Laurenzi Christina A, Rabie Stephan, Mamutse Sihle, Skeen Sarah, van Vuuren Nicola Jansen, Neethling Rosanne, Field Sally, Honikman Simone
Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa.
University of Cape Town, Cape Town, South Africa.
Health Promot Pract. 2024 Oct 5;26(4):15248399241285888. doi: 10.1177/15248399241285888.
. Effective empathic communication between health care providers and patients is an essential part of health care. In resource-poor contexts, evidence is needed to understand the quality and content of health care communication within real-life clinical engagements. We used the existing Enhancing Assessment of Common Therapeutic Factors (ENACT) tool to measure empathic communication skills among a group of community health workers (CHWs) receiving a novel quality improvement intervention called Nyamekela4Care in South Africa. . In two resource-limited sites in the Western Cape, South Africa, we audio-recorded CHWs, with consent, in routine client consultations at baseline and postintervention. All sessions were in Afrikaans. We used the adapted ENACT tool to rate recordings at both timepoints, assessing 11 items including communication skills, emotional engagement, process and interaction. We used ANOVA to assess preimplementation and postimplementation differences in empathic communication, and analyzed coders' feedback on the coding process itself. . We analyzed = 66 recordings from 11 CHWs, observing positive directionality overall, with most skills improving over time. Despite near-significant improvements in communication delivery ( = .083), self-confidence/groundedness ( = .029) significantly changed but in the opposite direction. Large effect sizes were observed in verbal communication, responsiveness to client, and identifying external resources, with no significant difference between timepoints. ENACT was feasible to apply to audio recordings; inter-coder reliability was suboptimal despite coder training and ongoing monitoring and support. . Quality improvement interventions may improve empathic skills in diverse contexts, and our results demonstrate how empathic skills could be more routinely assessed in low-resource health care settings.
医疗服务提供者与患者之间有效的共情沟通是医疗保健的重要组成部分。在资源匮乏的环境中，需要证据来了解现实临床接触中医护沟通的质量和内容。我们使用现有的增强常见治疗因素评估（ENACT）工具，来衡量在南非接受名为Nyamekela4Care的新型质量改进干预措施的一组社区卫生工作者（CHW）的共情沟通技巧。在南非西开普省的两个资源有限的地点，我们在征得同意后，对社区卫生工作者在基线和干预后的常规客户咨询中进行了录音。所有会话均使用南非荷兰语。我们使用改编后的ENACT工具对两个时间点的录音进行评分，评估包括沟通技巧、情感投入、过程和互动在内的11个项目。我们使用方差分析来评估共情沟通在实施前和实施后的差异，并分析编码员对编码过程本身的反馈。我们分析了来自11名社区卫生工作者的66份录音，总体观察到正向趋势，大多数技能随时间有所提高。尽管沟通传递方面有接近显著的改善（P = 0.083），但自信/沉稳度（P = 0.029）有显著变化，但方向相反。在言语沟通、对客户的反应能力和识别外部资源方面观察到较大的效应量，时间点之间无显著差异。ENACT应用于录音是可行的；尽管对编码员进行了培训并持续进行监测和支持，但编码员间的可靠性仍不理想。质量改进干预措施可能会在不同环境中提高共情技能，我们的结果表明了如何在资源匮乏的医疗保健环境中更常规地评估共情技能。
