Basics of communication skill in

health care

How inefficient communication affect health care

services??
 Introduction

Definition:-The transmission of information by means of a

channel from a source to a recipient, with a particular
purpose.
 Introd…..
• Health communication is a subset of
communication that dealt with how (individuals)
– health-related messages are disseminated, accessed
and interpreted.
• The focus of health communication is on specific
health-related interactions by which individuals
ascribe meaning to their experiences, their
efforts to share such meanings and adapt
behavior appropriately, and on the factors that
influence this interaction.
• Communication is a vital and integral part of health
care.
– However, it is often taken for granted, its complexities and
subtleties are overlooked and it receives little attention in
the literature on health care.
• Effective communication is as important to high
quality health care as technical competence.
• The communication needs of the doctor received the
most attention, while the needs of the consumer
were mostly ignored.
• The trend in modern health care shifted from
(patemalistic model) the doctor prescribed and the
patient had merely to comply) to a participative,
consumer-oriented approach, a new perspective on
health communication became evident, namely,
shared decision making.
 Why communication in health care matters
• Both clients and health professionals interact with
the health care settings and external environment
from where necessary and sometimes vital
information is obtained.
– Facilitate the cooperation between health professionals
and clients,
– To empower the client to make the best health care
choices and
– To deliver high quality health care.
• As a patient, the client often enters a strange world
populated by strangers uttering unfamiliar words.
• Often the patient does not understand what the
questions mean and lacks the vocabulary to respond
accurately and appropriately.
• Communication is the key to relieving much of the
stress and anxiety experienced by patients.
• If this aspect is not addressed by all members of a
health care team, as well as the patient, the result
may be;
• confusion, misinterpretation, lack of behavioural change
and noncompliance to treatment
• Their ways of communicating, verbal and non-verbal,
receive attention, as well as health promotion
campaigns and health marketing, important
methods of reaching mass audiences
• Barriers of communication
• Interactions may be;
– verbal or non-verbal,
– oral or written
– personal (informal) or impersonal (formal). And
– issue-oriented or relationship-oriented.  but they all
contribute to the quality of health care.
• Communication is the singularly most important tool
available to health professionals for promoting health,
providing health care services and gathering pertinent
information from clients, explaining procedures and
treatments, and eliciting cooperation from members
of a health care team.
• The clarity. timeliness. and sensitivity of human
communication in health care is often critical to the
physical and emotional well-being of all concerned
• A sole use tools of communication is not perfect
– Seeing: Deliver 55% of the message.
• It is seen or felt and consists of facial expression, dress,
grooming, posture, eye contact, touch, and gesture
– Hearing: delivers 38% of the message
• But the heard voice depends on the tone, vocal clarity, and
verbal expressiveness.
– The words by themselves delivering only 7% of the
message.
 Participants in health communication
• Health care – clients use interpersonal communication to:
– obtain relevant health information about their health problems
and treatments;
– elicit the cooperation and respect from health professionals;
– make complex and far-reaching health care decisions;
– cope with the often restrictive bureaucracy of the health care
system; and
– cope with health problems
• Health care professionals use interpersonal communication
skills to:
– establish rapport with a client;
– elicit full and accurate information from clients and health
professionals;
– increase compliance to treatment; and
– empower the client to make informed health care decisions.
 Considerations in health communication
• In health care, the 'care' refers to the 'level of
emotional involvement communicators express
for one another, ... the demonstration of interest
and concern for the other person's well-being‘.
• These are empathy, control, trust, self-disclosure
and confirmation.
• In addition, the transfer of messages through
verbal and nonverbal communication has
particular importance in a health care setting
while, from a patient compliance perspective, self-
efficacy is a key issue in the success of
communication.
 Verbal and non-verbal communication in health care
• In health care, communication is a means of creating meaning
from messages.
• The messages can be internally (thoughts and feelings) or
externally generated (communication).
• External messages can be communicated verbally and non-
verbally.
• In verbal health communication, meaning can be derived from a
semantic perspective, that is, from the meanings associated with
the words, or a pragmatic perspective where the way in which
people use words in different situations are examined. (jargon
words).
• Non-verbal communication is important in health care settings
because verbal communication may be hindered by a lack of
appropriate vocabulary, emotional condition of the client,
unfamiliar surroundings, differences in culture, or any of the
barriers to successful communication.
•
Types of non-verbal communication
Kinesic messages are the way people move their bodies and position themselves, for
example postures, gestures, head nods and leg movements.
• Occulesics, or facial expressions and eye behaviour such as blinking, are used to indicate a
person's emotional state and level of involvement in a situation or other person.
