Effective Interpersonal Communication

Effective InterpersonalCommunicationA Handbookfor Health Care ProvidersJuly 2008

Table of ContentsPreface . 3Acronyms . 4Section 1: Understanding IPC. 5Section 2: Key Elements of Effective IPC. 6Section 3: Verbal and Nonverbal Communication Techniques . 9Section 4: Using the G-A-T-H-E-R Method. 10Section 5: Using Visual Aids and Other Informational, Educational, andCommunication (IEC) Materials. 11Section 6: Guide to the ART Flipbook . 14Section 7: Guide to the Flipbook for counseling caregivers of HIV positivechildren . 17Section 8: Guide to the Family Planning Flipbook . 19Section 8: Guide to the IPT Gestation Wheel. 22Section 9: Guide to the Patient Adherence Calendar. 25Section 10: Guide to the TB Flipbook . 27ANNEX A: Pocket Guide for IPC . 292

PrefaceAcross Uganda, health care workers provide an invaluable frontline in theprevention and treatment of illness. One of the greatest challenges they face iscommunicating effectively with clients of various literacy levels and limitedexperience as patients. At the same time, accurate diagnosis, appropriatetreatment, and good adherence all depend upon an open flow of informationbetween health care providers and their clients. Health care workers who canenhance their interpersonal communication skills have the potential tomeasurably improve care and treatment outcomes.This handbook is part of a collaborative effort to build interpersonalcommunication skills among health care workers, and, in particular, developcapacity for the effective application of visual aids. Accompanying anorientation for providers, this handbook presents in-depth information oninterpersonal communication along with guidelines for using specific visualaids, including:oooooFamily Planning FlipbookAntiretroviral Therapy FlipbookTuberculosis FlipbookIPT Gestation WheelPatient Adherence CalendarHIPS developed this handbook with technical assistance from the JohnsHopkins University Center for Communication Programs. We would like tothank The Mildmay Center for their crucial assistance in orienting health careworkers to use these materials. Moreover, we would like to thank the healthcare workers across Uganda who will put these tools into action. Enjoy!About HIPS:Health Initiatives for the Private Sector, or HIPS, is a project that responds to Uganda’sunmet health needs with innovation and collaboration. Through partnerships with theprivate sector, the HIPS project helps companies expand access to health services. HIPSfocuses on ensuring clinical quality, efficiency and capacity building to promote healthservices that are effective and sustainable. In this way, HIPS aims to increase access to andimprove the quality of health care across the country. The HIPS project is the outcome of atruly collaborative effort. The consortium includes: Emerging Markets Group (EMG), JohnsHopkins Bloomberg School of Public Health Center for Communications Programs (CCP),The Mildmay Center, and O’Brien and Associates International.3

AcronymsAIDSAcquired Immune Deficiency SyndromeAFFORD/UHMGAfford/Uganda Health Marketing GroupARTAntiretroviral therapyCCPCenter for Communication ProgramsEMGEmerging Markets GroupFPFamily PlanningHIPSHealth Initiatives for the Private SectorHIVHuman Immune-deficiency VirusIECInformation, education and communicationIPCInterpersonal communicationITNInsecticide Treated NetMOHMinistry of HealthPLHAPeople Living with HIV/AIDSSTISexually Transmitted InfectionTMCThe Mildmay Centre4

Section 1: Understanding IPCWhat is Interpersonal Communication (IPC)Interpersonal Communication is face to face verbal or non-verbal exchange ofinformation and feelings between two or more people. Each time a serviceprovider has contact with a client, communication is taking place.Why Is Interpersonal Communication Important?Benefits for clientsShort term:o An accurate diagnosis is reached because theclient discloses enough information abouthis/her illnesso A medically appropriate treatment that is alsoaccepted by the client is selectedMedium term:o The client adheres to his/her treatment becausehe/she understands it and is committed to itLong term:o The client utilizes follow-up serviceso The client is better able to maintain his/herhealthBenefits for providerso Improved quality of services leads to increasednumber of clientso More efficient and effective diagnosis andtreatment reduces costs for providerso Effective communication reduces workload andsaves time because it reduces instances ofinaccurate diagnosis, inappropriate treatment,and poor adherenceOutcome ChecklistIf you have communicatedeffectively with your client, youshould be able to answer’ yes’ tothe following: Your client disclosed enoughinformation about the illness tolead to an accurate diagnosis You consulted with the clientto select a medically appropriatetreatment that is also acceptableto the client Your client understands his orher condition and the prescribedtreatment regimen You and your client have apositive rapport You and your client both feelcommitted to fulfilling yourresponsibilities during treatmentand follow-up careHealth system benefitso Increased efficiencyo Greater cost-effectivenesso Healthier population5

