Health dialogue elements present during health communication between patients with diabetes and nurses in a Northern Cape local municipality
Talbot, Lesley Jeanette
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Patients and nurses in health facilities interact daily with the purpose of improving health outcomes. However, it is not known to what extent the elements of health dialogue are incorporated into each individual patient and nurse interaction. A concept analysis of “health dialogue” laid the foundation to identify the presence of the antecedent and empirical referent health dialogue elements during health communication between patients with diabetes and nurses in the Northern Cape. The objective of the study was to assess, through observation, the presence of the health dialogue elements, namely, antecedents, which are a positive attitude, sensitivity and respect, and training; and empirical referents, which comprise shared responsibility and decision-making, a mutually beneficial health plan and contextsensitive communication strategies. A quantitative, non-experimental, descriptive, cross-sectional research design was used. Data were collected using an observational checklist aided by a guideline at public and private health facilities (n=16) in the Sol Plaatje local municipality located within the Frances Baard District. Patients with diabetes (N=88) and nurses (N=22) were observed while they interacted during one-on-one consultations (n=88). Each nurse interacted with more than one patient. Audio-recordings of interactions were used to verify and support observations. Data analysis was carried out using descriptive statistics, namely, frequencies and percentages for categorical data, medians and percentiles for continuous data, calculated per group, and comparing nurse and patient responses. McNemar’s test or Bhapkar’s test was applied to compare the statistical difference in responses between the nurses and the patients. Inconsistencies (48.8%) in the presentation of the health dialogue antecedent elements and sub-elements of positive attitude and sensitivity and respect during nurse-patient interactions, were noted. The antecedent element findings for training noted nurse training in diabetes (19.3%) and in communication skills (30.6%), whilst patient training and information about diabetes (48.7%) and communication skills (3.4%) were found. In accordance with the concept analysis of health dialogue, the inconsistencies noted in the presentation of antecedent health dialogue elements imply that it was not likely that the empirical referents could be realised. However, both nurses and patients stated that the empirical referent elements of shared responsibility/decision-making, a health care plan of mutual benefit and the application of context-sensitive communication strategies to convey health messages were experienced during the study. These findings indicate that both nurses and patients are unable to incorporate the antecedent health dialogue elements during interaction with one another. In addition, nurses and patients appear to be ill-prepared to include participatory health communication and health dialogue in interaction. Capacity building of both nurses and patients is recommended to enhance participatory health communication.