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PubMed2002

A qualitative study to explore undergraduate medical students' attitudes towards communication skills learning.

This qualitative study explores medical students' attitudes towards communication skills learning. Thirty-two medical students, including representatives from each year of the medical degree, participated in five focus-group discussions. Theme analysis of each transcript by two independent analysts produced two attitude-related themes: positive attitudes towards communication skills and negative attitudes towards learning communication skills. Students held both positive and negative attitudes towards different aspects of communication skills learning. Students' negative attitudes were related to communication skills being a subjective social science, which was viewed as 'non-academic' and 'common sense'. Students with negative attitudes towards communication skills learning were thought to be good communicators. Some reported being socialized into developing the negative attitudes held by older students and qualified doctors. The timing of communication skills learning was also thought to be important in determining attitudes. The findings within each of these themes and their educational implications are discussed in this paper.

Attitude of Health Personnel↗
PubMed2002

Mutual understanding: a communication model for general practice.

OBJECTIVE: To present our pursuits towards development of a simple model for clinical communication intended for application by the practitioner as a tool for enhancing mutual understanding. DESIGN: Inspired by theories about patient-centredness and interactive modes of understanding, and supported by the perspectives of the Danish philosopher Niels Thomassen, we reviewed audiotapes from our own consultations. Recognising four dimensions assumed to be essential for mutual understanding in the transcripts, we explored these dimensions further. RESULTS: We present a communication model consisting of the following dimensions: The Framework, within which the communication takes place; The Subject, about which the communication takes place; The Persons, between whom the communication takes place; and The Action, verbally and non-verbally, through which communication takes place. We describe these dimensions in detail. The nature of the dimensions indicates that there is an interrelationship between them, implying that the character of the communication may change if one of the factors is changed. CONCLUSION: Analysis of an ongoing or recent consultation completed in accordance with these four dimensions allows the doctor to refocus the communication, thus leading to a more extensive mutual understanding and perhaps enhanced freedom of action.

Communication↗
PubMedDate not supplied

Partner communication about hysterectomy.

Communication between marital partners about a woman's hysterectomy may be difficult and serve as a source of marital conflict. This study was conducted to determine marital partners' usual communication behaviors as well as what they communicated about hysterectomy with each other. Twenty-two educated Caucasian couples participated in the study. Individual, semistructured interviews were conducted with the women in the hospital following their hysterectomies and with their partners at a later time. Couples also completed the Primary Communication Inventory. Results showed that the couples had generally good usual communication. Couples reported that they communicated "everything" about the hysterectomy, but evidence (i.e., further questioning) showed that they communicated little. The authors discuss possible explanations for this apparent contradiction between perceived and actual communication behaviors.

Adult↗
PubMed2006

A 10-year retrospective of research in new technologies for health communication.

The use of new technologies is growing in virtually all areas of health communication, including consumer, patient, and provider education; decision and social support; health promotion; knowledge transfer; and the delivery of services. Many applications have the potential to make major contributions in meeting the needs of an unhealthy and aging population. Key questions confronting health communication research reflect long-standing concerns about effects of new technology on health knowledge, health behavior, health delivery, and health outcomes. A review of the literature provides useful insights about how technology has been used to communicate health messages and their associated outcomes. Focus is placed on effective health communication, lessons learned, and implications for the future. During the next 10 years, the application of new technologies in health communication will be enriched by a tradition that has evolved to reflect a more dynamic connection between health users and providers. Future applications have the potential to provide cost-effective communications tailored to large numbers of individuals and achieve positive health outcomes. Consequently, we should strive to answer research questions about tailoring communication content, the channel used to deliver the message, and evaluation models that are best suited for examining outcomes of multicomponent tailored, technology-based communication.

Communication↗
PubMedDate not supplied

An alumni-based evaluation of graduate training in health communication: results of a survey on careers, salaries, competencies, and emerging trends.

