Health Behavior Clinical Trial
Official title:
Sustainable Health Systems Through Health Literacy for Healthy Aging
In this study, the investigators evaluate an intervention aiming to increase participation and communication of older adults during primary care consultations with their General Practitioner(GP). The investigators are particularly interested in a Photo novel tool with this aim. Photo novels are picture stories, which have the advantage of using a familiar narrative format, thereby possibly increasing comprehension, personal involvement and motivation and self-efficacy to perform the relevant behaviors by offering role models (story characters that are similar to older adults themselves). The patient perspective on doctor-patient communication is underrepresented in most research. This study aims to incorporate the patient perspective in different ways: in addressing their needs and barriers during focus group discussions, in collecting their communication strategies and solutions to these barriers in the role play exercise, in involving them in developing the photo novel, and in studying their responses to the photo novel in the evaluation study the investigators describe in this research proposal.
In this study, the researchers evaluate an intervention aiming to increase participation and
communication of older adults during primary care consultations with their General
Practitioner (GP). The researchers are particularly interested in a Photo novel tool with
this aim. Photo novels are picture stories, which have the advantage of using a familiar
narrative format, thereby possibly increasing comprehension, personal involvement and
motivation and self-efficacy to perform the relevant behaviors by offering role models
(story characters that are similar to older adults themselves). The patient perspective on
doctor-patient communication is underrepresented in most research. This study aims to
incorporate the patient perspective in different ways: in addressing their needs and
barriers during focus group discussions, in collecting their communication strategies and
solutions to these barriers in the role play exercise, in involving them in developing the
photo novel, and in studying their responses to the photo novel in the evaluation study the
researchers describe in this research protocol.
Aim of the intervention (the Photo novel) is to:
1. increase older adults' awareness of their needs and barriers in conversations with
their GP;
2. improve older adults' access to information by enabling them to ask different and more
questions to their GP;
3. increase older adults' problem solving abilities during conversations with their GP to
ensure better self-management of health issues.
4. find out which format is most efficacious
This could include being honest about limited understanding, asking for more information to
enable or improve shared decision making during consultation or to enable or improve
self-management after consultation. This could also include filtering information and
enabling patients to determine relevance of information. Furthermore, this could include
strategies to translate advice into concrete actions, e.g. transforming 'knowing that' into
'knowing how' (I know / understand that I have to use less salt but… How to… decrease
salt-intake in daily life?) In our photo novel, the researchers will provide older adults
with 'template communicative behaviors' embedded in a picture story they can use before and
during primary care consultations with their GP. Relevant communicative behaviors will
include 'asking questions', 'expressing lack of or misunderstanding', 'expressing
uncertainty', 'expressing preferences and needs' and other relevant communicative behaviors
that will be identified during the focus group discussions with older adults and their
informal care givers. These relevant communicative behaviors are embedded within different
relevant domains, based on communication theory / literature and on the output of the focus
group discussions. The seven scenarios are linked to the endpoints of medical communication
framework developed by Haes and Bensing.
The researchers propose to evaluate the effectiveness of the photo novel using an
Experimental Design, including both quantitative and qualitative measurements. This
combination of measurements will provide us with insight with regard to three important
Research Questions:
1. To what extent is a photo novel an effective tool / intervention to empower older
adults in their conversations with their GP compared to a traditional brochure
containing tips on GP-patient communication?
2. Which elements or domains included in the photo novel are effective and why?
3. Which narrative / theoretical mechanisms account for the effectiveness of the photo
novel ?
The researchers will recruit older adult participants (>50 years), who live in areas
indicative of limited or marginal health literacy. The researchers perform the following
procedure for recruitment. The researchers recommend to build relationships with GP
practices, healthcare organizations and community organizations and ask them for their
cooperation during a pre-established period of time. The researchers pay careful attention
to this part of our study, e.g. carefully design recruitment wording: 'We are conducting a
study to improve the relationship/ conversations with your GP, as a way to make sure the
health care you receive is improved. We invite you to participate in this study. Would you
like to participate?' Participants will be asked to come to a neutral setting, for example
within the University, or will be visited in a community building, to take part in our
study. Based on their consent to participate, a schedule is developed with eligible
patients. Participants will be randomized to one of the two conditions and will be presented
with the photo novel or traditional brochure either presented as a hard copy brochure or as
pdf on a tablet computer (2x2 factorial design) and the accompanying questionnaire. The
researchers aim for participants of different ages.
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