Patient communication tools to enhance ART adherence counseling in low and high resource settings

Objective

Few articles have examined specific counseling tools used to increase antiretroviral therapy (ART) adherence. We present communication tools used in the context of Project MOTIV8, a randomized clinical trial.

Methods

We developed, piloted, and evaluated pictorial images to communicate the importance of consistent dose timing and the concept of drug resistance. Electronic drug monitoring (EDM) review was also used to provide visual feedback and facilitate problem solving discussions. Adherence knowledge of all participants (n = 204) was assessed at baseline and 48 weeks. Participant satisfaction with counseling was also assessed.

Results

Adherence knowledge did not differ at baseline, however, at 48 weeks, intervention participants demonstrated significantly increased knowledge compared to controls F(1, 172) = 10.76, p = 0.001 (12.4% increase among intervention participants and 1.8% decrease among controls). Counselors reported that the tools were well-received, and 80% of participants felt the counseling helped them adhere to their medications.

Conclusions

Counseling tools were both positively received and effective in increasing ART adherence knowledge among a diverse population.

Practice implications

While developed for research, these counseling tools can be implemented into clinical practice to help patients; particularly those with lower levels of education or limited abstract thinking skills to understand medical concepts related to ART adherence.     

The effect of using standardized patients or peer role play on ratings of undergraduate communication training: a randomized controlled trial

Objectives

Considering the expense of standardized patients (SP) for training communication skills and the convenience of peer role playing (RP) there is a surprising lack of studies directly comparing the two methods.

Methods

Fifth year medical students (N = 103) were assigned to three groups receiving a training in counseling parents of sick children with RP (N = 34) or SP (N = 35) or to a control group (CG, N = 34). We assessed self-efficacy, as well as objective performance in parent–physician communication using questionnaires and the Calgary-Cambridge-Observation-Guide Checklist in a six-station OSCE, respectively.

Results

The training led to an increase in self-efficacy ratings and in the post-intervention OSCE score after RP (p < .021 and p < .001 respectively) and SP-training (p < .007 and p < .006 respectively) compared to controls. Surprisingly, this benefit was higher after RP than after SP-training (p < .021) due to significantly higher performance in the domain understanding of parents’ perspective (p < .001).

Conclusion

Both RP and SP are valuable tools for training specific communication skills. RP offer a methodological advantage in fostering empathy for patient perspectives.

Practice implications

Both peer-role-play and standardized patients hold specific benefits for communication training. Peer-role-play seems to foster a more empathic approach towards patients’ concerns justifying its prominent role in medical curricula.     

Does motivational interviewing counseling time influence HIV-positive persons’ self-efficacy to practice safer sex?

Objective

This study examined the impact of motivational interviewing (MI) counseling time on self-efficacy to practice safer sex for people living with HIV/AIDS (PLWHA).

Methods

In 4 month intervals we followed a cohort of 490 PLWHA for 12 months.We conducted hierarchical linear regression models to examine changes in safer sex self-efficacy when participants received zero, low to moderate (5–131 min) and high (132–320 min) doses of MI time. We conducted a similar analysis using number of counseling sessions as the predictor variable.

Results

Participants with low to moderate doses of MI counseling had 0.26 higher self-efficacy scores than participants with zero MI time (p = 0.01). Also, they had 0.26 lower self-efficacy scores than participants with high amounts of MI time (p = 0.04). Participants with high doses of MI had a 0.5 higher self-efficacy score than participants with zero amount of MI time (p < 0.0001). Participants who received 3–4 counseling sessions had 0.41 greater self-efficacy scores than participants who did not receive any sessions (p < 0.0001) but did not differ from participants receiving 1–2 sessions.

Conclusion

MI time is a key to enhancing safer sex self-efficacy among PLWHA.

Practice implications

Safer sex self-efficacy improves the more MI counseling time and sessions PLWHA receive.     

Training physicians in shared decision-making-Who can be reached and what is achieved?

