Communication strategies to accomplish effective health dialogue in adults with chronic diseases in low and middle income countries: an integrative review

[摘要] English: Communication strategies are used to inform, influence and motivate individuals and communities about health. It is, however, imperative that health communication strategies suit the needs of the audience in order for the audience to comply with the health recommendations. In an era where chronic diseases in low- and middle-income countries (LMIC's) are reaching endemic proportions, using communication strategies that can accomplish effective health dialogue is crucial.The purpose of the study was to provide a critical review and synthesis of the best available evidence of communication strategies used to accomplish effective health dialogue in adults with chronic diseases in low- and middle-income countries from the year 2000 to 2014. The methodology of an integrative review was used since it is the broadest type of research review and can include theoretical literature, empirical literature, or both. A focused review question based on the PICO format (PICO = population, intervention, comparison intervention, outcome) guided the review process. Multiple databases and search methods were used to identify studies relevant to the review question. The systematic search strategy identified 3464 records and after a filtering process, eight studies met the criteria and were selected for critical appraisal. Four researchers critically appraised the studies in a round table discussion using standardised critical appraisal tools. Seven out of the eight studies were found methodologically adequate and were used for analysis. The seven studies made up a heterogeneous sample of five randomised controlled trials, one case-study and one qualitative study, and consequently, a meta-analysis was not feasible.After thematic analysis, the synthesis process led to the formulation of the following concluding statements related to the review question. The researcher also provided one example of the recommendations per concluding statement: Which communication strategies are used during effective health dialogue with adults with chronic diseases in low and middle income countries in terms of:1) How is communication conducted? A variety of strategies can be used to accomplish effective health dialogue in adults with chronic disease in low- and middle-income countries. Recommendation: Since healthcare providers mostly are involved in one-on-one and small-group health dialogue with adults affected by chronic diseases in low- and middle-income countries, a greater sensitivity needs to be created towards the benefits of tailoring such communication. This goes hand in hand with equipping these healthcare providers with the necessary skills to conduct such tailored communication. Skills training in tailored communication ideally should form part of undergraduate education, but also be included in in-service training of qualified healthcare providers.2) When is communication conducted? Frequently scheduled communication strategies can be used to accomplish effective health dialogue in adults with chronic disease in low- and middle-income countries. Recommendation: Since the frequency of communication reported differs from study to study, the healthcare provider should take the information needs of the patient into consideration and plan communication sessions according to the information needs of the patients.3) What is communicated? A communication strategy that provides focused and specific information to the individual or group can be used to accomplish effective health dialogue in adults with chronic disease in low- and middle-income countries. Recommendation: Since the focus of the communication was unique to each study reported, it is recommended that the healthcare providers who decide to make use of the strategy, should provide communication according to the condition and needs of the patient(s) involved. The healthcare provider should use a multi-strategy approach, for example, one-on-one communication augmented by brochures or mobile messages to re-enforce the message. A dedicated national and provincial health communication unit focusing on such a multi-strategy would strengthen healthcare providers' hands to implement such a strategy. 4) Where is communication conducted? A communication strategy that accomplishes effective health dialogue in adults with chronic disease in low- and middle-income countries, takes place in a convenient and private setting. Recommendation: The use of private rooms within nearby community facilities needs to be actively pursued by healthcare providers, especially in the light of the challenges faced by public healthcare facilities �?space being one such a challenge. Involving community members when creating clinic committees could be an example of how to go about securing such facilities.5) By whom is communication conducted? A communication strategy that accomplishes effective health dialogue in adults with chronic disease in low- and middle-income countries is provided by trained lay persons and/or healthcare professionals, as well as automated computer systems. Recommendation: Since 'trained' volunteers and peer leaders may not always be readily available, such individuals and groups should be purposefully involved in the health activities of the health facilities. The groups may be identified from patients, non-governmental organisations, or non-profit organisations in the community. Healthcare providers should become involved in the training of these groups. Training could involve disease management, but could also include communication skills.The comprehensive synthesis of the literature has led to the creation of new knowledge and perspectives that might be of great value in developing and using communication strategies in patients with chronic disease in LMICs.

[发布机构] University of the Free State