Effect of health education strategy on patient-physician discourse

Abstract

EFFECT OF HRALTH EDUCATION STRATECH ON PATIENT-PHYSICIAN DISCOURSE. Howard Schubiner. M.D., Susan Eggly, and Clarita Redley. Departments of Pediatrics and Internal Medicine, Wayne State University, Detroit, MI. There is evidence that patient participation in the health education (HE) process facilitates learning. This study investigates whether the strategies used in the delivery of HE to adolescent patients affect their participation. We examined the verbal discourse of HE in 30 videotaped adolescent-physician interviews. The tapes were reviewed far physician inquiries in 8 HE topics (seat belt use, drinking and driving, calcium intake, self exam, cigarette and alcohol use, am! contraceptive and condom use). Verbal exchanges during those inquiries were categorized into 7 internally consistent strategies (giving FACTS, giving OPINions, suggesting ALTernative strategies, soliciting QUEStions, telling PARables. exploring possible SOLutions. and posing HYPOthetical situations). The mean age of the patients was 19.3 (range 14-24). Of 240 possible HE opportunities (30 patients by 8 HE topics), 90 HE interactions occurred, generating 250 HE verbal exchanges (more than one exchange may occur per interaction). The table lists the number of verbal exchanges (N) and compares mean physician (DR) and patient (PT) time spent talking in each strategy in seconds (*-p<O.O5 by paired t-test).. FACT OPIN ALT QUES PAR -SOL HYPO N (250) 82 72 27 11 9 29 20 DR(sec) 16.6* 11.3* 15.3+ 6.5 ll.l* 8.4 5.1 PT(sec) 3.6 2.1 1.3 1.8 0.1 16.1 7.9 The ratio of the time spent talking by the patient versus the physician (PT/DR in seconds) for the first 5 listed strategies (considered to be unidirectional strategies) was compared to the last 2 strategies (bidirectional strategies) by a paired t-test. This ratio was 0.14 for the unidirectional strategies and 1.06 for the bidirectional strategies (p-0.004). These data indicate that bidirectional HE strategies encourage patient participation in the educational process.