/ 281 Saudi Diploma in Family Medicine Center of Post Graduate Studies in Family Medicine Patient Education Dr. Zekeriya Aktürk

/ 282 Objectives At the end of this session, the trainees should be able to: –Define the principles of patient education –Explain the integrated health behavior model –Explain the health behavior change model –Design and apply a health education

/ 283 Tobacco use Exercise Nutrition Traffic accidents Home accidents and environmental injuries Sexually transmitted diseases Unwanted pregnancies Oral health … USPSTF Recommendations

/ 284 Doctor-patient relationship always includes patient education. A good doctor HAS to be a good educator. Patient education spreads throughout all levels of the consultation. Timing

/ 285 Encourage patients to take responsibility of their health behaviors Establish doctor-patient partnership –Doctor: health counselor –“First information then choice” Aims

/ 286 Feed-back Reinforcement Individualization Facilitation Relevance Using multiple channels of education Principles

/ Establish a therapeutic relationship 2.Provide counseling to all patients 3.Ascertain that patient understands the relationship between behavior and health 4.Work with the patient to eliminate barriers to behavioral change 5.Include patients in the decision of which risk factor to change Suggestions from the USPSTF

/ Use combined strategies 7.Prepare a behavioral change plan 8.Track the changes by follow-up visits 9.Include all your personnel

/ 289 The Integrated Health Behavior Model

/ 2810 Health Behavior Change 1.Precontemplation: Not intending to take action in the foreseeable future, usually measured as the next 6 months. 2.Contemplation: Intending to change in the next 6 months; aware of the pros and cons of changing, leading to procrastination. 3.Preparation: Intending to take action in the immediate future, usually measured as the next month; have a plan. 4.Action: Have made specific overt modifications to behavior within the last 6 months. 5.Maintenance: Working to prevent relapse, increasing confidence; typically lasts 6 months to 5 years. 6.Termination: Zero temptation to relapse and 100% confidence in ability to maintain new behavior. From Prochaska JO, Velicer WF: The transtheoretical model of health behavior change. Am J Health Promot 12:38, 1997.

/ 2811 Motivation is critical –“What would you like to do?” –“How about making a change?” Giving information to a patient ready to change will motivate him/her for positive change. For simple behaviours just simple reminders may be enough. Difficult changes such as diet may need special discussion sessions. Good News!

/ 2812 Providing information and clues to patients without motivation is not useful –Health belief –Social support –Activity –MOTIVATION Bad News!

/ 2813 Leave open door Give time Determine aims and expectations of the patient Determine wrong informaiton and beliefs and substitute with correct ones Supports and barriers –family, social environment, occupation, income, working hours Low personal benefit If Patient not Motivated

/ 2814 Don’t blame, Reward successes (even if small), Be encouraging, Some will never change; whatever your efforts.. Education

/ 2815 Individualize: –Assess the present knowledge. –Use material relevant to patients understanding. Team work. Education

/ 2816 Most commonly neglected part. Don’t just give information and go!, Determine personal needs, Update the needs after evaluation, Make a new planning..... Establish continuity. Evaluate

/ 2817 Who will participate? Using verbal education Using printed materials Doing what is comfortable to ones self Other materials and methods Office design Planning of Patient Education

/ 2818 Involve all team members: –Makes the education stronger, –Gives more time to the doctor. Doctor: –Determines objectives of education, –Gives broad information on the importance of the objectives, –Determines which educational process to use, –Evaluateds the process. Who will participate?

/ 2819 According to the need, the doctor himself may provide the education or assign somebody else. –Education nurse, –The receptionist may provide relevant documents, Other resources of the public may be utilized, –Public education centers, –Social services, –Voluntary organizations. Patient education teams may be established in bigger organizations. Who will participate?

/ 2820 Patients should be evaluated with their families. –Family support will affect the success of educaitons. –In many occasions the partner should be involved as well. Diet education needs the contribution of the one who cooks. –Caregivers of children and elderlies are direct targets of the education. Who will participate?

/ 2821 The basis of education is established during the consultation. –Information should be approppriate. –The structure should be based on mutual expectations of the patient and educator. Verbal education

/ 2822 Should be non-judgmental and non- accusive, Make clear that patient views are respected, –Be a team with the patient for a mutual aim. Understand the beliefs, skills, readiness to change, and anxieties, –Low to medium anxiety will increase motivation; excessive anxiety may cause denial. Verbal education

/ 2823 Avoid medical jargon. –Use together with synonyms or avoid totally. Use clear and understandable statements. –“decrease fat consumption”, “make more exercise”, “don't lift heavy objects”, “take your medicine three times a day” are inappropriate. Ascertain the patient has understood you. –Encourage to ask questions. –Politely ask to repeat what was told. –Take over the fault of misunderstanding. Verbal education

/ 2824 Used very frequently. Wnated by patients. Should be supported with verbal education in advance. Printed material

/ 2825 Before used; –Is the content appropriate?, –Understandability, –Easiness to onbtain and keep Should be prepared according to the average level of the population. –Should be preferred in patients with well known edcucational level. Printed material

/ 2826 You may control the content –Focus on maximum 3-4 points –Avoid medical terminology, statistics or scary expressions –Use short sentences, understandable words –Give open messages Doing what is comfortable to yourself

/ 2827 Models Maquettes, manikins Tapes Video Computer … Other methods

/ 2828 Look to the office as a patient training center. –Educational materials in the waiting and examination rooms. –Posters on the walls. –Educational video in the waiting room. –Change the themes with some period. Office design