Christina A Laurenzi, Stephan Rabie, Sihle Mamutse, Sarah Skeen, Nicola Jansen van Vuuren, Rosanne Neethling, Sally Field, Simone Honikman
{"title":"Exploring Empathic Communication Among Community Health Workers: Applying the ENACT Tool in Two South African Sites.","authors":"Christina A Laurenzi, Stephan Rabie, Sihle Mamutse, Sarah Skeen, Nicola Jansen van Vuuren, Rosanne Neethling, Sally Field, Simone Honikman","doi":"10.1177/15248399241285888","DOIUrl":null,"url":null,"abstract":"<p><p><i>Introduction</i>. 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. <i>Methods</i>. 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. <i>Results</i>. We analyzed <i>n</i> = 66 recordings from 11 CHWs, observing positive directionality overall, with most skills improving over time. Despite near-significant improvements in communication delivery (<i>p</i> = .083), self-confidence/groundedness (<i>p</i> = .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. <i>Discussion</i>. 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.</p>","PeriodicalId":47956,"journal":{"name":"Health Promotion Practice","volume":null,"pages":null},"PeriodicalIF":1.6000,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health Promotion Practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/15248399241285888","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction. 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. Methods. 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. Results. We analyzed n = 66 recordings from 11 CHWs, observing positive directionality overall, with most skills improving over time. Despite near-significant improvements in communication delivery (p = .083), self-confidence/groundedness (p = .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. Discussion. 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.
期刊介绍:
Health Promotion Practice (HPP) publishes authoritative articles devoted to the practical application of health promotion and education. It publishes information of strategic importance to a broad base of professionals engaged in the practice of developing, implementing, and evaluating health promotion and disease prevention programs. The journal"s editorial board is committed to focusing on the applications of health promotion and public health education interventions, programs and best practice strategies in various settings, including but not limited to, community, health care, worksite, educational, and international settings. Additionally, the journal focuses on the development and application of public policy conducive to the promotion of health and prevention of disease.