The psychometric properties of a tool to assess brief behaviour change counselling in South Africa

Systematic review of observational coding systems to assess patient-healthcare professional interactions

OBJECTIVES

Systematic coding is used to study interactions between patients and healthcare professionals from an independent observer perspective. Many coding systems are available, but an up-to-date overview is lacking. We aimed to: (1) provide a comprehensive overview of systems for systematic coding of patient-healthcare professional interactions; and describe their 2) general characteristics and development, and 3) validation and adaptation.

METHODS

We systematically searched peer-reviewed empirical articles in five databases (Cochrane, Embase, PubMed/Medline, CINAHL, PsychINFO) using variations of the following keywords: (i) patient and/or other stakeholder, (ii) healthcare professional (iii), interactions in healthcare, (iv) coding tool, and (v) development and/or validation. All titles/abstracts and full-texts were screened independently and in duplicate. Additionally, coding systems were identified through an earlier review, an open-access research database, and a forward-reference search of all included coding systems up to that point. For all eligible systems, we extracted characteristics and psychometric properties.

RESULTS

From a total of 6950 identified articles from literature databases, 188 full-text articles were screened. Thirty-five articles were included from additional sources. In total, we included 124 articles describing 98 coding systems. Systems were highly variable in terms of topic (e.g., patient-centered communication, shared decision making, behavior change counseling), clinical context (e.g., oncology, pediatrics, generic), rigor of development and reporting, coding complexity, and extent of psychometric testing. Inter-rater reliability was reported for most coding systems; only few were tested for other types of reliability or for validity.

CONCLUSIONS

A plethora of coding systems are available, but more systematic reporting and psychometric testing are urgently needed to enhance evidence of validity. Testing may initially focus on the most relevant and broadly applicable coding systems.

PRACTICE IMPLICATIONS

These results can aid researchers in selecting the most suitable coding system for their purposes. Researchers may consider using or adapting existing systems, before developing new coding systems.

Evaluation of ImpENSA technology-enabled behaviour change module delivered to healthcare professionals in South Africa to improve micronutrient nutrition during the first 1000 days

Healthcare professionals (HCPs) have vital roles in providing evidence-based care to promote healthy micronutrient nutrition in early life. Providing such care requires scalable training to strengthen knowledge and confident application of effective behaviour change skills. Among 33 public and private HCPs (primarily dietitians) in South Africa, we evaluated the behaviour change aspects of a technology-enabled National Qualification Sub-Framework level 6 programme, Improving Early Nutrition and Health in South Africa ('ImpENSA'). This programme comprises two self-directed micronutrient and behaviour change knowledge-based eLearning and one facilitated online practical skills modules to improve maternal and infant micronutrient nutrition. Using assessments, questionnaires and interviews, we collected data at baseline, after module completion and at 3-month follow-up after programme completion. Questionnaire and interview data showed major improvements in understanding of and attitudes towards person-centred behaviour change support immediately following the eLearning module on behaviour change. The assessment pass rate increased from 38% at baseline to 88% postmodule, demonstrating significant knowledge gain in behaviour change support. Intention to change practice towards a person-centred approach was high and many had already started implementing changes. Three months postprogramme, support was centred around patients' needs. Open relationships with patients, improved patient outcomes and increased job satisfaction were among reported outcomes. Many reported becoming better change facilitators and reflective practitioners. Additional improvements in understanding and attitudes to behaviour change support were evident, reinforced by making changes and experiencing positive outcomes. The findings suggest that technology-enabled learning can equip HCPs with knowledge and skills to effectively support behaviour change for healthy micronutrient nutrition during pregnancy and infancy.

An approach to persons who are not willing to engage in behavioural change

With its unique position, primary health care (PHC) can provide health promotion and prevention services, including lifestyle behavioural counselling. Unhealthy lifestyle behaviours are very prevalent among patients attending PHC, with many patients unwilling to change or in the precontemplation stage. While patients in the contemplation stage are better managed using the 5As approach of motivational interviewing counselling, those unwilling or not ready for change necessitate a different approach, such as the 5Rs of motivational interviewing (MI) counselling. The 5Rs MI approach holds promise in motivating unwilling individuals to consider embarking on the journey of behavioural change. The 5Rs approach is not a stand-alone checklist of tasks implemented in isolation but is best integrated within a theoretical behavioural change framework. Of the four health-related behavioural change theoretical frameworks that are frequently used, the transtheoretical stages of the change model are the most used. This continued professional development article provides a summary review of the literature on behavioural change theories as they apply to lifestyle health behaviour change and presents the 5Rs approach as a feasible and practical approach to manage patients who are unwilling to change or in the precontemplation stage. This offers a beacon of hope for improved patient outcomes in a PHC system saddled with high prevalence of modifiable unhealthy lifestyle behaviours.

Undergraduate teaching in family medicine within the PRIMAFAMED network

No abstract available.