A dynamic approach to communication in health literacy education

Background: Research within the framework of Self-Determination Theory (SDT) indicates that patients' autonomy is to be considered a critical health care outcome in its own right since it promotes improved mental and physical health. This paper presents an analysis of studies addressing communication and interaction interventions in health literacy curricula for medical and health care practitioners, focusing on patient-oriented skills in making sense and to adapt and self-manage. For evaluating interventions, underlying communication models were traced. The criteria for good practice are making sense and supporting autonomy in making choices. For the search of interventions, keywords from both the framework of the EU-project, Intervention Research on Health Literacy among Ageing population (IROHLA (The IROHLA project received financial support from the European Union through FP7 Grant 305831)), as well as the SDT (Self Determination Theory) were applied. The research question of this paper is to what degree is autonomy supporting communication skills part of the curricula of health literacy (HL) for medical and health care practitioners and providers? A Pubmed search revealed: a) that making sense is clearly represented in HL interventions in curricula; however, b) very few interventions teach medical and health care practitioners how to give autonomy support in the interaction with their (future) patients. Four promising, beneficial practices were identified. Several recommendations were presented encouraging curriculum developers to adapt skills of supporting autonomy into their programs. Methods: A qualitative content analysis of interventions in the curricula of communication and interaction skills for medical students and practitioners. Results: A review of literature indicates: a) most interventions in curricula for medical students and practitioners are focusing on skills in adequately providing information to patients by using an underlying (advanced) Sender-Message-Receiver Model; and b) only a few interventions in curricula are available for providing the acquisition of interaction skills in supporting autonomy. Conclusions: The proposal of Huber and others to change the emphasis in the definition of the WHO definition on health towards to adapt and self manage has impact on the training of medical students and practioners in dealing with patients with low levels of health literacy. From the present study it can be concluded that a dynamic approach to communication can be linked to theoretical constructs on self-management. In such an approach interaction techniques like scaffolding can increase the level of HL of the patient.