Saudi Diploma in Family Medicine

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Patient Education
Saudi Diploma in Family Medicine Center of Post
Graduate Studies in Family Medicine
Dr. Zekeriya Aktürk zekeriya.akturk_at_gmail.com www.
aile.net
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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

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USPSTF Recommendations

• Tobacco use
• Exercise
• Nutrition
• Traffic accidents
• Home accidents and environmental injuries
• Sexually transmitted diseases
• Unwanted pregnancies
• Oral health

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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.

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Aims

• Encourage patients to take responsibility of
  their health behaviors
• Establish doctor-patient partnership
• Doctor health counselor
• First information then choice

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Principles

• Feed-back
• Reinforcement
• Individualization
• Facilitation
• Relevance
• Using multiple channels of education

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Suggestions from the USPSTF

1. Establish a therapeutic relationship
2. Provide counseling to all patients
3. Ascertain that patient understands the
   relationship between behavior and health
4. Work with the patient to eliminate barriers to
   behavioral change
5. Include patients in the decision of which risk
   factor to change

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1. Use combined strategies
2. Prepare a behavioral change plan
3. Track the changes by follow-up visits
4. Include all your personnel

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The Integrated Health Behavior Model
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Health Behavior Change

1. Precontemplation Not intending to take action in
   the foreseeable future, usually measured as the
   next 6 months.
2. Contemplation Intending to change in the next 6
   months aware of the pros and cons of changing,
   leading to procrastination.
3. Preparation Intending to take action in the
   immediate future, usually measured as the next
   month have a plan.
4. Action Have made specific overt modifications to
   behavior within the last 6 months.
5. Maintenance Working to prevent relapse,
   increasing confidence typically lasts 6 months
   to 5 years.
6. Termination Zero temptation to relapse and 100
   confidence in ability to maintain new behavior.

From Prochaska JO, Velicer WF The
transtheoretical model of health behavior change.
Am J Health Promot 1238, 1997.
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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.

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Bad News!

• Providing information and clues to patients
  without motivation is not useful
• Health belief
• Social support
• Activity
• MOTIVATION

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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

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Education

• Dont blame,
• Reward successes (even if small),
• Be encouraging,
• Some will never change whatever your efforts..

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Education

• Individualize
• Assess the present knowledge.
• Use material relevant to patients understanding.
• Team work.

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Evaluate

• Most commonly neglected part.
• Dont just give information and go!,
• Determine personal needs,
• Update the needs after evaluation,
• Make a new planning..... Establish continuity.

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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

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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.

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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.

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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.

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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.

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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.

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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.

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Printed material

• Used very frequently.
• Wnated by patients.
• Should be supported with verbal education in
  advance.

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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.

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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

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Other methods

• Models
• Maquettes, manikins
• Tapes
• Video
• Computer

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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.