Assist. Prof. Dr. Memet IŞIK Ataturk University Medical Faculty Department of Family Medicine Class 2:

Objectives At the end of this session, participants 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 / 282

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

Timing 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. / 284

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

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

Suggestions from the USPSTF 1. 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 / 287

Suggestions from the USPSTF 6. Use combined strategies 7. Prepare a behavioral change plan 8. Track the changes by follow-up visits 9. Include all your personnel / 288

The Integrated Health Behavior Model / 289

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. / 2810 From Prochaska JO, Velicer WF: The transtheoretical model of health behavior change. Am J Health Promot 12:38, 1997.

Good News! 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. / 2811

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

If Patient not Motivated 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 / 2813

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

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

Evaluate 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. / 2816

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

Who will participate? 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. / 2818

Who will participate? 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. / 2819

Verbal education 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. / 2820

Verbal education 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. / 2821

Verbal education 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. / 2822

Printed material Used very frequently. Should be supported with verbal education in advance. / 2823

Printed material 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. / 2824

Doing what is comfortable to yourself 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 / 2825

Other methods Models Maquettes, manikins Tapes Video Computer … / 2826

Office design 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. / 2827