You are on page 1of 73

Individual Patients,

Group & Community


Education
..Integral part of the
WHOlistic Healthcare Advocacy

CHALLENGES:
1.
2.
3.
4.

The need to educate in healthcare delivery


Discuss similarities/differences between patient
education and health teachings
Enumerate the patient education methods,
identify which of these is the most effective
Define the following terms:
a.
b.
c.
d.

Activated patient model


Informed patienthood
Behavioral Diagnosis
Educational-Behavioral Strategies

Our Goal
Better comprehension
about EFFECTIVE
PATIENT EDUCATION
and its application in
caring for the sick.

Objectives of patient education:


1. Acquire necessary skills about patient
education;
2. Develop and improve health literacy of patients;
3. Clarify equivocal or ambiguous advice and
medications instructions;
4. Empower patients in their participation to
clinical decision-making;
5. Enable patients to gain common procedural
skills in self-care;
6. Improve doctor-patient therapeutic relationship
through adherence to regimen and compliance
to medications.

Patient Education
..intrinsic to any specialty of medicine
..constitutes considerable portion of the time a
physician spends in caring for patients
According to studies, 19-41% of all direct patient
care time was devoted to patient education and
counseling activities
Bergman et all.,1966; Parrish et al.,1967; Hessel & Haggerty,1968;
Donaldson & London,1971.

What do clients reasonably


expect in clinical consultations?
Most patients expect:
Better understanding of the meaning of diagnosis,
cause and prognosis of the disease, and the
regimen.
Know the purpose of the laboratory and other tests
like radiographic or ultrasonographic examinations.
Be informed about the meaning of the signs and
symptoms elicited during the history and PE.
Physicians to illumine about their specific questions
and concerns.
Savings that result from disease prevention and
less hospitalization.

What do care providers expect


after a patient encounter?
Most physicians expect:
Patients satisfaction with the care they
receive
Active participation of their patients in
medical decision-making
Better adherence of their clients to the
preventive or therapeutic regimen

POOR COMPLIANCE or
NONADHERENCE

What must
be the
reasons?

POOR COMPLIANCE or
NONADHERENCE

scientific evidence and clinical

experiences

..indicate that non-adherence is influenced


by more than the patients
understanding of the facts about the
disease and regimen;

..a myriad of motivational, social, and


environmental factors are known to
come into play.

Expanded understanding about


PATIENT EDUCATION

not a simple process of increasing


the patients knowledge..
not only includes patient teaching
and other information
dissemination techniques, rather..
_a B R O A D RANGE of
other educational and

behavioral strategies.

Evidences that confirm the idea that


patient education improves adherence to
therapeutic regimen:

1. Hypertension (McKenny,1973;
Williamson et al.,1975;Inui,et al.,1976)

2. Asthma (Green,et

al.,1977; Maiman,et

al.,1979)

3. Streptococcal infections
(Linkewich,1974)

4. Diabetes (Miller and Goldstein,1972)


5. CHF (Rosenberg, 1971)

More recent studies


Patient-provider communication and
low-income adults: age, race,
literacy, and optimism predict
communication satisfaction
(Jenseen, King, Guntzviller and Davis, 2009)

Older, non-White, optimistic and literacy


deficient patients report greater patient
communication than their younger, White,
pessimistic and functionally literate peers.

PATIENT EDUCATION
METHODS
.. The PHYSICIANS
TEACHING STRATEGIES

Patient Education Methods

Most clinicians routinely use:


individual instruction,
demonstration, and instructional
aids.
Other effective methods are
available: group classes, peer
group discussions, and behavioral
modification.

Patient Education
METHODS
A.Individual Instruction
B.Instructional Aids
C.Demonstration
D.Group Classes
E. Peer Group Discussions
F. Behavior Modification

A. INDIVIDUAL
INSTRUCTION
Providing information and explanations to
the patient is an intrinsic part of the office
visit.
The physician provides instruction during
these encounters _course of history,
actual PE performance, and the
discussion of the diagnosis/regimen.

