score: 15.2% (compared to 29.2%) 7

Does the advice get remembered and implemented? [7] No. of changes as a result of this health talk: No. of changes as a result of the Slip, Slop, Slap campaign: 8

What do people think of doctors as educators? ‘Doctors are poor communicators and don’t explain things well.’ Agree: 27.0%, Disagree: 57.5%, Unsure: 15.5% ‘Doctors don’t have the time to give health education in the surgery.’ Agree: 60.2%, Disagree: 28.5%, Unsure: 11.3% ‘When a doctor tells me to do something, I am more likely to do it.’ [2,3,4,6] Agree: 88.0%, Disagree: 4.4%, Unsure: 5.2% 9

What factors inhibit effective health education by doctors? Time limits of the consultation Lack of remuneration for this aspect of patient care Poor communication skills, especially teaching skills [8] Inadequate preventive health knowledge Difficulty with the health educator role [9] Unrealistic expectation of what it will achieve [10] Poor follow-up written resources Difficulty recording and following up on HE given Belief that the patient is not interested or already knows [11] 10

Conclusion: While doctors have significant potential as public health educators, there are a number of factors which prevent them realising their potential. These factors need to be explored and addressed both for our existing and our future medical workforce. 11

References: 1. Marshall T, ‘Basic health education is for schools, not doctors, to provide.’ Medical Journal of Australia (2): Khoo K, Bolt P, Babl F E, Jury S, Goldman R D, ‘Health information seeking by parents in the Internet age.’ Journal of Paediatrics and Child Health, (7- 8). pp Sauvageau C, Groulx S, Pelletier A, Quakki M, Dube E, ‘Do general practitioners discuss lifestyle habits with their patients?’ Canadian Journal of Public Health, 99(1), pp Booth A, Nowson C, ‘Patient recall of receiving lifestyle advice for overweight and hypertension from their General Practitioner.’ BMC Family Practice :8. 5. Tan D, Zwar N, Dennis S, Vagholkar S. ‘Weight management in general practice: what do patients want?’ Medical Journal of Australia, : pp Thompson R, Summerbell C, Hooper L, Higgins J, Little P, Talbut D, Ebrahim S. ‘Dietary advice given by a dietician versus other health professional or self-help resources to reduce blood cholesterol.’ The Cochrane Collaboration, (Pub. John Wiley & Sons) 12

7. Wallace L, ‘Heart attacks don’t stop Mac attack.’ Australian Doctor summary report from American Journal of Cardiology, 2011.online. 8. Shahpurwala M, et al. ‘General medical practitioners in Pakistan fail to educate patients adequately about complications of diabetes.’ Practical Diabetes International.2006, Vol 23, Issue 2. pp Visser F, Hiddink G, Koelen M, van Binsbergen J, Tobi H, van Woerkum C. ‘Longitudinal changes in GP’s task perceptions, self efficacy, barriers and practices of nutrition education and treatment of overweight.’ Family Practice, Suppl. 1, pp McKinstry B, Watson P, Elton R, et al. ‘Comparison of the accuracy of patient’s recall of the content of telephone and face to face consultation: an exploratory study.’ Postgrad. Med. Journal March. online. 11. Colyer S. ‘GPs told to call a spade a spade.’ Australian Doctor summary report from Archives of Internal Medicine 2011; 171:pp

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