Nurse Practitioners' Use of Communication Techniques: Results of a Maryland Oral Health Literacy Survey

A cross-sectional survey study on the use of communication methods in the dentist-geriatric patient relationship

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The Influence of Robot-Assisted Learning System on Health Literacy and Learning Perception

Healthy aging is a new challenge for the world. Therefore, health literacy education is a key issue in the current health care field. This research has developed a robot-assisted learning system to explore the possibility of significantly improving health literacy and learning perception through interaction with robots. In particular, this study adopted an experimental design, in which the experiment lasted for 90 min. A total of 60 participants over the age of 50 were randomly assigned to different learning modes. The RobotLS group learned by interacting with robots, while the VideoLS group watched health education videos on a tablet computer. The content dealt with hypertension related issues. This study used the European Health Literacy Survey Questionnaire (HLS-EU-Q16), Health Knowledge Questionnaire, Reduced Instructional Materials Motivation Survey (RIMMS), and Flow Scale as evaluation tools. The result shows no significant difference in the pre-test scores between the two groups. Compared with the video-assisted learning system, the robot-assisted learning system can significantly improve health knowledge, health literacy, learning motivation, and flow perception. According to the findings of this study, a robot-assisted learning system can be introduced in the future into homes and care institutions to enhance the health literacy of the elderly.

Barriers and Facilitators to Promoting Oral Health Literacy and Patient Communication among Dental Providers in California

Studies demonstrate that dental providers value effective provider-patient communication but use few recommended communication techniques. This study explored perspectives of California dental providers and oral health literacy experts in the United States on use of communication techniques. We conducted a qualitative key informant interview study with 50 participants between November 2019 and March 2020, including 44 dental providers (dentists, hygienists, and assistants) in public or private practice in California and 6 oral health literacy (OHL) experts. We undertook thematic analysis of interview transcripts and descriptive statistics about interviewees from pre-surveys. Dental providers reported frequently speaking slowly, and using simple language and models/radiographs to communicate with patients, while infrequently using interpretation/translation, illustrations, teach-back, or motivational interviewing. Providers reported using only 6 of the 18 American Medical Association's (AMA) recommended communication techniques and only 3 of the 7 AMA's basic communication techniques. A majority of providers indicated using one of five oral health assessment and educational strategies. Key barriers to effective communication included limited time, financial incentives promoting treatment over prevention, lack of OHL training, limited plain-language patient education materials, and patients with low OHL knowledge. Dental organizations should prioritize supporting dental providers in effective patient communication practices. Standardizing OHL continuing education, creating an evidence-based OHL toolkit for dental teams, ensuring accessible interpretation/translation services, and incentivizing dental providers to deliver education could improve oral health literacy and outcomes.

Nurses' Perspectives on Health Education and Health Literacy of Older Patients

In the context of population aging, enhancing the health of older patients has become an urgent issue for public health. Health education and health literacy need to be further understood from the healthcare providers’ standpoint to increase older patients’ effective application of such information into their daily lives. We aimed to further understand nurses’ perspectives on the education of older patients and their health literacy, as nurses are one of the frontline providers interacting with older patients. In total, 16 nurses and nurse practitioners who had 5 or more years of clinical experience participated. Data were collected via face-to-face interviews and emails. Data analysis followed the thematic analysis suggested by Braun and Clarke. Five themes emerged from the analysis, as follows: attitudes that are hard to change; physical and cognitive functional barriers to understanding teaching materials; family caregivers—surrogate vs. gatekeeper; major contexts that moderate the elderly’s health literacy; and strategies to enhance teaching effectiveness and health literacy. These findings illustrate the conditions pertinent to communication with older adults from the patients’, providers’ and healthcare delivery viewpoints. Systemic assistance and interventions specialized for older patients and their healthcare providers need to be developed and tested to improve clinical practice and patient health literacy.

Midwives' self-reported knowledge and skills to assess and promote maternal health literacy: A national cross-sectional survey

BACKGROUND

Little is known about midwives' knowledge and skills to assess and promote maternal health literacy.

AIMS

To test the reliability and validity of a new tool to assess midwives' health literacy knowledge, skills and attitudes.

METHODS

Using a cross-sectional design, midwives were recruited through professional and social media networks. The online survey included demographic and professional questions and a new measure on midwives' health literacy knowledge, skills and attitudes. Convergent validity was assessed using ten items from the Caring Assessment Scale. Perceived barriers to promoting maternal health literacy were sought.