INDIVIDUAL INSTRUCTION
In dealing with individual patients
these principles for effective patient
teaching is applied:
Use unambiguous and appropriate
terminology
Be specific as possible
Provide the correct amount of
information, neither too little nor too
much.

..the principles
Use unambiguous and appropriate
terminology
Here are some commonly employed terms
and phrases which may mean differently to
some patients: esophagus, pills, under
control, monitor, explore lap, etc.
Convert medical terms to laymans
language whenever feasible.

..the principles
Be specific as possible
Do not say: you cut down on smoking, you watch
the sweets, take these capsules 3x a day

Instead say: try to decrease smoking to one


pack a day by the next time I see you,
please dont eat any sweet snacks this
week, take your prescribed medicines at
breakfast, lunch and dinnertime.

..the principles
Provide the correct amount of information,
neither too little nor too much.
Some enthusiastic clinicians undertake patient
education activities as they would approach a
lecture to third year medical students,
describing to the patients various pathophysiologic mechanisms and biochemical
pathways.
Asking the patient, Is there anything you would
like to know about your health condition? will
ensure that you do not undershoot the mark.

INDIVIDUAL Patient
INSTRUCTION
In simple terms, individual instruction
must be fitted to the patients need for
information considering his
demographics, socio-cultural background
and spiritual beliefs.
Putting into practice the preceding three
principles can lead to effective patient
teaching, thus_ the stronger adherence to
the regimen.

B. INSTRUCTIONAL
AIDS
Handwritten notes by the
physician(post-it or a small pad)
Leaflets and Pamphlets (from
voluntary agencies, pharmaceutical
industries, etc)
Others (models, audio-video
presentations from u-tubes,
simulated cases and role-plays)

INSTRUCTIONAL AIDS
this category includes a variety of audio and
visual techniques, such as pamphlets
anatomic models, posters in the waiting
room, and slide tape productions;
By definition, instructional aids are to
supplement, not as a replacement of the
verbal instructions given by the nurse or
physician himself.

INSTRUCTIONAL AIDS
Jotting down the regimen is
indicated at the following times:
Any new drug is prescribed
Any change in the dosage or schedule
of any medicine
If the patient is confused with the
regimen for any reason
Shifting of physicians with previous
prescriptions from the former

INSTRUCTIONAL AIDS
Many physicians have used the printed
materials from the pharmaceutical
companies or health agencies in addition
to materials that they themselves have
developed.
In recent years, a number of firms have
developed slide-tape programs or the
video presentations (x-plain.com)
accessible in the web.
At any rate, these instructional aids must
not interfere with the patient-physician
relationship.

C. ACTUAL Skills
DEMONSTRATION
This method is used to teach psychomotor
skills to patients
Breast self-examination
Self injection of insulin
Use of inhalers
Wound dressings at home
Eyedrop or topical dermatologic
applications
The see one, do one, teach one dictum
applies here.
Simply handling out a pamphlet is not
sufficient

D. GROUP CLASSES
These have been employed widely for
prenatal education and more recently for
community-wide health promotion
activities in nutrition, exercise, and the
like.
The classes generally consist of a
didactic lecture followed by a question
and answer period.
It may be given by the physician, nurse,
health education specialist, or
nutritionist.

GROUP CLASSES
More work needs to go into the planning
and publicity for a class than into
individual teaching.
It is helpful to write out formal behavioral
objectives. Examples: participants must
be able to demonstrate conscious
breathing, do stretching exercises,
monitor their blood sugar with the use of
handy glucometers, specimen collection
for lab exams, etc.
Instructional aids are useful in
conjunction with group classes.

E. PEER GROUP
DISCUSSIONS
The health professional serves

primarily as a friendly and pertinent


facilitator of the groups interaction and
not as an obstrusive provider of
information.
The recommended sitting pattern is
circular and._the educational
experience consist of the participants
sharing of experiences and methods of
coping for illness.

