Development and initial validation of an assessment tool for communication skills in dietetics

Abstract

Background: There is a growing interest in developing the communication skills of healthcare practitioners in order to promote health-related behaviour change (National Institute of Health and Clinical Excellence, 2007). Dietitians require a high level of communication skills and aim to build rapport with their patients to gain their trust and respect. A caring relationship involving active engagement, sharing and open communication is valued by clients as much as the clinical skills (Cant and Aroni, 2009). A difficulty with research in this area is assessing communication skills of dietitians because there are few validated tools available. This project is part of an ongoing research programme funded by Diabetes UK. The aim was to develop an evidence based, validated tool for the assessment of communication skills within dietetic patient consultations. Methods: Face validity was assessed by reviewing current tools in existence, the literature, tools used in undergraduate student training and via personal communication with experts in the field. Tools were mapped against each other and an item pool developed. Items were arranged in alignment with events in a routine dietetic consultation. Descriptors for each item were developed. Content validity was assessed by sending the resulting tool to an expert trainer for comment and revised. It was then sent to 31 dietitians with experience either with research in this area, facilitation of training courses for communication skills in dietetic consultations or assessment of students in practice. These people had relevant experience and may use such a tool but were independent from the research team. A questionnaire, descriptors and a DVD of a consultation were provided. Predictive validity was assessed by recruiting participants via five established post-registration communication skills training courses for dietitians. Information sheets were given and written consent was obtained. Participants completed a video recorded patient consultation before and after attending the course. Video recordings were assessed using the tool. Numerical results were inputted into SPSS for Windows, version 15 (SPSS Inc., Chicago, IL, USA) and paired t-tests were undertaken. Ethical approval was acquired from the University of Nottingham Medical School Ethics Committee. Results: Seventeen dietitians returned questionnaires commenting on the content validity of the tool. Fourteen considered that the tool included all of the key aspects of a dietetic consultation and 15 considered it had uses within dietetic practice. Changes required were minor wording changes to the tool and descriptors and a change in order of the items. Nine dietitians were assessed using the tool before and after a training course to look for predictive validity. A significant improvement in dietitians’ ability to listen to and demonstrate understanding of the client's story was found (P = 0.004) and also to summarise appropriately throughout the consultation (P = 0.04), although overall scores showed no significant change. Discussion: Preliminary results indicate that the assessment tool has content validity and may have some uses in future research into the role of communication skills in dietetic consultations. There was some evidence that the tool could predict changes in skill level following training in communication skills. Conclusions: An assessment tool for communication skills in dietetic consultations has been developed but work is required to further investigate validity and reliability of the tool.