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Table 4 Summary of Pubmed search on communication models in interventions of curricula HL

From: A dynamic approach to communication in health literacy education

Authors Keywords and citation Purpose of the intervention Intervention approach or strategy Sample & Evaluation method/ Communication model
(e.g. Huber, intrinsic motivation, SDT, self-efficacy, Health Literacy, Four Habits Model)
Chen [34] Health literacy education; (health literacy in student education) Improve verbal instruction skills of pharmacy students. Exercise with re-writing assignments targeting people of low health literacy; tools on measuring language difficulty like Flesch-Kincaid tool. Student pharmacists: N = 303
Evaluation questionnaire on perceived satisfaction of participants.
Focus on Sender and Message; information about Receiver; classical +SMR.
Cotugna [35] Study mentions: ‘problem of self-management skills’ (p. 878) The purpose of the project is to develop, implement and evaluate a health literacy module for a nutrition education course that would involve students interacting with professionals. Learning about the problem of health literacy: the outcome goal of the module was to have students produce and present a 3-hour workshop for health care practitioners on the topic of health literacy. Learning by developing a workshop on the topic. Female professionals: N = 33
Evaluation questionnaire on perceived satisfaction of participants on a workshop.
Focus on Sender and Message; information about Receiver; classical SMR.
Doyle [17] Language difficulty in healthcare Improving communication between healthcare professionals and patients focusing on writing patient information leaflets (PILs). Learning to write at the level of the target group using tools on measuring language difficulty like Flesch-Kincaid tool Medicine students: n = 357, physiotherapy students: n = 337.
Evaluating the PILs: measurement of language complexity with Flesch-scale on readability. The DISCERN tool was being used for measuring student feedback on the learning experience.
Focus on (readability of the) Message: Classical communication Model.
Finset [36] Four Habits communication and taking the patient perspective/person- centered approach To communicate with patients on a personal level. Four Habits Model (Krupat et al, 2006). The model is based on creating empathic opportunities. Some constructs of the model fit with the construct of autonomy in SDT such as face to face interpersonal exchange using sensitivity to patient cues and concerns. Literature review With emphasis on the patients’ perspective, changing R (patient) into S (sender); therefore creating RMS; R<>M<>S
This approach most likely takes into account the intrinsic motivation and autonomy of the patient (without making these aspects explicit).
Advanced SMR model
Goto [18] Health literacy education; (health literacy professionals) The training program was designed to help health professionals understand the gap between professional knowledge—including terms and concepts, and the public’s understanding of health and science related information. Model program by Rudd (c.f.: Updated 6 April 2015
Public Health Nurses: N = 33
Quantitative data: questionnaires.
Qualitative data: interviews and discussions with participants.
The intervention focuses on skills in developing texts and educational materials.
Classical SMR model
Grice [32] “Elicit the patient’s perspective”. In the model patients’ motivation is included as a part of habit 4: “Invest in the end”. To assess whether student pharmacists' communication skills improved using the Four Habit Model at a College of Pharmacy; focusing on empathy. Role play in exercising interviews with patients with formative feedback; summative assessment in real interactions with patients Student pharmacists: N = 158
Scoring of interactions with video; analysis of scores
Interaction model that ensures effectiveness on both sides of the interaction
McCleary [19] Health literacy education; (health literacy student knowledge) To improve students’ knowledge of health literacy A hybrid course on Health Literacy, using 16 online course modules and 7 live class meetings for a baccalaureate nursing program (topic: pharmacology). Nursing students; N = 89
Pretest- posttest; items scoring knowledge on HL
Classical SMR model
Patterson [37] Health literacy communication To develop and implement an advanced pharmacy practice experience aiming to increase student's awareness of, acceptance of and ability to apply public concepts in pharmaceutical care. Acquiring information on HL (reading the AMA's Health literacy manual for Clinicians) and actively participate in a community outreach day in a special community. Pharmacy student’s: N = 9
Discussions on several themes (formative) and assessment scores on 5 abilities, no 5 relates to communication: “Refer a patient to community resources as appropriate.
There are no special activities that can explicitly be linked to a distinct communication model. Assessed ability on five links to the classical SMR model.
Planas [38] Communication skills, scaffolding, self-directed learning There is a lack of consensus on the essential components of effective pharmacist-patient communication. There is a need for reliable, authentic, and comprehensive assessments of pharmacy students’ communication skills. The objective of the intervention is a) to describe a communication skills development system (CSD), and b) to evaluate the systems’ effectiveness in a clinical communications course. Implementing a Communication Skills Development (CSD), special for Clinical Communications. Vygotsky’s constructivists approach for scaffolding skill development of students.
A web-based environment also supporting video was used for practicing specific skills.
Student participation: N = 123
Evaluation of interviews (two rounds) on four criteria (n = 123 faculty, self and patient assessments; n = 284 peer assessments). Composition of SOAP notes was used as well.
