1. Module 10

2. HEP Purpose Provide concrete instructions on how to carry out an exercise or treatment at home

3. Development of HEP Content? Process: Who will develop? What methods to use? Will pt/family have input? When to issue?

4. Instructional Design Needs Assessment Goal Statement (Purpose) Key Concepts (Content Outline) Objectives Planning evaluation for objectives Designing teaching strategies Implementation of Design Evaluation Modify Instruction

5. Types of Communication Skills Used in Patient Education Expressive skills: Giving verbal information to others regarding their behaviors Articulating own beliefs and feelings Emotional skills: Taking responsibility Making difficult decisions when transmitting a message

6. Listening Skills Used in Patient Education Listening with undivided attention Using verbal/nonverbal expressions during listening Acknowledging patient’s message Checking with the patient for correct understanding/meaning of message Asking questions for clarification

7. Body Language Patterns During Patient Education Positive pattern: Non defensive behavior expressing trust, openness, sincerity, responsiveness, understanding Negative patterns: Aggressive expressing hostile and antagonistic behavior Appeasing expressing shy and nervous behavior

8. Addressing Patient’s Priorities Using Modified FIDO Feelings of the patient toward outcome Information given by the patient that is specific, accurate and relevant to the outcomes Decisions expressed by the patient Outcomes expressed by the patient - are to be accomplished

9. Communication Skills Promoting Therapeutic Relationships Asking the patient nonjudgmental questions Supporting patient’s perspective Listening to the patient’s replies to pick up clues about understanding of information Involving the patient in active problem solving Working with the patient and family members to set realistic goals for behavior change

10. Health Communication in Patient/Health Education Health communication - strategies to inform and influence patients and their decisions to enhance their health Importance: Adds to patient’s knowledge about health issues Decreases patient’s health risks Increases patient’s adherence to patient/health education Enhances the relationship between patient and therapist

11. Characteristics of Effective Health Communication Accurate and understandable - language/format appropriate for the patient Easily available Consistent Balanced including risks/benefits of potential actions Culturally competent Evidence-based Applied in a timely basis Targeting a large number of people

12. HEP Individual Considerations Can patient read? Can patient follow directions? Does patient understand English? What is their cognitive level? Is patient educable? Is someone available to help patient?

13. Illiteracy "A normal blood sugar is a range between 60 and 140. Today yours is 150. Is your blood sugar normal?" How many of your patients would be able to accurately respond to this question from the Test of Functional Health Literacy in Adults (TOFHLA)? In one survey of 3,200 elderly patients, 68% could not answer that question correctly.

14. HEP Key Factors to Remember Avoid medical jargon Health care providers tend to: give too much information Give information at too high a level When instructing, focus on three main ideas

15. HEP Key Factors to Remember Attentiveness to communication principles Be an active listener Reflect back to them what is being said Reinforce (repeating is ok) Make eye contact (if culturally appropriate) Be aware of your body language

16. HEP Key Factors to Remember Remember adherence factors Establish Trust Address main areas Knowledge Motivation Resources Help them overcome barriers

17. Addressing Main Conditions : Knowledge Condition itself How/when to do treatment program When to expect results Possible side effects Results of non-adherence Appropriate psychomotor skills

18. Addressing Main Conditions: Motivation Therapeutic relationship Discuss incentives/advantages to making behavioral change Ask questions that encourage patient to recognize positive or negative consequences to behavior May take a while to convince them Is it worth it?

19. Addressing Main Conditions: Resources Time Money Space Equipment

20. HEP Rationale for Patient to do HEP Patient MUST understand why the HEP is necessary or else they will not do it

21. HEP Keep it Simple Limit to 3 exercises Can add on extra exercises as patient progresses Always put it in writing to help patient remember (7 th -8 th grade level, but 5 th grade level for someone with low health literacy) Use large, easy to read type Use simple pictures or diagrams

22. HEP Specifications to Include Frequency = number of times per day E.g. once a day or twice a day Repetitions = number of exercises trials to do each time they exercise E.g. 2 sets of 10 Duration = number of days of performance E.g. daily for one week

23. HEP Contraindications / Precautions Provide specific and clear contraindications E.g. DON’T CONTINUE to exercise if leg becomes red, swollen or painful Provide specific and clear precautions E.g. do not raise your heart rate above 120 beats per minute E.g. hold on to a table for stability when balancing on one foot

24. HEP Be Available to Answer Questions Provide patient with: Work phone number Work fax number Work E-mail address Liability issue – you must respond to patient’s questions Avoid giving out home phone number, etc.

25. HEP Documentation Record exercises included in HEP in your daily note On HEP handout, include: Patient name Identifying information from facility PT name Exercises with specifications Contraindications and precautions

26. HEP Follow-Up Visit Have patient demonstrate exercises in HEP If performed correctly – okay If performed incorrectly -- modify

27. Assess your HEP Suitable? Feasible? Acceptable?

28. Assess your HEP Suitability Does it meet goals/objectives/purpose? Is it relevant to patient? Need both

29. Assess your HEP Feasibility Can they read it? (illiteracy vs poor vision) Size of print White space Cost Achievable?

30. Assess your HEP Feasibility Readability formulas – Flesh Reading Ease test, Gunning Fog index, SMOG 12 to 14 point font sizes Black letters on white background Bullets, headings, subheadings Plenty of white space Alignment on left side of page Interactive elements involving patient Short sentences, active voice

31. Assess your HEP Acceptability Amount of time? Willing to perform?

32. Sources for patient education Government documents Professional health organizations Commercial sources Human resources Web pages Video/DVD