• Paralinguistic communication includes vocal cues (e.g. volume, pitch, tone and rate) that
accompany speech and environmental sounds.
– The tone of voice that a health professional uses could communicate to the client the level of sincerity and
caring, or a lack of interest, intimidation, aggressiveness and contempt, or confirmation of the client as a person,
and may have a significant effect on the client's level of compliance. Environmental sounds (e.g. equipment
noise, music, wind, traffic noise) can either add to or detract from establishing a relaxed communication climate
between clients and health professionals
• Tactilic communication (touching behaviour) should be used with caution in health care
settings because some clients may experience it as an invasion of privacy. Nevertheless,
human touch fulfils physiological and sociological needs for people and may be a method of
showing empathy and caring
• Proxemic communication relates to the need for distance between people and objects,
popularly known as personal space.
– The spatial arrangement of chairs for group meetings, crowdedness in a consulting room or an uncomfortable
temperature may also influence the communication encounter
• The term chronemics refers to the effect of time on communication. We often keep clients
waiting, not realising how the waiting time has a negative effect on effective
communication.
 Models of health communication
• People respond to illness and health in different ways. For example,
some people ignore and deny health threats, while others face
threats, collect the necessary information and act accordingly and
appropriately
– Therapeutic model:- Therapeutic models of health communication
emphasize the importance of relationships in assisting clients to adjust to
circumstances and move from a perspective of illness towards one of health.
– Health belief model:- This model gives an indication of how healthy
individuals seek to avoid illness, that is, it explains the nature of an
individual's preventative health care.
– Health belief model for compliance :-This discussion is expanded to include
the health beliefs of patients already suffering from an illness and having to
comply to treatment. The aim was to predict patient compliance to
treatment, given the variables incorporated in the model.
– King's interaction model :- During HCP-patient interactions, both the HCP and
the patient simultaneously make judgments about their circumstances and
about each other, based on their perceptions of the situation.
– Model of participative decision making :- The patient participates as an active
partner in mutual provider­patient decision making ==> will result in • increased
acceptance of solutions • increased levels of satisfaction • greater commitment to health
care decisions.
 Therapeutic communication
• Increases patient well being, participation, shared decision,
satisfaction and compliance.
• Allow patients to collect adequate information  therapeutic
silence.
• Avoid asking personal questions, opinions, false reassurance, and
passive, offensive & aggressive response.
• Addresses patient concern
• Non-therapeutic communication;
– Assume the HCPs knows best and the patients do not think for them selves.
– Foster dependency.
– Does not allow patient to solve problems
– Asks personal questions
– Aggressively reacted
– Unsatisfactory information
 Communication barrier
• The communication of accurate and timely health information is crucial to
effective health care.
• On the other hand, if it’s not 'ineffective, leading to problems such as
miscommunication, misinformation, dehumanization, insensitive
interactions, dissatisfaction, and lack of cooperation between
interdependent health care providers and consumers‘.
• Whereas effective communication can promote high quality health care,
ineffective communication can have a negative influence on decision
making, the quality of care and compliance to treatment.
• Effective communication usually leads to:
– patient satisfaction;
– compliance with treatment regimes; and
– enhanced recuperative abilities.
• On the other hand, ineffective communication may lead to:
– dissatisfaction with health care services;
– alienation between health professionals and clients; and
– excessive competition between health professionals
• However; different barriers could impact negatively on communication
and the transfer of meaning between health professionals and clients.
• Ego involvement:- People tend to shy away from discussing topics that relate to physical
disability and inadequacy, illness and disease because they cause anxiety.
• Differences in knowledge:- The two main problems facing health care delivery today are:
– providing clients with enough information regarding their health, condition or treatment so that they
are sufficiently informed; and
– the high level of non-compliance to medication prescription on the part of the patient.
• Social status:- communication becomes difficult when the social distance between the
participant is significant (greater the disparity in education, income and social
standingstatus distinctions are emphasized).
• Differences in communicative purposes:- Because of the differences in position and
authority or power, differences in points of view arise.
• Emotional distance:- Where there is a lack of rapport, intimacy, empathy, closeness,
sensitivity, respect and dissatisfaction with health care, relational dominance and
dehumanization follow.
• One-way communication:- It is an accepted fact that one person cannot deposit meaning
in the mind of another. Sources and recipients participate mutually in the communication
process.
• Verbal manipulation:- a predetermined hidden agenda for decision & action.
• Ambiguity of language: - difficulty of understanding the sufferers language
• Cultural differences:-
• Time constraints:-
• Jargon words/ languages:-
• Mystification of medicine
• Lack of communication skill
• Lack of patient continuity