Published information about career options and the core competencies necessary for health communication professionals (HCPs) is limited. Although the number of graduate programs in health communication continues to grow, no formal assessment of the success of this type of training has been conducted. The current study presents the results of an evaluation of the Master's Program in Health Communication offered collaboratively by Emerson College and the Tufts University School of Medicine. The program was one of the first of its kind and has graduated more health communication students than any other in the United States. To conduct the assessment of the program, the two schools collaborated on the development of an on-line survey for the alumni. Of the 131 graduates eligible to participate, 106 completed the survey. The survey yielded detailed information on the following: (1) career options for individuals with master's degrees in health communication; (2) value of graduate coursework for developing competencies in health communication; (3) salary expectations for individuals with graduate degrees in health communication; and (4) emerging trends in the field. These findings have important implications for the development of new programs and the refinement of existing ones in health communication.

Attitude of Health Personnel↗
PubMedDate not supplied

Communication for HIV/AIDS prevention in Kenya: social-cultural considerations.

The acquired immune deficiency syndrome (AIDS) epidemic is spreading fast in Africa in spite of the various efforts and resources put in place to prevent it. In Kenya, reproductive health programs have used the mass media and other communication interventions to inform and educate the public about the disease and to promote behavior change and healthy sexual practices. This effort has led to a discrepancy between awareness and behavioral change among people of reproductive age. In this article I examine the discrepancy in Kenya from a communications perspective addressing social cultural and related factors contributing to the lack of change in behavior and sexual practices. I draw on the theoretical framework of Grunig's model of excellence in communication, the importance of understanding and relationship building between programs and their stakeholders. Data were gathered qualitatively using focus groups and in-depth interviews among men and women in rural Kenya. Key findings indicate that although awareness of sexually transmitted diseases (STDs) including human immunodeficiency virus (HIV)/AIDS is high in Kenya, a majority of the population, particularly those in the rural communities, lack understanding of the communicated messages. They also lack the knowledge of other ways of transmitting HIV particularly among those not sexually involved. Cultural beliefs, values, norms, and myths have played a role in the rapidly increasing epidemic in the rural communities and yet HIV/AIDS communication programs have not addressed these factors adequately. I conclude that successful behavior change communication must include strategies that focus on increasing understanding of the communicated messages and understanding of the audience through application of appropriate methodologies. Building a relationship with the audience or stakeholders through dialogues and two-way symmetrical communication contributes toward this understanding and the maintenance of the newly adopted behaviors and practices.

Adolescent↗
PubMed2006

Towards safer interprofessional communication: constructing a model of "utility" from preoperative team briefings.

"Improved team communication" is broadly advocated in the discourse on safety but rarely supported by a precise understanding of the relationship between specific communication practices and concrete improvements in collaborative work processes. We sought to improve such understanding by analyzing the discourse arising from structured preoperative team briefings among surgeons, nurses, and anesthesiologists prior to general surgery procedures. Analysis of observers' fieldnotes from 302 briefings yielded a two-part model of communicative "utility", defined as the visible impact of communication on team awareness and behavior. "Informational utility" occurred when team awareness or knowledge was improved by provision of new information, explicit confirmation, reminders, or education. "Functional utility" represented direct communication - work connections: many briefings identified problems, prompting decision-making and follow-up actions. The crux of the model is an elaboration of the causal pathway between a specific communication practice (the team briefing), intermediary processes such as enhanced knowledge and purposeful action, and the quality and safety of collaborative care processes. Modeling this pathway is a critical step in promoting change, as it renders visible both the latent dangers present in current team communication systems and the specific ways in which altered communication patterns can impact team awareness and behaviors.

Communication↗
PubMed2000

Open mother-pre-schooler communication: relations with early secure attachment.

The study examined the links between early infant-mother attachment assessed using Ainsworth's Strange Situation at 1 year and mother-pre-schooler communication at 4.5 years in 113 mother-child dyads. Mother-child communication was assessed during a reunion that followed a one-hour separation and was classified into one of three Open communication or one of five Non-open communication patterns. Results showed that boys who were classified as Secure (B) in infancy tended to have open communication with their mothers, while children of both genders who were classified as Insecure/Disorganized (D) in infancy were likely to have non-open communication with their mothers. No associations were found between the Insecure/Ambivalent (C) attachment pattern and later communication. The contributions of this study to the understanding of the expression of the secure base phenomenon in open mother-child communication are discussed.

