1,562 research outputs found
Identifying context factors explaining physician's low performance in communication assessment: an explorative study in general practice
BACKGROUND Communication is a key competence for health care professionals. Analysis of registrar and GP communication performance in daily practice, however, suggests a suboptimal application of communication skills. The influence of context factors could reveal why communication performance levels, on average, do not appear adequate. The context of daily practice may require different skills or specific ways of handling these skills, whereas communication skills are mostly treated as generic. So far no empirical analysis of the context has been made. Our aim was to identify context factors that could be related to GP communication. METHODS A purposive sample of real-life videotaped GP consultations was analyzed (N = 17). As a frame of reference we chose the MAAS-Global, a widely used assessment instrument for medical communication. By inductive reasoning, we analyzed the GP behaviour in the consultation leading to poor item scores on the MAAS-Global. In these cases we looked for the presence of an intervening context factor, and how this might explain the actual GP communication behaviour. RESULTS We reached saturation after having viewed 17 consultations. We identified 19 context factors that could potentially explain the deviation from generic recommendations on communication skills. These context factors can be categorized into doctor-related, patient-related, and consultation-related factors. CONCLUSIONS Several context factors seem to influence doctor-patient communication, requiring the GP to apply communication skills differently from recommendations on communication. From this study we conclude that there is a need to explicitly account for context factors in the assessment of GP (and GP registrar) communication performance. The next step is to validate our findings.We also thank the Dutch Ministry of Health for funding the collection and videotaping of routine GP consultations
Context factors in general practitioner - patient encounters and their impact on assessing communication skills - an exploratory study
BACKGROUND Assessment of medical communication performance usually focuses on rating generically applicable, well-defined communication skills. However, in daily practice, communication is determined by (specific) context factors, such as acquaintance with the patient, or the presented problem. Merely valuing the presence of generic skills may not do justice to the doctor's proficiency.Our aim was to perform an exploratory study on how assessment of general practitioner (GP) communication performance changes if context factors are explicitly taken into account. METHODS We used a mixed method design to explore how ratings would change. A random sample of 40 everyday GP consultations was used to see if previously identified context factors could be observed again. The sample was rated twice using a widely used assessment instrument (the MAAS-Global), first in the standard way and secondly after context factors were explicitly taken into account, by using a context-specific rating protocol to assess communication performance in the workplace. In between first and second rating, the presence of context factors was established. Item score differences were calculated using paired sample t-tests. RESULTS In 38 out of 40 consultations, context factors prompted application of the context-specific rating protocol. Mean overall score on the 7-point MAAS-Global scale increased from 2.98 in standard to 3.66 in the context-specific rating (p<0.00); the effect size for the total mean score was 0.84. In earlier research the minimum standard score for adequate communication was set at 3.17. CONCLUSIONS Applying the protocol, the mean overall score rose above the level set in an earlier study for the MAAS-Global scores to represent 'adequate GP communication behaviour'. Our findings indicate that incorporating context factors in communication assessment thus makes a meaningful difference and shows that context factors should be considered as 'signal' instead of 'noise' in GP communication assessment. Explicating context factors leads to a more deliberate and transparent rating of GP communication performance.The study was funded by the SBOH Foundation, employer of Dutch Family Medicine Residents and funder of the national residency program for GPs in the Netherlands
Doctors' responses to patients' concerns; an exploration of communication sequences in gynaecology
Aims - Like other medical doctors, gynaecologists have difficulty attending to psychosocial issues and concerns. Communication training has proven to be effective in teaching them to spend more time on discussing these factors. However, whether or not they do this in response to patients' utterances remains unclear. The question is how gynaecologists respond to patients' concerns, whether or not they do this adequately and what the effects of a communication training are on the use of these communication sequences. Methods - Nineteen gynaecologists participated in a study which examined the effects of a three-day residential communication training. Before and after the training the gynaecologists videotaped series of consecutive outpatient visits. The communication during these visits was rated using the Roter Interaction Analysis System. Gynaecologists' responses to patients' concerns were examined at lag one, i.e. immediately following the patient's concern. Results - The most prevalent responses made by the gynaecologists were showing agreement and understanding and giving medical information. Affective responses were observed less. At postmeasurement, the gynaecologists responded neither more adequately nor inadequately to patients' concerns. Conclusions - The gynaecologists did not respond in a very affective way to patients' concerns. However, the patients did not express many concerns. Future studies should focus on more prevalent communication behaviours and incorporate more lags. Declaration of Interest: non
