Chapter 5 One-to-One Communication © John Hubley & June Copeman 2013

One-to-One Communication One-to-one communication can take place in health facilities, the workplace, home, community and other settings. It is used when talking with individuals (‘clients’) as part of general health promotion activities, discussions with patients as part of treatment, specific advice-giving or more extended counselling. One-to-one usually involves direct face-to-face encounters but we will also discuss its use in telephone advice lines

Non-verbal Communication can involve Body language: hand gestures, head nodding, smiles, frowns Personal space: proximity, touching Clothing and general appearance Voice sounds: loudness, pitch, ums and ers

Active Listening Allowing time to explain. Not interrupting. Giving encouragement – smiles, nods, encouraging remarks like “that’s interesting”, “Really?”, “Please go on…”, etc. Asking questions for clarification: “Can you explain what you meant by….?” Showing empathy “That must be a real problem”, “You must feel terrible” ,“ I am not surprised that you feel that way” Looking interested – keeping eye contact, not looking at your watch or reading over notes. Keeping out interruptions – if someone calls you say to them “I am seeing someone – I will call you back.” Summarizing “So what you mean is…?” Allowing time to explain. Not interrupting. Giving encouragement – smiles, nods, encouraging remarks like “that’s interesting”, “Really?”, “Please go on…” etc. Asking questions for clarification. “Can you explain what you meant by….?” Showing empathy “That must be a real problem”, “You must feel terrible” “ I am not surprised that you feel that way” Looking interested -keeping eye contact, not looking at your watch, reading over notes. Keeping out interruptions – if someone calls you say to them “I am seeing someone – I will call you back.” Summarising “So what you mean is…?

Common Barriers in Interpersonal Communication The context - unsuitable surroundings The mismatch between the health promoter and client The mental and emotional state of the person The physical state of the person Fear of being judged or confidentiality being compromised. Failure to ‘recognize’ the uniqueness of the person The language used The nature of the advice The subject matter Box 5.3 Common barriers in interpersonal communication The context - unsuitable surroundings e.g. formal situations, lack of privacy. The mismatch between the health promoter and client – e.g. in age, educational level, gender and ethnic background. The mental and emotional state of the person - high levels of stress, anxiety, mental health or depression or strong emotions such as anger and denial which may prevent the person from paying attention and listening to what you are saying. This is especially important when the person is experiencing a crisis e.g. bereavement or discovering that he/she has a serious and even terminal illness. The physical state of the person – the symptoms experienced by the patient e.g. pain or nausea can act as barriers to communication. Disabilities such as deafness and eye sight problems can affect communication. Fear of being judged or confidentiality being compromised. A person might withhold information e.g. about their sexual orientation or potential risk behaviours if they feel that they will be judged or treated in a negative way. Failure to ‘recognize’ the uniqueness of the person. This happens when the health promoter does not show respect and acknowledge the uniqueness of the person and their experiences, concerns and needs and they are treated as just one of many patients or clients. Patients feel ignored, under-valued and not treated as a real person. The language used -using technical terms e.g. units of alcohol rather than actual drinks. Assuming that the person you are talking with is familiar with parts of the body and their basic function. Difficulty that people have in understanding ‘probability’ and ‘risk’. The nature of the advice - giving vague information e.g. take this three times a day, take more exercise, cut down on salt rather than specifying exactly what kind of exercise, how much salt is enough The subject matter - embarrassment on both parties when dealing with sensitive subjects like sex, alcoholism, death. The reluctance to break bad news.

Communication barriers in health worker-patient communication Use of technical language Non-verbal communication (gestures, expressions, clothing) Pressure of time – not enough time given to explain information and answer questions Information overload for patient who cannot remember everything Background noise, lack of privacy and interruptions

Key elements of Participatory One-to-One Communication Establishing rapport, trust. Showing recognition that the person is unique and special. Maintaining confidentiality. Assessing needs. Asking open-ended questions. Active listening. Being aware of one’s own feelings and values so they do not influence the advice you give. Providing any necessary information. Helping the client to make decisions and set goals (using strategies like listing pros and cons of actions). Building the client’s confidence to put decisions into practice (self efficacy). In this book we advocate a participatory approach to one-to-one communication approaches to promote health empowerment and informed decision-making. While the term counselling is sometimes used to describe any form of participatory one-to-one communication, we prefer to reserve the use of the word counselling for more extended processes over a series of sessions that involve some form of therapeutic content. Key elements Establishing rapport, trust. Showing recognition that the person is unique and special. Maintaining confidentiality Assessing needs. Asking open-ended questions. Active listening Being aware of one’s own feelings and values so they do not influence the advice you give. Providing any necessary information Helping the client to make decisions and set goals (using strategies like listing pros and cons of actions) Building the client’s confidence to put decisions into practice (self efficacy)

Risks to avoid Becoming over-involved with the client so as to affect your judgement. Letting one’s own feeling influence the process. Making negative judgements on the other person’s actions. Going for the ‘quick fix’ and over-simplifying issues. Making someone feel over-dependent on you to make decisions for them. Creating over-confidence. Overlooking possible negative consequences of following your advice. Risks to avoid: Becoming over-involved with the client and affecting your judgement. Letting one’s own feeling influence the process. Making negative judgements on the other person’s actions. Going for the ‘quick fix’ and over-simplifying issues. Making someone feel over-dependent on you to make decisions for them. Creating over-confidence. Overlooking possible negative consequences of following your advice.