PEER GROUP DISCUSSIONS


PGD or SGD is indicated when the
behavioral diagnosis is suggestive of
the patients lack of motivation or
confidence in his or her ability to
manage the condition.
PGD have been used effectively for
patients with asthma, or hypertension
and for those attempting to quit
smoking.

PEER GROUP DISCUSSIONS


Facilitating a group discussion requires
more advanced skills.
The skills can be acquired thru a
combination of relevant training,
participation as a member of such a
group, and appropriate readings
Peer discussions have been documented
in some studies to be exceptionally
effective patient education method
(Green,et al.,1977; Levine et al.,1979, Hughes et al.,1981)

F. BEHAVIOR
MODIFICATION
Behavior Modification particularly
refers to those methods developed
by behavioral psychology.
The techniques are utilized more
often in psychiatric care but have
considerable relevance to patient
education, particularly preventive
health education(Pomerleau,1975).

BEHAVIOR MODIFICATION
Before a care provider appropriately
assist a patient to transform health
behavior, he must first attempt to
understand and diagnose what
behavior needs to be changed_ the
Behavioral Diagnosis in
Practice

Common clinical problems that


needs behavioral interventions
1. AECB (cigarette smoking)
2. OBESITY (consumption of high
calorie foods, poor eating habits)
3. Depression and Mood Disorders
(disruptive behavior patterns)
4. Phobias

BEHAVIOR MODIFICATION
The most important consequences are
rewards or punishments.
People are more influenced by immediate
than long-term consequences
Techniques fall under 9 general categories
that pertain to one link in the A-B-C chain

BEHAVIOR MODIFICATION
Behavior Modification Specialists
attempt to understand and diagnose
behavior in terms of its A-B-Cs ..
the repetitive cycle of Antecedents,
Behaviors, and Consequences that
occur in a persons daily life.

BEHAVIOR MODIFICATION
Antecedents
Internal _craving for food or cigarette; boredom; tiredness;
depression and so on..

External _ at a party where friends are indulging in pleasures, at


work, in the car, movie and TV ads, multimedia influences, etc..

Problem Behaviors
Commonly are substance abuse; consumption of high
caloric foods; disruptive behavior patterns; phobias.

Consequences
People are more influenced by immediate than long-term
consequences.

The A-B-Cs of BEHAVIOR MODIFICATION


Anteceden Behaviors
ts
1.

Control
antecedents
(smoke only 5
cigarettes a day)

1.

2.
2.

Eliminate
antecedents
(throw away all
ashtrays)

3.

Arrange for new


antecedents
(Thank You for
not Smoking
signage in the
office)

3.

Do incompatible
behaviors
(eat celery and
carrots)
Gradually
change over
time or the
shaping
method
(smoke 3
cigarettes less
each day)
Use modeling
and rehearsal of
desired behavior

Consequenc
es
1.

Use rewards

2.

Use extinction
(remove rewards for
undesired behavior)

3.

Use punishment

Case Scenario
Alex, a 28-year-old male, single,
electronics technician works at his own
shop after he graduated from a 2-year
vocational course.
He started smoking at the age of 18 after
finishing high school; consumes about
10-15 sticks a day depending upon his
work load and day to day stresses.
He habitually drinks coffee every time he
feels tense and claims to experience
difficulty in concentrating due to
frequent incoming phone-calls.

Example of BEHAVIORAL DIAGNOSIS of a


cigarette smoker

Antecedent
s
1.
2.

3.

Availability of
cigarettes.
Tense feeling,
associated
with coffee
drinking.
Frequent
incoming
telephone
calls.

Behavior

Consequen
ces (of
stopping)

Smokes 10-15
1.
sticks of cigarettes
a day, mostly at
2.
working time.

Feel less
nervous.
Better able to
concentrate
on work.