FINDINGS

Three hundred and seven participants completed the survey. A two-factor solution accounted for 41% of variance and resulted in 14 items, including all attitude items, being removed. Cronbach's alpha reliability was acceptable (Skills=.76; Knowledge=.66). Convergent validity was established. Most midwives (77.1%, n=221) reported giving limited attention to formally assessing women's health literacy. Between 30 to 60% of midwives never or only sometimes used specific techniques to promote maternal health literacy. Most (75%, n=201) had not received education about health literacy.

DISCUSSION AND CONCLUSIONS

The new Transforming Maternity Care Collaborative Health Literacy tool was valid and reliable. Few midwives formally assessed or promoted women's health literacy. Midwives require education about maternal health literacy assessment and promotion to ensure women understand information being conveyed. A large national survey of midwives using the new tool is recommended.

Communication Skills Training for Surgical Inpatient Advanced Practice Providers in an Academic Health-Care System

BACKGROUND

Good communication skills enhance the patient experience, clinical outcomes, and patient satisfaction.

OBJECTIVE

A course was developed by an interdisciplinary team (surgeon, nurse practitioner, and nurse MBA) for advanced practice providers (APPs) working for the department of surgery-a mix of practice and hospital-employed professionals-to enhance communications skills in an inpatient setting.

METHODS

Current concepts on provider-patient communication were discussed. Participants also asked to view and critique a video "provider-patient communication gone wrong" scenario. Lastly, participants were provided with techniques for improving provider-patient communication. The participants assessed the course. Provider communication scores were tracked from quarter 1, Fiscal Year 2014 to quarter 4 Fiscal Year 2017.

RESULTS

Of 110 eligible APPs, 95 (86%) attended the course. The anonymous survey response rate was 90% (86/95). Participants expressed satisfaction with the course content confirmed by Likert score weighted averages of >4.6/5 in all 8 domains. Communication scores increased with time.

CONCLUSION

An interdisciplinary course aimed at enhancing provider-patient communication skills was well-received by the APP participants. The course was part of ongoing system-wide efforts to improve patient experiences, satisfaction, and outcomes. Continuing education in communication continues to play a key role in improving clinical outcomes and patient satisfaction.

Learning programmes and teaching techniques to enhance oral health literacy or patient-centred communication for healthcare providers: A systematic review

OBJECTIVE

To investigate the learning programmes and teaching techniques used in interventions to enhance oral health literacy (OHL) or patient-centred communication (PCC) for healthcare providers.

MATERIALS AND METHODS

A systematic review of OHL and PCC were obtained from four electronic databases (PubMed, ScienceDirect, ProQuest and Scopus) was undertaken. These searches covered the period from January 2008 to December 2017. The quality assessment tool was the Joanna Briggs Institute Critical Appraisal tool for systematic reviews of effectiveness.

RESULTS

The final review included nine studies amongst a total of 1475 studies. They showed three learning programmes (workshops, training and community-based rotation) and 17 related teaching techniques to promote OHL and PCC. The most commonly used learning programmes to enhance OHL and PCC for healthcare providers were workshops, and the teaching techniques included feedback and reflection. The intervention periods of the programmes took 20 minutes to half a day. The three studies did not have a follow-up, whilst the rest showed a follow-up range of 2 months to 3 years. Interestingly, there was one study, which applied double follow-ups to show the effectiveness of the programme.

CONCLUSION

Either workshops or training programmes with a combination of teaching techniques were effective in terms of enhancing their OHL or PCC. The more frequent follow-up might increase the long-term effectiveness of the learning programme.

The HLKES-2: Revision and Evaluation of the Health Literacy Knowledge and Experiences Survey

BACKGROUND

Low health literacy impacts individual health and the health care system. The Health Literacy Knowledge and Experience Survey (HLKES) was created to evaluate preparedness of nurses to provide health literate care. However, the instrument was developed a decade ago and needs revision. The purpose of this study was to update and shorten the HLKES into a feasible, valid, and reliable instrument.

METHOD

The HLKES was refined into a 14-item instrument (10 knowledge questions and four experience questions). Expert review was obtained. Face validity was assessed, and pilot and field testing with students was conducted.

