Saudi Diploma in Family Medicine Center of Post Graduate Studies i n F amily M edicine

1. Patient Education Saudi Diploma in Family Medicine Center of Post Graduate Studies in Family Medicine Dr. Zekeriya Aktürk zekeriya.akturk@gmail.com www.aile.net / 28

2. Objectives • At the end of this session, the trainees should be able to: • Define the principles of patient education • Explain the integrated health behavior model • Explain the health behavior change model • Design and apply a health education / 28

3. USPSTF Recommendations • Tobacco use • Exercise • Nutrition • Traffic accidents • Home accidents and environmental injuries • Sexually transmitted diseases • Unwanted pregnancies • Oral health • … / 28

4. Timing • Doctor-patient relationship always includes patient education. • A good doctor HAS to be a good educator. • Patient education spreads throughout all levels of the consultation. / 28

5. Aims • Encourage patients to take responsibility of their health behaviors • Establish doctor-patient partnership • Doctor: health counselor • “First information then choice” / 28

6. Principles • Feed-back • Reinforcement • Individualization • Facilitation • Relevance • Using multiple channels of education / 28

7. Suggestions from the USPSTF • Establish a therapeutic relationship • Provide counseling to all patients • Ascertain that patient understands the relationship between behavior and health • Work with the patient to eliminate barriers to behavioral change • Include patients in the decision of which risk factor to change / 28

8. Use combined strategies • Prepare a behavioral change plan • Track the changes by follow-up visits • Include all your personnel / 28

9. The Integrated Health Behavior Model / 28

10. Health Behavior Change • Precontemplation: Not intending to take action in the foreseeable future, usually measured as the next 6 months. • Contemplation: Intending to change in the next 6 months; aware of the pros and cons of changing, leading to procrastination. • Preparation: Intending to take action in the immediate future, usually measured as the next month; have a plan. • Action: Have made specific overt modifications to behavior within the last 6 months. • Maintenance: Working to prevent relapse, increasing confidence; typically lasts 6 months to 5 years. • Termination: Zero temptation to relapse and 100% confidence in ability to maintain new behavior. / 28 From Prochaska JO, Velicer WF: The transtheoretical model of health behavior change. Am J Health Promot 12:38, 1997.

11. Good News! • Motivation is critical • “What would you like to do?” • “How about making a change?” • Giving information to a patient ready to change will motivate him/her for positive change. • For simple behaviours just simple reminders may be enough. Difficult changes such as diet may need special discussion sessions. / 28

12. Bad News! • Providing information and clues to patients without motivation is not useful • Health belief • Social support • Activity • MOTIVATION / 28

13. If Patient not Motivated • Leave open door • Give time • Determine aims and expectations of the patient • Determine wrong informaiton and beliefs and substitute with correct ones • Supports and barriers • family, social environment, occupation, income, working hours • Low personal benefit / 28

14. Education • Don’t blame, • Reward successes (even if small), • Be encouraging, • Some will never change; whatever your efforts.. / 28

15. Education • Individualize: • Assess the present knowledge. • Use material relevant to patients understanding. • Team work. / 28

16. Evaluate • Most commonly neglected part. • Don’t just give information and go!, • Determine personal needs, • Update the needs after evaluation, • Make a new planning..... Establish continuity. / 28

17. Planning of Patient Education • Who will participate? • Using verbal education • Using printed materials • Doing what is comfortable to ones self • Other materials and methods • Office design / 28

18. Who will participate? • Involve all team members: • Makes the education stronger, • Gives more time to the doctor. • Doctor: • Determines objectives of education, • Gives broad information on the importance of the objectives, • Determines which educational process to use, • Evaluateds the process. / 28

19. Who will participate? • According to the need, the doctor himself may provide the education or assign somebody else. • Education nurse, • The receptionist may provide relevant documents, • Other resources of the public may be utilized, • Public education centers, • Social services, • Voluntary organizations. • Patient education teams may be established in bigger organizations. / 28

20. Who will participate? • Patients should be evaluated with their families. • Family support will affect the success of educaitons. • In many occasions the partner should be involved as well. • Diet education needs the contribution of the one who cooks. • Caregivers of children and elderlies are direct targets of the education. / 28

21. Verbal education • The basis of education is established during the consultation. • Information should be approppriate. • The structure should be based on mutual expectations of the patient and educator. / 28

22. Verbal education • Should be non-judgmental and non-accusive, • Make clear that patient views are respected, • Be a team with the patient for a mutual aim. • Understand the beliefs, skills, readiness to change, and anxieties, • Low to medium anxiety will increase motivation; excessive anxiety may cause denial. / 28

23. Verbal education • Avoid medical jargon. • Use together with synonyms or avoid totally. • Use clear and understandable statements. • “decrease fat consumption”, “make more exercise”, “don't lift heavy objects”, “take your medicine three times a day” are inappropriate. • Ascertain the patient has understood you. • Encourage to ask questions. • Politely ask to repeat what was told. • Take over the fault of misunderstanding. / 28

24. Printed material • Used very frequently. • Wnated by patients. • Should be supported with verbal education in advance. / 28

25. Printed material • Before used; • Is the content appropriate?, • Understandability, • Easiness to onbtain and keep • Should be prepared according to the average level of the population. • Should be preferred in patients with well known edcucational level. / 28

26. Doing what is comfortable to yourself • You may control the content • Focus on maximum 3-4 points • Avoid medical terminology, statistics or scary expressions • Use short sentences, understandable words • Give open messages / 28

27. Other methods • Models • Maquettes, manikins • Tapes • Video • Computer • … / 28

28. Office design • Look to the office as a patient training center. • Educational materials in the waiting and examination rooms. • Posters on the walls. • Educational video in the waiting room. • Change the themes with some period. / 28