Child, Preschool↗
PubMed1989

Junctional communication is induced in migrating capillary endothelial cells.

Using an in vitro model in which a confluent monolayer of capillary endothelial cells is mechanically wounded, gap junction-mediated intercellular communication has been studied by loading the cells with the fluorescent dye, Lucifer Yellow. Approximately 40-50% of the cells in a nonwounded confluent monolayer were coupled in groups of four to five cells (basal level). Basal levels of communication were also observed in sparse and preconfluent cultures, but were reduced in postconfluent monolayers. 30 min after wounding, coupling was markedly reduced between cells lining the wound. Communication at the wound was partially reestablished by 2 h, exceeded basal levels after 6 h and reached a maximum after 24 h, at which stage approximately 90% of the cells were coupled in groups of six to seven cells. When the wound had closed (after 8 d), the increase in communication was no longer observed. Induction of wound-associated communication was unaffected by exposure of the cells to the DNA synthesis inhibitor mitomycin C, but was prevented by the protein synthesis inhibitor, cycloheximide. The induction of wound-associated communication was also inhibited when migration was prevented by placing the cells immediately after wounding at 22 degrees C or after exposure to cytochalasin D, suggesting that the increase in communication is dependent on cells migrating into the wound area. In contrast, migration was not prevented when coupling was blocked by exposure of the cells to retinoic acid, although this agent did disrupt the characteristic sheet-like pattern of migration typically seen during endothelial repair. These results suggest that junctional communication may play an important role in wound repair, possibly by coordinating capillary endothelial cell migration.

Adrenal Cortex↗
PubMed2006

Inaccurate communications in telephone calls to an antimicrobial stewardship program.

BACKGROUND: Antimicrobial stewardship programs (ASPs) decrease unnecessary antimicrobial use, decrease antimicrobial resistance, and improve patient outcomes. The effectiveness of a prior approval system--that is, the requirement that approval be obtained from ASP practitioners before certain antimicrobials can be used--depends on the accuracy of the patient data communicated from the primary service. OBJECTIVES: To determine the incidence of inaccurate communication of patient data during ASP interactions, describe examples of inaccurate communications, and identify risk factors for inaccurate communication. DESIGN: We used a retrospective cohort design. We evaluated the communicated patient data for clinically important inaccuracies, using the patients' medical records as the gold standard. SETTING: A tertiary care medical center that has a prior approval system for restricted antimicrobials. PATIENTS: Inpatients discussed in telephone ASP interactions. INTERVENTION: Observational study. RESULTS: Of telephone calls requesting prior approval from ASP practitioners, 39% (95% confidence interval [CI], 31%-48%) contained an inaccuracy in at least 1 type of patient data (eg, current antimicrobial therapy); the incidence varied widely between data types. Examples of inaccuracies are given to demonstrate their clinical relevance. In multivariable analysis, inaccurate communications were more common for telephone calls from surgical services (versus calls from nonsurgical services: odds ratio, 2.1 [95% CI, 1.1-3.9]) and for calls received by Infectious Diseases fellows (versus pharmacists: odds ratio, 2.0 [95% CI, 1.1-3.8]). CONCLUSIONS: A high proportion of ASP calls requesting prior approval included patient data inaccuracies, which have the potential to affect the prescribing of antimicrobials. Although risk factors were identified, these communication errors were common across the different types of ASP interactions. Inaccurate communications may compromise the utility of ASPs that use a prior approval system for optimizing antimicrobial use.

Academic Medical Centers↗
PubMed2000

Physician beliefs about antiretroviral adherence communication.