Possible BEHAVIOR MODIFICATION


TECHNIQUES for this particular
cigarette
smoker
Antecedent Behavior
Consequen
s
1.

2.

3.

Cut down on
coffee
drinking.
Go to work
one hour
earlier when
the office is
quiet.
Do deep
breathing
exercises.

ces
1.
2.

3.

Chew gum.
Jog four
times a
week.
Practice
refusal
responses
to friend
who offers
cigarette.

Go to a trip to
your favorite
vacation place
or buy yourself
a new
gadget/motor
vehicle as a
reward for
quitting.

Behavioral Diagnosis, how it is done


basic
description of
the pathophysiology,
prognosis, and
the regimen.
extent that the
patient followed
the regimen

Most physicians tend


to launch into a
discourse detailing a
catastrophic effects of
untreated illness and
repaet the regimen to
the patient
Others listen to
patients explanations
and reasons why the
failure to adhere to
such
recommendations

Simply
BEHAVIORALof
DIAGNOSIS
is..
the put,
assessment
the reasons

why the patient could not


follow the regimen as well as
the positive influences that
can make it easier for him to
adhere

FINDINGS of
BEHAVIORAL
DIAGNOSIS
1.
Lack of awareness or understanding
INDIVIDUA
L

2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Lack of confidence to control condition


Forgetfulness
Denial
Inadequate motivation
Fear of getting hooked on drugs
Lack of skills
Behaviors are repetitive and unconscious
(smoking, diet)
Reluctance to accept sick role
Psychiatric disturbance
Skepticism towards providers statements

SOCIAL

12.
13.

Lack of support from family and friends


Poor relationships with health provider

ENVIRONMENTAL

14.
15.
16.

Inadequate money to purchase medications


Inadequate money to pay for health care
Long clinic waiting time

MEDICAL
REGIMEN

17.
18.

Side effects
Complex regimen

Other examples
Patient has not completed a course
of antibiotics for UTI
She did not realize that she had to
continue taking the pills even after the
pain went away
She wanted her bottle of pills to last for
a second attack of UTI because of
limited financial resources

Other examples
Housewife trying to lose weight
Identify the easy availability of high
calorie foods
Feelings of boredom and depression
relieved by eating cookies

Other examples
A teenager who has no interest in
managing her condition
Denial of the existence of the disease
because of the ardent desire to be
normal like the rest of her friends
Lack of confidence in her ability to
successfully manage the condition

Once the
behavioral
diagnosis is made,
the most
appropriate
educational-

EDUCATIONAL-BEHAVIORAL
STRATEGIES
INDIVIDUAL
Teaching, instructional aids, repetition
Reassurance, encouragement, attribution, peer-group discussions
Simplify regimen, cue pill-taking to other activities, weekly pill dispenser,
involve family
Supportive exploration of patients feelings and perceptions
Point out dangers of untreated condition and benefits of therapy
Try non-pharmacological treatment, reassure patient that drugs will be
used minimally
Demonstration and guided practice
Behavior modification techniques (contingency management, contracting,
etc.)
Give patient ample freedom and respect, explore patients feelings
Psychiatric referral, if necessary

SOCIAL
Telephone call, invite to accompany patient to next clinic follow-up, home
visit, etc.
Develop provider communication skills, improve accessibility and
continuity of care

ENVIRONMENTAL
Prescribe generics, provide free care and samples, referral to social
worker
Community organizing; practice management to reduce waiting time

Behavioral Diagnosis in practice


At the patients initial visit, the
following are recommended:
Educational activities that are appropriate
and concerned with the patients illness
Basic description of pathophysiology,
prognosis, and disease management
Options are laid out
Patient is encouraged to actively participate
with the regimen

Behavioral Diagnosis in practice


At the patients follow-up visit, the
following must be done:
Inquiry into the extent of the patients
compliance to the regimen
Queries about idiosyncratic reactions to
medications
Motivate the patient to talk about other
difficulties regarding adherence