Objective

To report on experiences with a general shared decision-making (SDM) physician training program offered to physicians throughout Germany.

Methods

This study enrolled 150 physicians in an 8-h SDM training program. Physicians were assessed with standardized instruments before and after training. Main variables of interest were physician professional attributes, personality characteristics, attitudes, measures of training success (quality rating, knowledge, competency ratings), and variables associated with training success.

Results

The SDM training obtained positive quality ratings, led to an amelioration in an objective SDM knowledge test (p < .001), and highly improved physicians’ confidence in their SDM competencies (p < 0.001). It attracted experienced, middle-aged (45 years), male and female (46%) physicians, mostly office-based (2/3) general practitioners and internists (2/3). Most physicians (94%) reported positive attitudes towards SDM. They were securely attached (63%) with predominant social career choice motives (46%). Physicians with personality characteristics clashing with the SDM concept benefited mostly from the training.

Conclusion

A voluntary SDM training program is attractive to practicing physicians and effective in increasing SDM-related confidence and knowledge.

Practice implications

Even physicians who are highly motivated to use SDM can improve their skills and benefit from SDM training. The dissemination of SDM training programs should be encouraged.     

Legumes and soy products consumption and functional disability in older women

Objectives

This study was to examine the association between frequency of legumes and soy products consumption and functional disability in older Korean women.

Study design

Cross-sectional study. Data came from the 2005 Korea National Health and Nutrition Examination Survey (KNHANES). Subjects were 562 women aged 65 years and older living in the community.

Main outcome measures

Frequency of legume consumption was obtained by using food frequency questionnaire and functional disability was assessed using the instrumental activities of daily living (IADL) and ADL scales. Poisson regression analyses were conducted to examine the association of frequency of legume and soy consumption with functional disability, controlling for covariates.

Results

Dietary intake of legumes and soy products was associated with a significantly reduced risk of IADL disability after controlling for potential risk factors (p = 0.002 for trend). Compared with women who consumed legumes and soy products <1 time per week, those who consumed ≥3 times per day had a reduced risk of IADL disability (prevalence ratio = 0.70; 95% confidence interval: 0.51–0.96). In contrast, legumes and soy products consumption was not significantly associated with ADL disability.

Conclusions

Frequent legumes and soy products consumption was inversely associated with IADL disability in older women. Further studies are needed to clarify the protective effect of legume consumption on functional disability in older people.     

Development and validation of the high blood pressure-focused health literacy scale

Objective

While the role of health literacy in chronic disease management is well documented, few intervention studies have been reported. A major barrier to designing and implementing such interventions is the lack of valid health literacy tools. This study developed and tested a novel health literacy scale for individuals with high blood pressure (HBP).

Methods

A two-step design process was used: In the construction phase, focus group studies and a literature review were conducted to generate a pool of items. The testing phase involved a psychometric evaluation and pilot-testing of the scale on hypertensive Korean Americans (n = 386). The end product was a HBP-health literacy scale (HBP-HLS) with two essential domains, print literacy and functional health literacy.

Results

Psychometric testing indicated that the scale was reliable (Kuder–Richardson-20 coefficient = 0.98), valid (content validity index ≥0.8), and significantly correlated with theoretically selected variables (education, r = 0.67, p < 0.01; HBP knowledge, r = 0.33, p < 0.01).

Conclusion

The HBP-HLS demonstrated its utility for evaluating HBP management interventions in the community setting.

Practice implications

Utilizing the HBP-HLS should be considered as a potential tool for improving health literacy and evaluating intervention studies in the context of HBP management.     

Validating the Medical Data Interpretation Test in a Dutch population

Objective

To validate the Dutch translation of the Medical Data Interpretation Test.

Methods

A test–retest design with a 2-week interval was used.

Results

The intraclass correlation coefficient (ICC = .82), the limits-of-agreement interval (LOA = −8.96 to 2.48) and the test–retest reliability (Pearson's r = 86) suggest that the Dutch translation has good reproducibility. Construct validity was tested by two hypotheses, both of which were confirmed. University participants had higher test scores than non-university participants (p = .02), and males did not score differently than females (p = .61).