Group-Based Modeling of Time Spent in Structured Activity Trajectories From Middle Childhood Into Early Adolescence
Discussing patient's lifestyle choices in the consulting room: analysis of GP-patient consultations between 1975 and 2008
<p>Abstract</p> <p>Background</p> <p>The increasing prevalence of chronic diseases and the growing understanding that lifestyle behaviour plays an essential role in improving overall health suggest a need for increased attention to lifestyle choices in the consulting room.</p> <p>This study aims to examine whether or not healthy and unhealthy lifestyle choices of patients are currently being discussed more often in primary care consultations than in former decades. Furthermore, we are interested in GPs' approach to lifestyle behaviour during consultations. Lastly, we examine whether lifestyle behaviour is discussed more with certain patients during consultations, depending on gender, age and educational background.</p> <p>Method</p> <p>We analysed video-recordings of medical consultations, collected between 1975 and 2008 in Dutch GP practices. Data were analysed using logistic regression.</p> <p>Results</p> <p>This study shows that discussion of smoking behaviour and physical activity has increased somewhat over time. A change in discussion of nutrition and alcohol is, however, less clear. Overall, alcohol use is the least discussed and physical activity the most discussed during consultations. GPs mainly refer to lifestyle when it is relevant to the patient's complaints (symptom approach). GPs' approach to lifestyle behaviour did not change over time. In general, lifestyle behaviour is discussed more with older, male patients (except for nutrition). GPs talk about lifestyle behaviour with patients from different educational backgrounds equally (except for physical activity).</p> <p>Conclusion</p> <p>In recent years there is greater awareness of a healthy lifestyle, which is reflected to a limited extent in this study. Still, lifestyle behaviour is discussed in only a minority of consultations. GPs do not refer to lifestyle behaviour as a routine procedure, i.e. do not include it in primary prevention. This highlights the importance of the introduction of prevention consultations, where GPs can discuss lifestyle issues with patients who do not (yet) have risk symptoms.</p
The Association of Attachment Anxiety and Avoidance with Emotional Dating Abuse Perpetration Using Multimethod, Dyadic Data
This study examined the relationship between emotional dating abuse perpetration and attachment anxiety and avoidance using multimethod, multi-informant dyadic data. Data were derived from a sample of young adult heterosexual dating couples (N = 113 couples). We measured attachment through self-report survey data and emotional dating abuse through self-report surveys, partner-report surveys, and ratings by independent observers of a videotaped couple interaction. Both female and male anxiety were related to female emotional abuse across each method. Male anxiety was related to male emotional abuse in survey data, but female anxiety was related to male emotional abuse in observed data. Neither male nor female avoidance was related to emotional abuse. Dating abuse prevention should focus on attachment anxiety factors (e.g., jealousy, anger) to reduce emotional abuse in young adult romantic relationships
Mobile Health Care and Health Behavior Change : Development of a System for Virtual Counseling based on Written Diary Questionnaires and Situational Feedback
In the future virtual e-health counseling through the mobile phones will be an important feature of health care. Patients are shortly in face to face contact with health care personal. Many patients face challenges living with chronic diseases and the patients have to change health behavior and life style to life as healthy as possible with a high degree of quality of life. Development of new ways of health counseling should also apply principles of universal design as accessibility for all and ease of use. We have designed a system for virtual counseling through written questionnaire diaries and situational feedback – the www.wsf.hio.no that is delivered to the patient through an internet enabled mobile phone. The system is applied in a pilot study with patients with widespread chronic musculoskeletal pain and is currently running in a randomized controlled study within the same patient group. The system ensures safe contact with the patients and has been running successfully for 30 month. The patients are able to use the cell phone with a short f2f instruction. The therapists can easy follow patients’ responses independent of place. The researcher can easily extract data from the system. At the present moment the 2nd generation of the system will be redesigned in order to improve the functionality further and to be tested out in other patient samples – contributing to increase the universal accessibility of new methods in health counseling
Effects of a pre-visit educational website on information recall and needs fulfilment in breast cancer genetic counselling, a randomized controlled trial