Assessing the quality of one-to-one communication Has the person been put at ease? Is the environment conducive – in a private place, free from noise and distractions ? Has the person been given a chance to explain exactly what their problem is and what they need? Box 5.9 How to assess the quality of one-to-one communication Here is a simple checklist you can use to assess the quality of one-to-one communication. Has the person been put at ease? Is the environment conducive – in a private place, free from noise and distractions? Has the person been given a chance to explain exactly what their problem is and what they need? Has the educator/counsellor gained the trust of the person? Has the educator/counsellor used active listening skills? Is the body language helpful e.g. smiles, looks of concern, gestures, posture? Was the person encouraged to ask questions? Has the educator/counsellor asked sufficient questions to understand the problem and give the appropriate advice? Was sufficient allowance made for cultural differences between the educator/counsellor and the person? Is the advice presented relevant/balanced and accurate? Is it based on evidence-based practice? Is the advice presented clearly using appropriate language? Was the person given alternative options and allowed to make a decision? Does the advice take into account what the person already knows about the health topic? Does the advice take into account the family situation of the person and the influence of partners, significant others? Have all the questions of the person been answered and their needs met? Was sufficient time available to meet the needs of the person? Has feedback been obtained at the end of the session to confirm that everything has been understood?

Assessing the quality of one-to-one communication Has the educator gained the trust of the person? Has the educator used active listening skills? Is the body language helpful, e.g. smiles, looks of concern, gestures, posture? Was the person encouraged to ask questions? Has the educator asked sufficient questions to understand the problem and give the appropriate advice? Box 5.9 How to assess the quality of one-to-one communication Here is a simple checklist you can use to assess the quality of one-to-one communication. Has the person been put at ease? Is the environment conducive – in a private place, free from noise and distractions? Has the person been given a chance to explain exactly what their problem is and what they need? Has the educator/counsellor gained the trust of the person? Has the educator/counsellor used active listening skills? Is the body language helpful e.g. smiles, looks of concern, gestures, posture? Was the person encouraged to ask questions? Has the educator/counsellor asked sufficient questions to understand the problem and give the appropriate advice? Was sufficient allowance made for cultural differences between the educator/counsellor and the person? Is the advice presented relevant/balanced and accurate? Is it based on evidence-based practice? Is the advice presented clearly using appropriate language? Was the person given alternative options and allowed to make a decision? Does the advice take into account what the person already knows about the health topic? Does the advice take into account the family situation of the person and the influence of partners, significant others? Have all the questions of the person been answered and their needs met? Was sufficient time available to meet the needs of the person? Has feedback been obtained at the end of the session to confirm that everything has been understood?

Assessing the quality of one-to-one communication Is the advice presented relevant/balanced and accurate? Is it based on evidence-based practice? Is the advice presented clearly using appropriate language? Was the person given alternative options and allowed to make a decision? Does the advice take into account what the person already knows about the health topic? Box 5.9 How to assess the quality of one-to-one communication? Here is a simple checklist you can use to assess the quality of one-to-one communication. Has the person been put at ease? Is the environment conducive – in a private place, free from noise and distractions? Has the person been given a chance to explain exactly what their problem is and what they need? Has the educator/counsellor gained the trust of the person? Has the educator/counsellor used active listening skills? Is the body language helpful e.g. smiles, looks of concern, gestures, posture? Was the person encouraged to ask questions? Has the educator/counsellor asked sufficient questions to understand the problem and give the appropriate advice? Was sufficient allowance made for cultural differences between the educator/counsellor and the person? Is the advice presented relevant/balanced and accurate? Is it based on evidence-based practice? Is the advice presented clearly using appropriate language? Was the person given alternative options and allowed to make a decision? Does the advice take into account what the person already knows about the health topic? Does the advice take into account the family situation of the person and the influence of partners, significant others? Have all the questions of the person been answered and their needs met? Was sufficient time available to meet the needs of the person? Has feedback been obtained at the end of the session to confirm that everything has been understood?

Assessing the quality of one-to-one communication Does the advice take into account the family situation of the person and the influence of partners/ significant others? Have all the person’s questions been answered and their needs met? Was sufficient time available to meet the needs of the person? Has feedback been obtained at the end of the session to confirm that everything has been understood? Box 5.9 How to assess the quality of one-to-one communication Here is a simple checklist you can use to assess the quality of one-to-one communication. Has the person been put at ease? Is the environment conducive – in a private place, free from noise and distractions? Has the person been given a chance to explain exactly what their problem is and what they need? Has the educator/counsellor gained the trust of the person? Has the educator/counsellor used active listening skills? Is the body language helpful e.g. smiles, looks of concern, gestures, posture? Was the person encouraged to ask questions? Has the educator/counsellor asked sufficient questions to understand the problem and give the appropriate advice? Was sufficient allowance made for cultural differences between the educator/counsellor and the person? Is the advice presented relevant/balanced and accurate? Is it based on evidence-based practice? Is the advice presented clearly using appropriate language? Was the person given alternative options and allowed to make a decision? Does the advice take into account what the person already knows about the health topic? Does the advice take into account the family situation of the person and the influence of partners, significant others? Have all the questions of the person been answered and their needs met? Was sufficient time available to meet the needs of the person? Has feedback been obtained at the end of the session to confirm that everything has been understood?