Conclusion

The results suggest that the Dutch version of the Medical Data Interpretation Test is an adequate scale to assess ability to interpret medical data.

Practice implications

Assessing patients’ numeracy skills before a counseling session will enable the counselor to adjust subsequent communication accordingly and, as such, improve the session's effectiveness.     

Optimizing acceptability and feasibility of an evidence-based behavioral intervention for obese adults with obesity-related co-morbidities or additional risk factors for co-morbidities: an open-pilot intervention study in secondary care

Objective

To test and optimize the feasibility and acceptability of a physical activity (PA) and healthy eating behavior change intervention for obese adults with obesity-related co-morbidities or additional risk factors for co-morbidities.

Methods

Open-pilot intervention study using an uncontrolled pre and post design with ongoing measures on intervention acceptability and feasibility. Participants received 5 weekly nurse-led one-hour long group sessions. Acceptability and feasibility were assessed throughout. PA, dietary behavior and weight were measured before and after the intervention.

Results

Of 74 consenting participants, 61 (82%) received and 47 (64%) completed the intervention. Average ratings of intervention materials and components by participants ranged between 4.1 and 4.9 out of 5. Average facilitator satisfaction rating was 90% (range 75–100%). The intervention delivery was feasible as indicated by ratings and comments from participants and the facilitator. Participants lost −0.86 kg of weight t(45) = 3.84, p = 0.0001, and increased PA by an additional 1.6 (SD = 2.7) sessions/week, t(31) = −3.3, p = 0.002. No significant dietary differences emerged.

Conclusion

The intervention was acceptable to the facilitator and participants and feasible for delivery. Several intervention aspects were further optimized.

Practice implications

The current study outlines a PA and dietary behavior change pilot intervention coupled with a systematic and transparent process of intervention optimization.     

Training medical students to conduct motivational interviewing: a randomized controlled trial

Objective

To examine the effectiveness of motivational interviewing (MI) training among medical students.

Methods

All students (n = 131) (year 5) at Lausanne Medical School, Switzerland were randomized into an experimental or a control group. After a training in basic communication skills (control condition), an 8-h MI training was completed by 84.8% students in the exprimental group. One week later, students in both groups were invited to meet with two standardized patients. MI skills were coded by blinded research assistants using the Motivational Interviewing Treatment Integrity 3.0.

Results

Superior MI performance was shown for trained versus control students, as demonstrated by higher scores for “Empathy” [p < 0.001] and “MI Spirit” [p < 0.001]. Scores were similar between groups for “Direction”, indicating that students in both groups invited the patient to talk about behavior change. Behavior counts assessment demonstrated better performance in MI in trained versus untrained students regarding occurences of MI-adherent behavior [p < 0.001], MI non-adherent behavior [p < 0.001], Closed questions [p < 0.001], Open questions [p = 0.001], simple reflections [p = 0.03], and Complex reflections [p < 0.001]. Occurrences were similar between groups regarding “Giving information”.

Conclusion

An 8-h training workshop was associated with improved MI performance.

Practice implications

These findings lend support for the implementation of MI training in medical schools.     

Maintenance of lifestyle changes: 3-year results of the Groningen Overweight and Lifestyle study

Objective

This study aims to evaluate the three-year effect of lifestyle counseling by a nurse practitioner (NP) on physical activity (PA) and dietary intake compared with usual care by a general practitioner (GP).

Methods

At baseline, subjects were randomly allocated to the NP group (n = 225) or to the GP group (n = 232). The NP group received a low-intensive lifestyle intervention for three years by the NP and the GP group received one consultation by the GP and thereafter usual care. PA and dietary intake were assessed with questionnaires at baseline, 1 year follow-up and 3 year follow-up.

Results

After three years, leisure-time activity increased and favorable improvements towards a healthy diet were made for both groups. These three-year changes in PA and diet did not differ significantly between groups. Changes in PA and dietary habits after one year were practically maintained after 3 years, because only small relapses were found.