INTRODUCTION: Pre-visit education which helps counselees to prepare for their first visit for breast cancer genetic counseling might enhance information recall and needs fulfilment. This study assessed the effects of a pre-visit website with tailored information and question prompt sheet (QPS), named E-info gene(ca). METHODS: A total of 197 counselees were randomized to receive usual care (UC) or UC plus E-info gene(ca). All counselees completed a pre- and post-visit questionnaire and visits were videotaped. We studied effects on counselees' information recall, knowledge about breast cancer and heredity, fulfillment of needs, risk perception alignment, anxiety and perceived personal control, using multilevel regression analyses. RESULTS: Intent-to-treat analysis showed that counselees in the intervention group (n = 103) had higher levels of recall of information from the consultation (β = .32; confidence interval (CI): .04 to .60; P = .02; d = .17) and post-visit knowledge of breast cancer and heredity (β = .30; CI: .03 to .57; P = .03) than counselees in the UC group (n = 94). Also, intervention group counselees reported better fulfilment of information needs (β = .31; CI: .03 to .60; P = .03). The effects of the intervention were strongest for those counselees who did not receive an indication for DNA testing. Their recall scores showed a larger increase (β = .95; CI: .32 to 1.59; P = .003; d = .30) and their anxiety levels dropped more in the intervention compared to the UC group (β = -.60; CI: -1.12 to -.09; P = .02). No intervention effects were found after the first visit on risk perception alignment or perceived personal control. CONCLUSIONS: This study shows that pre-counseling education, using tailored information technology, leads to more effective first visits for breast cancer genetic counseling, in particular for counselees who received no indication for DNA testing and, therefore, had no indication for a second visit. Future study should focus on the effects of a pre-visit website on the outcomes after a complete series of visits. TRIAL REGISTRATION: Dutch Trial Register ISRCTN82643064
The effects of the implementation of snoezelen on the quality of working life in psychogeriatric care
BACKGROUND: Dementia among nursing home residents is often accompanied by high care dependency and behavioral disturbances, resulting in an increased workload for the caregivers. Snoezelen, integrated into 24-hour dementia care, is an approach that might improve the quality of working life of dementia caregivers. This study aims to investigate the effectiveness of integrated snoezelen on work-related outcomes (workload and psychological outcomes) of caregivers in psychogeriatric nursing homes. METHODS: A quasi-experimental pre- and post-test design was used, comparing six psychogeriatric wards that implemented snoezelen in 24-hour care to six control wards that continued giving usual care. One hundred and twenty-nine Certified Nursing Assistants (CNAs) were included in the pre-test and 127 CNAs in the post-test. The six intervention wards received a 4-day in-house training program. The intervention further consisted of implementation activities on the ward (e.g. stimulus preference screening, workgroup), three in-house follow-up meetings and two general meetings. Measurements on workload, perceived problems, stress reactions, job satisfaction and burnout were performed at baseline and after 18 months. RESULTS: A significant treatment effect in favor of the experimental group was found for time pressure, perceived problems, stress reactions and emotional exhaustion. CNAs of the experimental group also improved on their overall job satisfaction score. In particular, they were more satisfied with the quality of care and with their contact with residents. CONCLUSION: The implementation of snoezelen improved the quality of the working life of dementia caregiver
Determinan minat menggunakan quick response indonesian standard (QRIS)
Adanya layanan aplikasi Quick Response Indonesian Standard (QRIS) yang diberikan oleh bank indonesia kepada pihak pengguna untuk memungkinkan melakukan transaksi non-tunai melalui smartphone akan tetapi mahasiswa/i perbankan syariah IAIN Padangsidimpuan delapan puluh sembilan
persen tidak mengetahuinya, seharusnya mahasiswa/i perbankan itulah yang lebih paham dan sekaligus sebagai pemihak. Sehingga rumusan masalah dan tujuan masalah dalam penelitian ini adalah apakah ada pengaruh pengetahuan
terhadap minat menggunakan QRIS, apakah ada pengaruh manfaat terhadap minat menggunakan QRIS dan apakah ada pengaruh risiko terhadap minat menggunakan QRIS dan untuk mengetahui apakah ada pengaruh pengetahuan terhadap minat menggunakan QRIS, untuk mengetahui apakah ada pengaruh
manfaat terhadap minat menggunakan QRIS, dan untuk mengetahui apakah ada pengaruh risiko terhadap minat menggunakan QRIS Teori yang digunakan dalam penelitian ini adalah mengenai minat pengetahuan, manfaat, risiko, dan Quick Response Indonesian Standard (QRIS). Kemudian hubungan pengetahuan terhadap minat menggunakan Quick Response Indonesian Standard (QRIS), manfaat terhadap minat menggunakan Quick Response Indonesian Standard (QRIS) dan hubungan risiko terhadap minat menggunakan Quick Response Indonesian Standard (QRIS). Penelitian ini merupakan penelitian kuantitatif. Sumber data yang digunakan adalah data primer. Teknik pengumpulan data yang digunakan adalah
angket dengan jumlah sampel 90 orang. Pengolahan data menggunakan software SPSS versi 24. Teknik analisis yang digunakan adalah uji validitas, uji reliabilitas, uji normalitas, uji linearitas, uji mulitikolineritas, uji
heteroskedastisitas, koefisien determinasi, uji (t) parsial dan uji (f) simultan dan analisis regresi linear berganda.
Hasil penelitian uji (t) menunjukkan bahwa variabel pengetahuan berpengaruh negatif dan tidak signifikan terhadap minat menggunakan QRIS, variabel manfaat berpengaruh positif dan signifikan terhadap minat
menggunakan QRIS, variabel risiko berpengaruh negatif dan tidak signifikan terhadap minat menggunakan QRIS. Sedangkan hasil uji (f) simultan variabel pengetahuan, manfaat dan risiko terdapat pengaruh terhadap minat menggunakan Quick Response Indonesian Standard (QRIS)
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