Patient education and health literacy
Patient education and counselling contribute to behaviour change for primary prevention of disease.22 More broadly they may also help create greater ‘health literacy’ – the knowledge and skills patients require to maintain their own health including use of health services. The use of behavioural techniques, especially for self monitoring is recommended, as well as the use of personal communication and written or other audiovisual materials (A).22
Patients view the GP as a key, first contact and credible source of preventive advice. Health education messages have a large impact when delivered by the GP. When patients present with symptoms and concerns, they are more receptive to advice about how to minimise or avoid illness. Doctors can enhance their patients’ understanding by taking time to explain and by using simple language (ie. avoiding medical jargon).
Factors that increase the effectiveness of patient education delivered by GPs include:
- assessing the patient’s health literacy23
- the patient’s sense of trust in their GP24
- face-to-face delivery25
- patient involvement in decision making26–28
- highlighting the benefits and the costs29,30
- strategies to help the patient remember what they have been told31
- tailoring the information to the patient’s interest in change32
- strategies that address the difficulty in adherence28,33
- the use of decision aids.34
Many prevention activities involve a change in health related behaviour. As the patient plays a large role in making this happen, it is useful to facilitate more active inclusion of patients in their care. This process is an essential component of self management strategies35,36 and has the potential to increase the patient’s responsibility for their health. In addition, it:
- enhances the quality of communication37,38
- enhances the doctor patient consultation26
- can reduce the cost of aspects of care through better informed patients27
- increases the demand and use of appropriate referral to other health professionals and agencies,38 and
- increases adherence to recommended prevention activities and therapeutic regimens.38,39
General practitioners can encourage their patients to participate in protecting their own health through better knowledge, increased skills and better access to services and programs. They can support their patients to do this, through simple counselling or more structured interventions in their practice or by referral to other health care providers.
For those whose first language is not English, a professional interpreter should be considered.
Approaches to patient education
Patients need to develop their own understanding of the problem and what can be done about it. For simple behavioural changes such as having a Pap test, patients weigh up the perceived benefits and costs.40 These benefits and costs may include answers to the following questions:
- How big is the problem to the individual?
- What are the consequences of not doing it?
- What are the benefits?
- What are the barriers?
A recall notice should specifically address the above issues in order to be effective. Some health education may require more complex actions over a period of time, such as changing diet, stopping smoking or increasing physical activity. The ‘stages of change model’41 identifies five basic stages of change, which are viewed as a cyclical, ongoing process during which the person has differing levels of motivation or readiness to change, and the ability to relapse or repeat a stage. Each time a stage is repeated, the person learns from the experience and gains skills to help them move to the next stage.
Stages of change model |
|
|---|---|
| Pre-contemplation (Not thinking about change) |
Stage during which a person does not consider the need to change
|
| Contemplation (Thinking of change) |
In this stage, a person considers changing a specific behaviour
|
| Determination (Ready for change) |
The stage where a person makes a serious commitment to change
|
| Action (Changing behaviour) |
Change begins (these can be large or small changes)
|
| Maintenance (Maintaining change) |
Change is sustained over a period of time
|
Motivational interviewing is dealt with in more detail in the ‘green book’.
Many of the motivators and barriers to behavioural change lie outside the patient and their immediate family. Advertising, availability of resources (eg. fresh food), and social and economic forces all exert a strong influence on patients. These need to be addressed at community, state and national levels.
The complex needs and health problems of disadvantaged groups
The complex needs and health problems of disadvantaged groups and the interactions between social, psychological, environmental and physical determinants of health, mean that special effort is required for patient education to be effective. In particular, GPs need to employ a range of strategies and work in collaboration with other services.42 To be effective in patient education for indigenous communities, GPs need an understanding of the Aboriginal view of health, culture and history and an ability to provide services within a culturally appropriate framework. This also requires GPs to collaborate with other agencies and providers to ensure the provision of high quality preventive health care for Indigenous Australians.43
© The Royal Australian College of General Practitioners
Printed from www.racgp.org.au/redbook