Conclusion

After three years, subjects were more physically active and had a healthier diet compared to baseline. Lifestyle counseling by NP resulted in similar lifestyle changes compared to GP consultation.

Practice implications

NPs could also advice patients at cardiovascular risk by lifestyle counseling, to possibly reduce GP barriers.     

Factors affecting frequency of communication about family health history with family members and doctors in a medically underserved population

Objective

Family history contributes to risk for many common chronic diseases. Little research has investigated patient factors affecting communication of this information.

Methods

1061 adult community health center patients were surveyed. We examined factors related to frequency of discussions about family health history (FHH) with family members and doctors.

Results

Patients who talked frequently with family members about FHH were more likely to report a family history of cancer (p = .012) and heart disease (p < .001), seek health information frequently in newspapers (p < .001) and in general (p < .001), and be female (p < .001). Patients who talked frequently with doctors about FHH were more likely to report a family history of heart disease (p = .011), meet physical activity recommendations (p = .022), seek health information frequently in newspapers (p < .001) and in general (p < .001), be female (p < .001), and not have experienced racial discrimination in healthcare (p < .001).

Conclusion

Patients with a family history of some diseases, those not meeting physical activity recommendations, and those who do not frequently seek health information may not have ongoing FHH discussions.

Practice implications

Interventions are needed to encourage providers to update patients’ family histories systematically and assist patients in initiating FHH conversations in order to use this information for disease prevention and control.     

The development and preliminary testing of a multimedia patient-provider survivorship communication module for breast cancer survivors

Objective

This paper describes the development of a theory-guided and evidence-based multimedia training module to facilitate breast cancer survivors’ preparedness for effective communication with their health care providers after active treatment.

Methods

The iterative developmental process used included: (1) theory and evidence-based content development and vetting; (2) user testing; (3) usability testing; and (4) participant module utilization.

Results

Formative evaluation of the training module prototype occurred through user testing (n = 12), resulting in modification of the content and layout. Usability testing (n = 10) was employed to improve module functionality. Preliminary web usage data (n = 256, mean age = 53, 94.5% White, 75% college graduate and above) showed that 59% of the participants accessed the communication module, for an average of 7 min per login.

Conclusion

The iterative developmental process was informative in enhancing the relevance of the communication module. Preliminary web usage results demonstrate the potential feasibility of such a program.

Practice implications

Our study demonstrates survivors’ openness to the use of a web-based communication skills training module and outlines a systematic iterative user and interface program development and testing process, which can serve as a prototype for others considering such an approach.     

Communicating quality of care information to physicians: a study of eight presentation formats

Objective

Non-hospital based physicians usually counsel their patients which hospital to choose. Our aim was to determine which formats for presenting quality of care data are preferred by physicians.

Methods

300 randomly recruited non-hospital based physicians participated in a survey. We created eight presentation formats which varied in terms of information aggregation and usage of evaluative cues. Participants rated clarity, comprehensibility, information content, acceptance, and preference of the presentation formats. Additionally, we tested physicians’ comprehension of the formats.

Results

Physicians’ ratings of the formats differed significantly (p < 0.001). Formats combining numeric information and evaluative cues performed best in terms of information content, comprehensibility and preference. Comprehension of presentation formats also differed (p < 0.001). Even though physicians’ accuracy of interpreting “Simple Star Rating” was best a majority of participants accepted only formats that contained detailed numerical information (p < 0.001).

Conclusion

In order to support physicians’ use of quality of care information in counseling patients, report cards should depict indicator values in a format that combines actual indicator values with evaluative cues.

Practice implications

If authors of comparative hospital quality reports apply the results of our study in designing reports, the results may increase physicians’ use of comparative performance reports in their counseling of patients.     

Sleep quality and aerobic training among menopausal women--a randomized controlled trial

Background

Menopause is associated with poor sleep quality and daytime sleepiness, which may lead to impaired quality of life and impaired functioning in daily activities.