..Physicians most basic role


in PATIENT
EDUCATION
Once
it is realized
that the aim of
patient education is nothing less
than the changing the behavior
of individual patients and often
with their families, in the
interest of better health
outcomes, it is also apparent
why the physician must be
personally involved in achieving
this purpose

Family Physicians Tasks


He/She reinforces and lends credibility to
the efforts of others who are personally
performing specific educational tasks.
..he identifies patients medical needs,
placing an appropriate priority on specific
needs with health information related to it.
..he incorporates educational activities into
the overall plan of management.

Family Physicians Tasks


..he prepares patient to accept the need for
behavioral change may be the most
important contribution the physician can
make.
..he delegates, assigns, or requests specific
activities from others but does not lose
interest nor give up personal participation
in the patients care.

knowing
is not enough

..on patient education _

Most health problems or conditions


are amenable to improvement if not
actual elimination. The lack of
knowledge or lack of therapeutic
method is less limiting than the lack
of motivation and commitment or
the lack of optimism and hope.
Knowing must somehow be connected
to acting if we are to deal effectively
with habits, beliefs, and lifestyles
that are currently most detrimental
to the health of individuals,
communities and populations..

..pause for a while


Health Literacy didactics
Group Activity patient education
methods

CASE STUDY
..The case illustrates the
interrelationships and
complexities that are likely
to be encountered by any
Family Physician. The
intended emphasis,

the patient
35-year-old, married, female fastfoodchain corporation branch manager
Remarkably overweight with multiple
somatic complaints
chest pains, difficulty of breathing, easy
fatigability, pain on weight bearing joints
PE and Labs are within normal limits, except
for the BMI of 40

the patient

negative for smoking and alcoholic beverages


negative for heredofamilial diseases
lacks gratification in her marriage to a seaman
has a 6-year-old daughter with ADHD who
complains frequently of stomach-aches and
headaches

this patient previously tried many popular


advertised diets, read best seller diet books,
attended weight control salons, consulted fat
doctors, took injections, and consumed
anorectic diet pills, all in a futile experience of
repeated failure.

Clinical Interventions
Diagnosis - Depression
Management - counseling (CSCP) and antidepressants
Notes:
The dynamics of her weight and sloppy appearance clarified as a
safe expression of rage at her abusive husband, she was then
able to participate successfully in a rational weight control
program supervised by a behaviorally oriented nutritionist.
The physicians therapeutic strategy was not an immediate
attack on her apparent problem of obesity, which was less a
problem of ignorance about nutrition than a defense against
anger and fear.

The central feature of behavioral diagnosis of her eating


habits was that in making herself unattractive to her
husband, she also became unattractive to herself
resulting in depression that perpetuated her need to
fail in any weight reduction program.

Clinical Notes
Diagnosis - Depression
Management - counseling (CSCP) and

antidepressants

Notes:

Effective behavioral change in weight reduction for this


talented, intelligent, and psychologically sensitive
woman was only possible after she was able to see
her psychological investment in obesity.
The physician utilized the services of a social worker
and a nutritionist in understanding and treating
the patient.
It was important, however, to ask for their help at an
appropriate time and sequence and to communicate
with each about the overall strategy. It would seem
unlikely that a simple referral of the patient for
instruction in dieting would have been equally
successful.

the decision to
institute a planned
program of patient
education in a
particular practice
is not governed so
much by financial
considerations as
it is by the
commitment of the
physician to the
value of such
services and
willingness to be
responsible for
their quality

PRACTICE MANAGEMENT
CONSIDERATIONS
Despite the superordinate importance of
considering patient education within the
context of patient-provider interaction, it is
also useful to view patient education from
the perspective of practice management
considerations.
It is mainly a decision to formalize and
improve the educational activities that are
already being done on an informal basis.

