Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, FA10, 9700 RB Groningen, The Netherlands.
Faculty of Medical Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, FA10, 9700 RB Groningen, The Netherlands.
Int J Environ Res Public Health. 2019 Dec 20;17(1):81. doi: 10.3390/ijerph17010081.
Comprehensible communication by itself is not sufficient to overcome health literacy related problems. Future doctors need a larger scope of capacities in order to strengthen a patient's autonomy, participation, and self-management abilities. To date, such comprehensive training-interventions are rarely embedded in curricula, nor systematically evaluated. We assessed whether comprehensive training increased these health literacy competencies, in a randomized controlled trial (RCT), with a waiting list condition. Participants were international undergraduate medical students of a Dutch medical faculty (intervention: 39; control: 40). The 11-h-training-intervention encompassed a health literacy lecture and five interactive small-group sessions to practise gathering information and providing comprehensible information, shared decision-making, and enabling of self-management using role-play and videotaped conversations. We assessed self-reported competencies (knowledge and awareness of health literacy, attitude, self-efficacy, and ability to use patient-centred communication techniques) at baseline, after a five and ten-week follow-up. We compared students' competencies using multi-level analysis, adjusted for baseline. As validation, we evaluated demonstrated skills in videotaped consultations for a subsample. The group of students who received the training intervention reported significantly greater health literacy competencies, which persisted up to five weeks afterwards. Increase was greatest for providing comprehensible information (B: 1.50; 95% confidence interval, CI 1.15 to 1.84), shared decision-making (B: 1.08; 95% CI 0.60 to 1.55), and self-management (B: 1.21; 95% CI 0.61 to 1.80). Effects regarding demonstrated skills confirmed self-rated competency improvement. This training enhanced a larger scope of health literacy competences and was well received by medical students. Implementation and further evaluation of this training in education and clinical practice can support sustainable health literacy capacity building of future doctors and contribute to better patient empowerment and outcomes of consultations.
可理解的沟通本身不足以克服与健康素养相关的问题。未来的医生需要更广泛的能力，以增强患者的自主性、参与度和自我管理能力。迄今为止，此类综合性培训干预措施很少被纳入课程，也没有系统地进行评估。我们在一项随机对照试验（RCT）中，通过等待名单条件评估了综合培训是否能提高这些健康素养能力。参与者是荷兰一所医学系的国际本科医学生（干预组：39 人；对照组：40 人）。11 小时的培训干预包括健康素养讲座和五个互动小组会议，以练习收集信息和提供易懂的信息、共同决策以及使用角色扮演和录像对话来实现自我管理。我们在基线、五周和十周后随访时评估了自我报告的能力（知识和健康素养意识、态度、自我效能感以及使用以患者为中心的沟通技巧的能力）。我们使用多水平分析比较了学生的能力，调整了基线。作为验证，我们评估了在录像咨询中展示的技能。接受培训干预的学生群体报告的健康素养能力显著提高，这种提高持续了五周。提供易懂的信息（B：1.50；95%置信区间，CI 1.15 至 1.84）、共同决策（B：1.08；95% CI 0.60 至 1.55）和自我管理（B：1.21；95% CI 0.61 至 1.80）的能力提高最大。关于展示技能的效果证实了自我评估的能力提高。这种培训提高了更广泛的健康素养能力，受到医学生的欢迎。在教育和临床实践中实施和进一步评估这种培训，可以支持未来医生可持续的健康素养能力建设，并有助于更好地赋予患者权力和改善咨询结果。
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