RESULTS

Scale content validity index was 0.95, and individual questions demonstrated appropriate item difficulty and discrimination. Cronbach's alpha coefficient was .565 for the 10 multiple choice questions and .843 for the four Likert-type questions, indicating good reliability.

CONCLUSION

A reliable and valid HLKES-2 was developed to evaluate health literacy knowledge and experiences in a contemporary setting. [J Nurs Educ. 2019;58(2):86-92.].

Use of Recommended Communication Techniques by Diabetes Educators

Background:

Diabetes educators are challenged to teach diabetes self-management to patients, ensuring comprehension. Effectiveness with patients may be dependent on the communication skills of the diabetes educator.

Objective:

This study sought to determine diabetes educators' use of and perceived effectiveness of recommended communication techniques with patients to teach diabetes self-management and to determine differences in communication by educator characteristics.

Methods:

In this cross-sectional study, a convenience sample of 522 diabetes educators, comprised mostly of nurses, dieticians, and pharmacists, completed the American Medical Association (AMA) Communication Techniques Survey at a national conference. The AMA survey assessed diabetes educators' self-reported use of and perceived effectiveness of 14 communication techniques. Internal consistency for items reporting frequency of communication techniques was α = 0.83 and for items reporting perceived effectiveness was α = 0.87.

Key Results:

Simple language, written patient education materials, and using Teach-Back were the most frequently reported techniques. Follow-up phone calls and drawing pictures were the least reported. Educators of Hispanic ethnicity used significantly more communication techniques than Caucasian respondents (p < .05). Educators with more than 16 years in practice and those who provided more than 16 hours of diabetes education per week used significantly more techniques than those with less experience (p < .01). Nurses used significantly more techniques than dieticians (p < .01) and those who had health literacy or communication as part of their schooling used more techniques than those who did not (p < .05). No significant difference on the routine use of communication techniques was found by education level or diabetes educator certification status.

Conclusions:

The findings provide a baseline assessment of diabetes educator communication practice. Inclusion of health literacy and communication in health professional school curricula appears to support competency, suggesting opportunities for inter-professional health literacy and communication education and research. [Health Literacy Research and Practice. 2017;1(4):e145–e152.]

Plain Language Summary:

We did a survey asking diabetes educators how they communicate with their patients with diabetes. They mostly used simple language, gave out pamphlets, and used Teach-Back. They did not draw pictures to help explain things. Diabetes educators who were Hispanic, nurses, and had health literacy training in school used more communication techniques. Health literacy and communication should be included in training of health providers.

The AMA Communication Techniques Survey: A Psychometric Analysis

BACKGROUND

Health care providers are continually seeking to improve patient communication to improve patient outcomes. The American Medical Association (AMA) developed a set of recommended communication practices and an instrument to evaluate health care providers' use of and perceived effectiveness of these techniques.

OBJECTIVE

The purpose of the study was to assess factor structure of the AMA Communication Techniques Survey using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to evaluate reliability of the instrument among nurses and allied health professionals who provide diabetes education.

METHODS

A national convenience sample of 522 diabetes educators completed the survey; this sample was split into two subsamples-the EFA (n = 302) and CFA (n = 220). Of this sample, 60.2% (n = 314) were nurses. Factor structure and reliability analysis of the AMA Communication Techniques Survey was conducted.

KEY RESULTS

EFA with varimax rotation revealed two internally consistent subscales labeled basic and advanced communication techniques. CFA determined that basic and advanced technique subscales were a good fit for the factors. Basic techniques included items such as speaking slowly and using simple words. Advanced techniques included the Teach-Back method, underlining words in printed materials, and presenting 2 to 3 concepts at a time. The Cronbach's alpha coefficient for the total scale was .81 and .70 (basic subscale) and .74 (advanced subscale), indicating good reliability.

CONCLUSIONS

The AMA Communication Techniques Survey appears to be a valid and reliable instrument to examine communication practices of diabetes educators. Additionally, EFA confirms previously hypothesized basic and advanced subscales. However, the factors included in each scale differ from previous conceptualization. [Health Literacy Research and Practice. 2017;1(4):e208-e215.].

PLAIN LANGUAGE SUMMARY

This study established reliability and validity for the American Medical Association Communication Technqiues Survey among diabetes educators. Data support the creation of two separate groups of items: basic and advanced techqniues.