Adherence to antiretroviral regimens is thought to be imperative for HIV-positive patients. However, little is known about health care professionals' willingness to discuss adherence with patients, nor what barriers, if any, may impede their adherence communication. The aims of the study were to examine physicians' beliefs regarding: (1) the efficacy of adherence communication, (2) the barriers which impede such communication, and (3) their roles and responsibilities regarding adherence communication. Semi-structured interviews were conducted with 15 physicians who specialize in providing care to HIV-positive patients. Results showed that most physicians believed that communicating with patients about adherence issues was important, even though doing so may not have an immediate impact on patients' behaviors. Physicians believed that adherence communication was a good use of their time and fell within their role as a primary care professional. However, time constraints were cited as a barrier to performing adherence communication, indicating that physicians may do less communicating about adherence than may be optimal if they are burdened with other tasks. Results highlight the need to develop innovative strategies, such as the use of multi-disciplinary adherence teams, to ensure that each HIV-positive patient receives the optimal amount of information about and support for adherence.

Adult↗
PubMed1989

Mechanistic studies on the DDT-induced inhibition of intercellular communication.

Two structurally unrelated compounds, 1,1'-(2,2,2-trichloroethylidene) bis(4-chlorobenzene) (DDT) and 12-O-tetradecanoylphorbol-13-acetate (TPA), are both potent inhibitors of cell-cell communication in vitro as well as tumour promoters in vivo. There is evidence that TPA acts via a specific receptor mechanism involving activation of protein kinase C (pkC). The mechanism of action of DDT has been discussed in terms of membrane perturbation, increased intracellular calcium, interaction with calmodulin and decreased cAMP levels. In the present study the objective was to examine the potential role of pkC activation in DDT-induced inhibition of intercellular communication in cultured cells. The V79 metabolic cooperation assay was used for measuring intercellular communication. Furthermore, the effects of DDT on the activity of partially purified pkC from V79 cells was measured, as was the interaction of DDT with the phorbol ester/DAG-binding site on the pkC enzyme. Results from the biochemical studies showed that DDT neither activates pkC nor binds to the phorbol ester/DAG-binding site, as measured by displacement of PDBU binding. Using the metabolic cooperation assay it was demonstrated that pretreatment with TPA made cells refractory, i.e. a second application of TPA did not inhibit cell-cell communication. DDT added to cells down-regulated with TPA inhibited cell-cell communication, even though these cells were refractive to TPA. This result further supports the hypothesis that DDT and TPA inhibit intercellular communication primarily by different pathways. At non-cytotoxic concentrations, pkC inhibitors (H7, W7 and palmitoyl carnitine) did not affect the TPA- or DDT-induced inhibition of cell-cell communication in the V79 metabolic cooperation assay. Quercetin, a pkC inhibitor which has been reported to eliminate DDT- or TPA-induced inhibition of intercellular communication, was investigated in an in vivo study that measured promotion of enzyme-altered foci in DEN-treated rat liver. Quercetin co-administered with DDT did not act as an antipromoter.

Animals↗
PubMed1991

Cell-to-cell communication: a differential response to TGF-beta in normal and transformed (BEAS-2B) human bronchial epithelial cells.