Section 2: Key Elements of Effective IPCThere are three main types of communication interactions that occur within aprovider-client relationship. They are: Caring: The goal is to establish and maintain a positive rapport with thepatient. Problem solving: The goal is for the patient and provider to share allnecessary information for accurate diagnoses and appropriate treatment. Counseling: The goal is to for clients to understand their condition andadhere to their treatment.While they occur throughout an interaction, these types of communicationoften happen sequentially, with caring communication to establish a positivetone, then problem solving to diagnose, and finally counseling to providerelevant health education. To communicate effectively through these differentinteractions, it can help to keep in mind some key elements of effective IPC.Creating a Caring AtmosphereWhen patients believe that their provider cares about them and is committed totheir welfare, they are more likely to communicate effectively and engage intheir own health. Both verbal and non-verbal communication help the providerconvey interest and concern to patients. Appearing busy or distracted makespatients feel insecure, anxious or fearful of their relationship with the provider.On the other hand, being attentive, making eye contact, listening, questioningthoughtfully, and demonstrating comprehension and empathy make patientsfeel important and worthy.Building Partnerships with ClientsHealthcare occurs through a partnership between provider and client. Eventhough the provider is the medical expert, both provider and patient areresponsible for the outcome of their interaction. Mutual respect, trust, andjoint decision-making increase the likelihood of a positive outcome. Treatmentregimes are more effective with providers and clients make decisions togetherand patients have an active role in their care and treatment, asking questions,and making commitments and relevant changes in their health behaviors.6

Bridging of Social DistanceSocial gaps between clients and providers can arise from differences that existbetween them such as differences in education, economic status, gender, age,and many other factors. These differences can hinder IPC substantially.Establishing an open dialogue, a feeling of partnership, and an atmosphere ofhonesty and caring all help to bridge social distances.Fostering Two-way DialogueGood interpersonal interaction between client and provider is, by definition, atwo-way street where both speak and are listened to without interruption, bothask questions, express opinions and exchange information -- and both are ableto fully understand what the other is trying to say.Providing Opportunities for Patients to Speak About Their IllnessProviding ample opportunity for a patient to describe his or her illness leads tostrong IPC. Storytelling has its own healing value, in that it provides patientswith a release and opportunity for insight and perspective. It may also affordthe health provider the insights needed to understand, interpret and explorethe significance of the symptoms and clues the patient provides.Using Verbal Communication EffectivelyVerbal communication consists of spoken and written words that people use toconvey ideas. In a healthcare encounter, the choice of words clients andproviders use greatly influences how well they understand each other. Themedical jargon physicians use to describe symptoms and treatments oftenconfuses to patients. At the same time, patients often communicate in theirdialects, accents and slang, often making comprehension difficult for providersfrom other areas. Patients also describe health problems in peculiar ways,often reflecting their unique perspective on the illness’s origin or severity.Using Non-Verbal Communication EffectivelyWords express only part of a message being conveyed, while tone, attitude andgestures convey the rest. Avoiding distractions, such as answering thetelephone during a patient’s visit or scribbling notes on other cases, andappearing fully attentive communicate positive messages to clients. Often,simple gestures by the provider, such as a warm greeting, can help put theclient at ease and enhance IPC.7

Checklist for the elements of effective IPCCaringProblem SolvingCounselingHave you . . .Have you . . .Have you . . .o Greeted the client in anopen and appropriatewayo Listened activelyo Explored the client’sunderstanding of his/herillnesso Used nonverbalcommunication to showthat you are listeningo Invited the patient to tellyou how the/she feelsboth physically andemotionallyo Shown the client thathe/she is respected andvaluedo Demonstrated concernand empathyo Echoed the clientsemotionso Expressed support andpartnershipo Given realisticencouragement andreassuranceo Acknowledged anyservice problems,apologized, and offereda solutiono Encouraged dialogueusing open-endedquestionso Avoided interrupting thepatiento Avoided distractionso Asked the client whatthey think has causedthe ailmento Probed the client formore information usingphrases like “please goon”o Waited until you have allthe relevant informationto make a diagnosiso Correctedmisunderstandings ormisinformationo Used vocabulary andexplanations that theclient can understando Used visual aids ifavailableo Recommended concretebehavioral changeso Collaborated with theclient to select anappropriate and feasibletreatmento Motivated the client tocomply with thetreatmento Summarized thediagnosis, treatment,and recommended stepsin simple termso Asked the client torepeat or describe thetreatment termso Urged the patient to askadditional questionso Confirmed follow upactions with patient8