Exploring Empathic Communication Among Community Health Workers: Applying the ENACT Tool in Two South African Sites.

IF 1.6 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Health Promotion Practice Pub Date : 2024-10-05 DOI:10.1177/15248399241285888
Christina A Laurenzi, Stephan Rabie, Sihle Mamutse, Sarah Skeen, Nicola Jansen van Vuuren, Rosanne Neethling, Sally Field, Simone Honikman
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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.

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探索社区卫生工作者之间的移情沟通:在南非两地应用 ENACT 工具。
导言医疗服务提供者与患者之间有效的移情沟通是医疗保健的重要组成部分。在资源匮乏的情况下,我们需要证据来了解实际临床工作中医护沟通的质量和内容。我们使用现有的 "常见治疗因素强化评估"(ENACT)工具来测量南非一组接受名为 "Nyamekela4Care "的新型质量改进干预措施的社区医疗工作者(CHWs)的移情沟通技能。方法在南非西开普省的两个资源有限的地点,我们在征得同意的情况下,对社区保健员在基线和干预后的常规客户咨询过程进行了录音。所有咨询均以南非荷兰语进行。我们使用经过改编的 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移情沟通实施前和实施后的差异,并分析了编码员对编码过程本身的反馈。结果。我们分析了来自 11 名社区保健工作者的 n = 66 份录音,观察到总体上存在积极的方向性,大多数技能随着时间的推移得到了提高。尽管在沟通表达方面有了近乎显著的提高(p = .083),但自信心/踏实度(p = .029)却发生了显著变化,但方向相反。在口头交流、对客户的响应能力和识别外部资源方面,观察到了较大的效应大小,不同时间点之间没有明显差异。ENACT 适用于录音是可行的;尽管对编码员进行了培训并提供了持续的监控和支持,但编码员之间的可靠性并不理想。讨论。质量改进干预措施可在不同情况下提高移情技能,我们的研究结果表明了如何在资源匮乏的医疗环境中对移情技能进行更常规的评估。
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来源期刊
Health Promotion Practice
Health Promotion Practice PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
3.80
自引率
5.30%
发文量
126
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.
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