The effects of transforming growth factor beta (TGF-beta) on cell-to-cell communication were investigated in the log phase of growth in normal BE and in adenovirus-12 SV40 hybrid virus transformed BE cells (strain BEAS-2B). Gap junctions in these cells were identified immunocytochemically. Exposure of BE cells to exogenous TGF-beta (0.04-4.0 pM) in serum-free keratinocyte growth medium (KGM) for 1 or 24 h reduced the rate of fluorescent dye transfer (i.e. cell-to-cell communication) by 30-50% in BE cells. Inversely, in BEAS-2B cells, TGF-beta after 1 h induced a 2- to 10-fold increase in the rate of dye transfer. After 24 h of TGF-beta, communication among BEAS-2B cells was not significantly different from controls (no exogenous TGF-beta). The protein kinase C (PKC) inhibitor H-7 induced a dose-dependent enhancement in communication, which was even higher in the presence of TGF-beta (4 pM X 24 h). The calmodulin antagonist W-7 enhanced communication in BEAS-2B cells independently of the presence of TGF-beta. In keratinocyte basal medium (KBM) supplemented with EGF (5 ng/ml) or with TGF-beta (4.0 pM) dye transfer was reduced or enhanced respectively. The combination of EGF and TGF-beta in KBM antagonized the stimulatory effect of the latter on communication in BEAS-2B cells. In BE cells, continuous exposure (4 days) to TGF-beta in KGM induced a dose-dependent inhibition of proliferation and an increased expression of a keratinized, epidermoid phenotype. This correlated with a reduction in the expression of a mucous secretory phenotype. Increased exposure to TGF-beta (0.04-4.0 pM) decreased the labeling index in BEAS-2B cells, but the cells retained a growth advantage over normal BE cells, and did not express a keratinized epidermoid morphology. With respect to dye transfer as an index of cell-to-cell communication, we conclude (i) that an inhibition or enhancement of communication is involved in the response of bronchial epithelial cells to mitogens (e.g. epidermal growth factor) or growth inhibitors (e.g. TGF-beta), (ii) that PKC and Ca(2+)-calmodulin-dependent processes regulate dye transfer, and (iii) the effects of TGF-beta are mediated by PKC.

1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine↗
PubMed1983

Role of intercellular communication in the promotion of C3H/10T1/2 cell transformation.

The effects of 12-O-tetradecanoylphorbol-13-acetate (TPA) upon intercellular communication and promotion were studied in cultures of C3H/10T1/2 mouse embryo fibroblasts. Cell-to-cell communication was quantitated by autoradiographic analysis of [3H]uridine transfer from prelabelled donor cells to an excess of unlabelled recipient cells during a 4 h co-cultivation. Extensive transfer of label was observed from donor to recipient cells in contact. Treatment of non-transformed C3H/10T1/2 cultures with 250 ng/ml TPA at co-cultivation of donor and recipient cells markedly inhibited intercellular communication during the 4 h incubation, producing an 80% reduction in uridine exchange relative to solvent-treated control cultures. Concentrations of TPA ranging from 0.25 to 25 ng/ml were also effective in inhibiting [3H]uridine exchange in a dose dependent fashion from 13% to 74%. This inhibition of intercellular communication was transient; cells exposed to 250 ng/ml TPA for 1.5 h prior to co-cultivation with TPA exhibited a 60% inhibition and the exchange of uridine had increased to control values in cultures pretreated for 12-72 h. An examination of label transfer between non-transformed and transformed C3H/10T1/2 cells indicated that both the extent of inhibition by TPA and the kinetics of communication inhibition were similar to that observed for non-transformed cells. Initiation and promotion experiments demonstrated that exposure to 250 ng/ml TPA for 5 weeks, but not to reduced concentrations of 0.25, 2.5 or 25 ng/ml, was capable of promoting morphological transformation. The lack of correlation between the dose responses of TPA for promotion and for reduction of cell-to-cell communication, and the transient nature of intercellular communication inhibition by TPA, suggests that an inhibition of cell-to-cell communication is not a sufficient event for promotion of oncogenic transformation in these cells.

Animals↗
PubMed2005

The impact of visual communication on the intersubjective development of early parent-child interaction with 18- to 24-month-old deaf toddlers.

This article presents a study that examined the impact of visual communication on the quality of the early interaction between deaf and hearing mothers and fathers and their deaf children aged between 18 and 24 months. Three communication mode groups of parent-deaf child dyads that differed by the use of signing and visual-tactile communication strategies were involved: (a) hearing parents communicating with their deaf child in an auditory/oral way, (b) hearing parents using total communication, and (c) deaf parents using sign language. Based on Loots and colleagues' intersubjective developmental theory, parent-deaf child interaction was analyzed according to the occurrence of intersubjectivity during free play with a standard set of toys. The data analyses indicated that the use of sign language in a sequential visual way of communication enabled the deaf parents to involve their 18- to 24-month-old deaf infants in symbolic intersubjectivity, whereas hearing parents who hold on to oral-only communication were excluded from involvement in symbolic intersubjectivity with their deaf infants. Hearing parents using total communication were more similar to deaf parents, but they still differed from deaf parents in exchanging and sharing symbolic and linguistic meaning with their deaf child.