PRACTICE MANAGEMENT
CONSIDERATIONS
All physicians perform educational functions for their
patients in their course of their ordinary clinical work
when they_

Explain
Advise
Recommend
Warn
Reassure and
Persuade
However, they may not think about these actions as uniquely
educational. These are delivered impromptu or
extemporaneous, occurring as the need arises, and not usually
subjected to evaluation.

PRACTICE MANAGEMENT
CONSIDERATIONS

Nothing about a formalized plan for patient education should


ever substitute for the physicians personal communications with
the patients.
The purpose of a plan is not to protect the doctor from the
intimate contact or to get somebody to do it.
Patient education is not about

developing a plan
hiring new professionals to do
buying a package of audio-visual equipment
library of pamphlets
sets of up-to-date books, audio-cassettes or videotapes
internet access

PRACTICE MANAGEMENT
CONSIDERATIONS
The first step to patient education is to examine
the practice as a whole to determine what needs
to be done and among the staff can become more
involved.
Any practice can improve and grow its
educational services by utilizing existing
resources and personnel.
The location, as well as the size and maturity of
practice will determine where to begin and will
set initial limits on the scope of the plan and
resources available

Frequently
Encountered PATIENT
EDUCATION PROBLEMS:

DIET THERAPY
DIABETES MELLITUS
ESSENTIAL HYPERTENSION
CONTRACEPTIVE COUNSELING
ANXIETY and RELATED PROBLEMS
CHRONIC ARTHRITIS
HABITS
CHILDBIRTH EDUCATION
PARENTING PROBLEMS
WELL-CHILD PROTOCOLS

Frequently Encountered
Patient Education Problems:
1. DIET THERAPY

Weight Reduction
Fad diets
Controlled sodium
Potassium-enriched
Bulky, high fiber
Diets for pregnancy
Infant and child diets
Diets for eliminating common allergies

2. DIABETES MELLITUS

Type I, Type II
MODY, DM in pregnancy

Frequently Encountered
Patient Education Problems:
3.

ESSENTIAL HYPERTENSION

4.

CONTRACEPTIVE COUNSELING

5.

Weight control
Exercise
Antihypertensive drugs
Family planning
Barrier methods
Oral contraceptive pills
Sterilization procedures

ANXIETY and RELATED PROBLEMS

Relaxation techniques
Exercise
Stress reduction techniques
Anti-anxiety drugs

Frequently Encountered
Patient Education Problems:
6.

HABITS

7.

CHRONIC ARTHRITIS

8.

Foods to avoid
Classification

CHILDBIRTH EDUCATION

9.

Stop smoking methods


Reduction or elimination of alcohol abuse
Drug use disorders

Leopolds

PARENTING PROBLEMS

Age-related issues

10. WELL-CHILD PROTOCOLS

Immunization updates
Developmental milestones

Other Important Matters


1.

There are common elements in all practices that


lend themselves to inclusion in an educational
plan, but the specific priorities should
reflect the determination of the needs based
upon the data from the practice itself.

2.

Age and Sex Distribution of Patients


Most Common Reasons for Visit
Range of Professional Services

The frequently encountered reasons for consult


are illustrative of the broad range of clinical
problems that require relatively repetitive and
predictable teaching.

Ways to Improve Patient


Education Effectiveness

Maintain appropriate records that can be audited periodically


_checklists, rating scales, flow sheets,written
information and instructions or informal
assessment of patients cognitive knowledge.
Enlist staff and personnel who can share the patient
education load.
Analyze the amount of waiting time _ the patients down
time & where such waiting occurs.
Create an informed patienthood and a climate of health
promotion _to remind, inform, motivate, and
persuade that you are interested in listening to
their stories.
Exercise a friendly openness to questions and willingness to
discuss topics of interest to patients.

SALAMAT YA

BALBALEG
ed INDENGEL tan
INPIBIANG YO
..Thank you very much
for listening, and
more importantly, in

You might also like