Objective

To study whether exercise training improves sleep quality or decreases the amount of night time hot flushes among menopausal women with vasomotor symptoms.

Study design

A randomized controlled trial. Sedentary women (N = 176) aged 43–63 years with menopausal symptoms were randomized to a six-month unsupervised aerobic training intervention (50 min 4 times per week) or a control group. Both groups attended lectures on physical activity and health once a month.

Main outcome measures

Sleep quality and the amount of hot flushes disturbing sleep. The women reported daily via mobile phone whether hot flushes had disturbed their sleep and how they had slept (scale 1–5). Responses received by mobile phone over the 6-month period totaled on average 125 (5.2 per week) responses per participant.

Results

At baseline there was no difference between the groups in the demographic variables. Sleep quality improved significantly more in the intervention group than in the control group (OR 1.02; 95% CI = 1.0–1.05, p = 0.043). The odds for sleep improvement were 2% per week in the intervention group and a decrease of 0.5% per week in the control group. The amount of hot flushes related to sleep diminished (p = 0.004) by the end of the intervention.

Conclusions

Aerobic training for 6 months may improve sleep quality and reduce hot flushes among symptomatic menopausal women.     

Family communication as strategy in diabetes prevention: an observational study in families with Dutch and Surinamese South-Asian ancestry

Objective

To explore the possibility of utilizing family communication as a diabetes prevention strategy, specifically targeting high-risk families with South-Asian ancestry in the Netherlands.

Methods

In a cross-sectional study, type 2 diabetes patients from Dutch (n = 311) and Surinamese South-Asian (n = 157) origin filled in a questionnaire assessing socio-demographic characteristics, beliefs and concerns about familial diabetes risk, primary prevention, and diabetes-related family communication.

Results

Discussing diabetes is regarded acceptable in most families. Especially Surinamese South-Asian patients (68%) seemed motivated to convey risk messages to their relatives; they reported a higher risk perception and expressed more concern than Dutch patients. While 40% in both groups thought relatives are able to prevent developing diabetes, 46% in Dutch and 33% in Surinamese South-Asian patients were unsure.

Conclusion

Promoting family communication appears a feasible strategy in diabetes prevention in high-risk (Surinamese South-Asian) families. Health care providers should address patients’ concern and emphasize opportunities for prevention.

Practice implications

Findings favor training of clinicians in utilizing a family approach as prevention strategy. Patients (particularly Surinamese South-Asians) are in need of professional help in the process of family risk disclosure. (Online) Educational tools should be made available at which patients can refer their relatives.     

The impact of patient and physician computer mediated communication skill training on reported communication and patient satisfaction

Objective

The objective was to evaluate parallel patient and physician computer-mediated communication skill training on participants’ report of skill use and patient satisfaction.

Methods

Separate patient and clinician web-tools comprised of over 500, 10-s video clips demonstrating patient-centered skills in various ways. Four clinician members of the American Academy of Family Physicians National Research Network participated by enrolling 194 patients into a randomized patient trial and 29 physicians into a non-randomized clinician trial of respective interventions. All participants completed baseline and follow-up self-report measures of visit communication and satisfaction.

Results

Intervention patients reported using more skills than controls in five of six skill areas, including identification of problems/concerns, information exchange, treatment adherence, shared decision-making and interpersonal rapport (all p < .05); post intervention, physicians reported using more skills in the same 5 areas (all p < .01). Intervention group patients reported higher levels of satisfaction than controls in five of six domains (all p < .05).

Conclusion

Communication skill training delivered in a computer mediated format had a positive and parallel impact on both patient and clinician reported use of patient-centered communication and in patient satisfaction.

Practice Implications

Computer-mediated interventions are cost and time effective thereby increasing patient and clinician willingness to undertake training.     

Iodine deficiency influences thyroid autoimmunity in old age--a comparative population-based study

Objective

To assess thyroid autoimmunity among elderly people living in an area with low iodine intake compared to the sustained recommended iodine intake from a natural source, and to estimate the importance of migration.