Child Development↗
PubMed2003

Communication in general practice: differences between European countries.

BACKGROUND: Based on differences in national health care system characteristics such as the gatekeeping role of GPs (at the macrolevel) and on diverging GP and patient characteristics (at the microlevel), communication may differ between countries. Knowledge of the influence of these characteristics on doctor-patient communication will be important for setting European health care policies. OBJECTIVES: Our objectives were (i) to compare doctor-patient communication in general practice between European countries; and (ii) to investigate the influence of the gatekeeping system and GP and patient characteristics on doctor-patient communication in general practice. METHODS: Fifteen patients per GP (in total 2825 patients) of 190 GPs in six European countries were included. Participating countries were The Netherlands, Spain, the UK (gatekeeping countries), Belgium, Germany and Switzerland (non-gatekeeping countries). Data were collected by means of patient and GP questionnaires and observation of videotaped consultations, and analysed by one-way and multilevel, multivariate analysis. RESULTS: Differences in communication between countries were found in: affective and instrumental behaviour; biomedical and psychosocial talk; GPs' patient-directed gaze; and consultation length. The study showed that GPs' gatekeeping role (with registered patients) was less important for doctor-patient communication than was expected. Patient characteristics such as gender, age, having psychosocial problems, and familiarity between the doctor and the patient were the most important in explaining differences in communication. CONCLUSION: The gatekeeping role of GPs is hardly important in explaining doctor-patient communication. The relationship is more complex than expected. Patient and GP characteristics are more important. Cultural factors should be included in future studies.

Adult↗
PubMed2001

Health literacy: communication for the public good.

This article builds upon a presentation at the Fifth Global Health Conference on Health Promotion (Mexico City, 9 June 2000), seeking to advance the development of health literacy through effective communication. First, it offers a timely reflection for health promotion epistemology in particular, and the potential approach to framing health promotion activities in general, with health literacy as a bridging concept. The concept of health literacy is briefly explained and defined, followed by identification of some promising communication interventions to diffuse health literacy. Four predominant areas within the communication field are described that shed light on approaches for developing health literacy: integrated marketing communication, education, negotiation and social capital. Each component can contribute to strategic science-based communication. Finally, the article elucidates that communication and developing health literacy are not simple solutions. Communication is not simply message repetition, but includes the development of an environment for community involvement to espouse common values of humankind. With effective communication, worldwide health literacy can become a reality in the 21st century, embodying health as a central tenet of human life.

Educational Status↗
PubMed2005

Sexual health promotion in Chennai, India: key role of communication among social networks.

Communication about sex and sexual health is an important facilitator in gaining accurate knowledge about prevention of sexually transmitted diseases (STDs) and promotion of sexual health. Understanding how and with whom communication about sex occurs and the nature of the information exchanged is valuable in designing sexual risk prevention interventions. In this study of low-income communities residents in Chennai, India, our aim was to understand the composition of personal communication networks, the nature of information related to sex and sexual health that is exchanged in these networks and the value of communication among members of these networks. We conducted in-depth open-ended interviews using a structured interview guide with 43 individuals. We also conducted 12 focus group discussions. Individuals were selected using snowball sampling. Our results indicate that information about sex and sexual health is exchanged within and between four groups: married women, married men, unmarried men and unmarried women. Communication leads to an expansion of sexual networks among unmarried men and treatment seeking behaviour for STDs in all groups. Unmarried men offer immense potential for intervention given the range of topics related to sex and sexual health that are discussed and the risky sexual behaviours practiced. Spousal communication about sexual behaviour or sexual health is minimal and shifting norms for prevention would be difficult. Interventions identifying communication networks and influencing the natural communication patterns in these networks may be a viable HIV prevention strategy in the study area.

Adolescent↗