The learning outcomes are dealing with: “a) effective communication while conducting interviews, b) gather and use pertinent information during patient interview to optimize patients’ drug therapy outcomes, c) compose a well-written SOAP note.
d) Provide constructive feedback to self and peers (..) to improve communication with patients, e) construct, present, implement and reflect on a plan of action to achieve goals for improved communication with patients”.
Advanced SMR-model.
Poirier [39] Health promotion and literacy To design, implement, and evaluate a course on health promotion literacy Students acquired intercultural communication skills in the context of HL. Activities were grouped into 7 clusters, like the exploration of health beliefs, discussing a film, and developing knowledge on HL and getting familiar with instruments to identify HL Pharmacy students: N = 81
Pre-post model using Inventory for assessing the process of cultural competence among healthcare professionals (IAPCC-R) scores.
Developing cultural competences refers to an advanced SMR model
Primack [40] Health literacy, patient interaction, patient education To evaluate an innovative, theory-based, educational intervention involving social marketing and health literacy. The intervention aims to train health care providers to deliver care sensitive to the needs of diverse individuals with varying degrees of HL
Applying theory of social marketing on communication in HL contexts. Developing skills in developing effective patient materials. Brochure development. Key elements of the approach are: considering the background, abilities and desires of a particular group of patients in their effort to “market” a specific health-related outcome to this “target audience” (cf 1. Introduction). First year medical students: N = 147
Pretest-posttest, matching individuals for comparing results in t-test model. Data were derived from questionnaires (“I feel comfortable taking care of a patient of a different race than me”).
Advanced SMR model, focusing on marketing the message
Roberts [41] Health literacy curriculum, Teach back method To implement and evaluate a new health literacy curriculum for third year medical students. Student learned:
1. to define the concept of HL
2. to describe the impact of HL on patient care (..)
3. to identify patients with low HL (..)
4. to use methods for better communication (like Teach Back)
Third year medical students: N = 152
1. written evaluation
2. pre-test - post-test questionnaire
3. assessment on discussion board Blackboard
4. score communication skills with standardized patients in teach back
5. extra post-test (two questions
Advanced SMR
Stacey [10] Nursing curriculum, patient decision support, decision coaching. To integrate patient decision support into an existing curriculum. The Ottawa Decision Support Framework (ODSF) focuses on three aspects: decisional needs, decision quality decision support. Nursing students: N = 114
The integration of the ODSF is being guided by the method of Knowledge to Action Process (Graham et al, 2006).
The intervention is not based on experimental data.
Advanced SMR (static interpretation of support)
Sullivan [42] Health promotion access To describe a teaching-learning strategy in a baccalaureate school of nursing. Partnering with community agencies to provide nursing students with cultural awareness experiences and refugee health promotion access. literature studies, formative interviews in the communities; making use of informants for obtaining information Hmong refugee family representatives: N = 40
Outcomes from student and for refugee population. Student outcomes: evaluation of a weekly reflective journal; communication and didactic tools that were developed by the student were assessed. Also a presentation of each student was assessed. For the refugees outcomes to be assessed could be e.g. newly learned words, their verbal explanations etc., summarizing their (growth in) understanding of information taught by the students.
cf. evaluation method:
advanced SMR model
Scheckel [30] Self-efficacy, to provide patients education in a broader systems level context To describe undergraduate nursing students’ experiences of learning and providing patient education Students reflected on the question: “One of the core responsibilities of nurses is providing patient education. Nursing education courses often include teaching students to provide patient education. Can you tell me of a time during your nursing education, one that stands out to you, that reflects what it meant to learn and provide patient education?”
The answers (also including examples of their practices) of the students were interpreted by the authors.
Undergraduate nursing students: N = 8
Interpretative phenomenology; Unstructured face-to-face audio-taped interviews revealed communication skills and sensitivity for patient-contexts of students focusing on understanding and instruction
Classical SMR, model; taking the context of patients into account
Shieh [43] Nurse education, HL, curricular development; self-regulating To explore undergraduate nursing students’ experiences in caring for patients with low health literacy. Student wrote an essay linking a definition of HL to their experiences with patients. Nursing students: N = 70.
Qualitative analysis of the essays in several rounds; coding with, e.q.:
Simplifying information, reinforcing information, giving written information, using demonstration and Teach Back, adopting additional communication strategies, collaborating with experts; changing patient knowledge and behavior, reducing patient emotional strain, feeling positive about the interaction/experience, failing to change the patient,
Coding refers to (advanced) SMR model
Weiss [44] Health literacy, clear two way communication To inform professionals on health literacy; information, approaches 1. web based course;
2. promoting Teach Back
Medical students, residents, fellow, physicians, nurses, therapists, social workers and caregivers (N = not provided in the article)
Short quizzes, health literacy tests and video vignettes are included in a web based module
1. classical SMR;
2. Teach Back: advanced SMR