Design and setting

Iodine content of drinking water is highly different in the Danish towns Randers and Skagen. We collected blood and spot urine samples from 430 long-term Randers and Skagen dwellers aged 75–80 years, who filled in a questionnaire. We measured thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) in serum and iodine and creatinine in urine.

Results

Participation rate was 47% (n = 212 (men/women 82/130) in Randers; 218 (84/134) in Skagen). Iodine deficiency prevailed in Randers while Skagen dwellers were iodine replete (median urinary iodine 74 μg/24 h vs. 184 μg/24 h, p < 0.001). Thyroid antibodies were more frequent in Randers than in Skagen residents (42% vs. 32%; p = 0.006) and more likely with iodine excretion <50 μg/24 h (OR, 95%CI: 1.9, 1.1–3.4). Differences between towns increased with longer duration of residence as trends in the occurrence of TGAb and TPOAb were opposite (p < 0.001; p = 0.007).

Conclusions

Thyroid autoantibodies were common in old age, influenced by the iodine intake level, and the lowest frequency was found at the recommended iodine intake level.     

Self-management abilities, physical health and depressive symptoms among patients with cardiovascular diseases, chronic obstructive pulmonary disease, and diabetes

Objective

This study aimed to identify the predictive role of direct resources (educational level and marital status) and self-management abilities on physical health and depressive symptoms in patients with cardiovascular diseases (CVD), diabetes, or chronic obstructive pulmonary disease (COPD).

Methods

Our cross-sectional questionnaire-based study included 1570 CVD patients, 917 COPD patients, and 412 patients with diabetes.

Results

Physical health and depressive symptoms of COPD patients was lower than those of CVD and diabetic patients. Correlation analyses indicated that self-management abilities were strong indicators for physical health and depressive symptoms (all p < 0.001). This relationship was strongest for depressive symptoms. Self-management abilities were related to educational level in all groups (all p < 0.001). Regression analyses revealed that self-management abilities were strong predictors of physical health and depressive symptoms in all three patient groups (all p < 0.001).

Conclusion

This research showed that self-management abilities are strong predictors of physical health and depressive symptoms.

Practice implications

Interventions that improve self-management abilities may counteract a decline in physical health and depressive symptoms. Such interventions may be important tools in the prevention of the loss of self-management abilities, because they may motivate people who are not yet experiencing serious problems.     

A cognitive behavior therapy-based intervention among poorly controlled adult type 1 diabetes patients—A randomized controlled trial

Objective

To examine the impact of a Cognitive Behavior Therapy (CBT)-based intervention on HbA_1c, self-care behaviors and psychosocial factors among poorly controlled adult type 1 diabetes patients.

Methods

Ninety-four type 1 diabetes patients were randomly assigned to either an intervention group or a control group. The intervention was based on CBT and was mainly delivered in group format, but individual sessions were also included. All subjects were provided with a continuous glucose monitoring system (CGMS) during two 3-day periods. HbA_1c, self-care behaviors and psychosocial factors were measured up to 48 weeks.

Results

Significant differences were observed with respect to HbA_1c (P < 0.05), well-being (P < 0.05), diabetes-related distress (P < 0.01), frequency of blood glucose testing (P < 0.05), avoidance of hypoglycemia (P < 0.01), perceived stress (P < 0.05), anxiety (P < 0.05) and depression (P < 0.05), all of which showed greater improvement in the intervention group compared with the control group. A significant difference (P < 0.05) was registered with respect to non-severe hypoglycemia, which yielded a higher score in the intervention group.

Conclusion

This CBT-based intervention appears to be a promising approach to diabetes self-management.

Practice implications

Diabetes care may benefit from applying tools commonly used in CBT. For further scientific evaluation in clinical practice, there is a need for specially educated diabetes care teams, trained in the current approach, as well as cooperation between diabetes care teams and psychologists trained in CBT.