Assist. Prof. Dr. Memet IŞIKAtaturk University Medical Faculty

Department of Family Medicine

Class 2: 10.10.2011

ObjectivesAt the end of this session, participants should

be able to:Define the principles of patient educationExplain the integrated health behavior modelExplain the health behavior change modelDesign and apply a health education

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USPSTF RecommendationsTobacco useExerciseNutrition Traffic accidentsHome accidents and environmental

injuriesSexually transmitted diseasesUnwanted pregnanciesOral health…

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TimingDoctor-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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AimsEncourage patients to take responsibility of

their health behaviorsEstablish doctor-patient partnership

Doctor: health counselor“First information then choice”

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PrinciplesFeed-backReinforcementIndividualizationFacilitationRelevanceUsing multiple channels of education

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Suggestions from the USPSTF1. Establish a therapeutic relationship2. Provide counseling to all patients3. Ascertain that patient understands the

relationship between behavior and health4. Work with the patient to eliminate barriers

to behavioral change5. Include patients in the decision of which

risk factor to change

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Suggestions from the USPSTF6. Use combined strategies7. Prepare a behavioral change plan8. Track the changes by follow-up visits9. Include all your personnel

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The Integrated Health Behavior Model

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Health Behavior Change1. 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.

/ 28 10From Prochaska JO, Velicer WF: The transtheoretical model of health behavior change. Am J Health Promot 12:38, 1997.

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 usefulHealth beliefSocial supportActivity MOTIVATION

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If Patient not MotivatedLeave open doorGive timeDetermine aims and expectations of the

patientDetermine wrong informaiton and beliefs

and substitute with correct onesSupports and barriers

family, social environment, occupation, income, working hours

Low personal benefit

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EducationDon’t blame,Reward successes (even if small),Be encouraging,

Some will never change; whatever your efforts..

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EducationIndividualize:

Assess the present knowledge.Use material relevant to patients

understanding.Team work.

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EvaluateMost commonly neglected part.Don’t 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 EducationWho will participate?Using verbal educationUsing printed materialsDoing what is comfortable to ones selfOther materials and methodsOffice design

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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 educationThe 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 educationShould 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 educationAvoid 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. Should be supported with verbal education

in advance.

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Printed materialBefore 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 contentFocus on maximum 3-4 pointsAvoid medical terminology, statistics or scary

expressionsUse short sentences, understandable wordsGive open messages

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Other methodsModelsMaquettes, manikinsTapes VideoComputer…

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Office designLook 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.

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