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NHS PgCert-HC Cohort 4 celebrate their graduation @ Missenden Abbey in October 2018. Belated congratulations to Cohort 4 of the NHS PgCert-HC who graduated at Missenden Abbey in October 2018. […]
Antibiotic resistance is one of the fastest growing threats to modern health. It is no exaggeration to say that it calls for urgent attention.
In early 2012, for example, BBC news highlighted the problem of drug-resistant infections caused by bugs such as E.coli and gonorrhoea. On many occasions, Professor Dame Sally C Davies, the Chief Medical Officer for England, has given serious warnings about the consequences of antibiotic resistance. She also created the #keepantibioticsworking campaignon Twitter.
Meanwhile, since 2015 and on a global scale, The World Health Organization (WHO) has organised World Antibiotic Awareness Week every November. Its theme is: “Antibiotics: Handle with care”.
Sometimes it must be ‘no’
For communicators the challenge is to convince those who demand antibiotics – as the ‘easy’ option – that, sometimes, they must take ‘no’ for an answer. I.e. must accept a provider’s evidence-based judgment when their prescription is declined.
This confronts a nexus of misunderstanding across both motivations and normative beliefs.
Granted there is some public understanding that antibiotic over-use is unwise. But few grasp the concept of antibiotic resistance (Davies and Davies, 2010). And probably fewer still, according to C. Lee Ventola’s research, appreciate the significant healthcare and economic consequences of antibiotic-resistant infections. Where first- and second-line treatments prove incomplete, HC professionals may escalate to more toxic, and usually far more expensive, antibiotics.
Many such patients require, by extension, extended hospitalisation and more GP visits. Not least, they may also experience higher incidence of long-term disability.
Individual challenge: emotional re-framing
To break through antibiotics resistance campaigners must migrate from general and logically-argued principles to address the individual. Person-centered approaches are essential.
Success depends on re-framing the issue. So, today’s apparently ‘magic’ cure becomes re-defined as the start of a spiral down into increasingly severe, and antibiotic-resistant, infections. Today’s brief relief triggers tomorrow’s increased suffering.
Pauline Norris identifies two key principles for campaigners – a research-based understanding of both:
- The target audience’s pre-existing conceptions (motivations, beliefs); and
- Its level of knowledge of the relationship between managing infections and antibiotics resistance.
In short, among would-be consumers, we need simultaneously to lower expectations of antibiotics’ efficacy and to raise perceptions of the severity of antibiotic-resistant infections (Norris et al., 2013).
Coping with caregiving is never easy. And , at some point, most people end up becoming a caregiver. According to newsinhealth, about 43 million U.S. adults provide unpaid care for someone with a serious health condition each year. Such home caregivers, as noted by NHSUK, face many challenges – including practical, financial and emotional factors.
Ensuring that caregivers receive appropriate support from communities and healthcare providers is a crucial task for communications.
Family caregivers assist patients with everyday tasks and emotional support, such as meals, schedules, bathing and dressing. The role can also include managing medication, doctor visits, health insurance and, not least, money. Some, for example elderly caregivers, face special risks and challenges to provide informal care.
In short, while many caregivers find joy and fulfilment, the consequent strain may overwhelm them.
Creating social support for caregivers
For caregivers, part of the solution lies in mobilising effective social support from friends, family and the wider community. Existing research confirms this requirement. Social support refers to the various types of support (i.e., assistance/help) that people receive from others and is generally classified into two (sometimes three) major categories: emotional and instrumental (and sometimes informational) support. These kinds of support served as “protective” factors to help protect these vulnerable people from the negative effects of stress (University of Twente, 2018).
Confronted with stress and emotions such as guilt, helplessness and anger, emotional and structured informational support is vital. This may come from family members, friends, religious organizations, online and offline support groups and professional assistance.
According to APOS’s 2015 caregiver poster, family and friends are the first sources from which to seek support for most caregivers. However, they build up a variety of trusted sources of information, though most prioritise doctors/ nurses and the Internet.
Alzheimer’s Disease International published useful and concrete data, a perfect example of reliable informational support, onhow to aid family support groups, community support and self-help groups to take care of family members affected by dementia. The resource includes practical tips on managing dementia along with more specific information and advice for carers to utilise.
The case for the benefit of social support to caregivers can be seen in a recent case in Kent. Social workers were supporting a client called “Amanda” and, with the guidance of her care coordinator, had discussed a record of what specific care needs she required. This produced a custom tailored approach to supporting her and her family increasing her confidence in these support structures and contributing to the ethos of treating the patient like a person rather than a condition (King, 2018).
The care coordinator and Amanda’s family also made an integrative care plan for Amanda. Depending on her family’s caregiving needs, it allowed her family to receive updates on her condition as and when they need them. This more individual and “person-centered”
care services approach was vastly more efficient and very well received by both “Amanda” and her family.
A better way to communicate
Understanding of to where and how caregivers turn for information and support is essential to ensure successful and effective communications. Better relationships between social support and health outcomes will only become a reality if staff, service users, caregivers and the public are fully informed and engaged with proposed reforms. Social support resources and services should be tailored to the caregiver’s demands and include evaluation on the type of support to be offered (Wittenberg-Lyles et al., 2013).
Good interpersonal communication skills in healthcare can improve health outcomes. If we get it right, we can develop treatments, reduce errors, cut costs and even save lives. However, a challenge is always there. Concerning a social distance, there is still a communication gap among healthcare providers, health communicators and patients resulting from differences in economic, social and cultural backgrounds. We need a soft and effective way to overcome or transcend these differences.
International and National news
Undoubtedly, interpersonal skills are one of the most essential elements to improve effective communication. According to the GULF-TIMES, an international training course-entitled Mastering Emotional Intelligence-has been introduced by The Institute for Population Health (IPH), Qatar. This course aims to help healthcare practitioners in a multi-cultural environment to gain and enhance interpersonal skills. A national news’ review, noted at BMC Health Service Research, states that comprehensive approaches to quality improvement of interpersonal care are a key focus of international health policy.
The construction of dialogues and the exchange of ideas smoothly are substantial ways to enhance Interpersonal communication. Notably, A research study performed in rural South India by a Unite For Sight Global Impact Fellow, Abraar Karan, indicates that visual aids as teaching tools improve treatments of patients in the developing world. In the effort to educate eye patients about their medical conditions, the use of visual images transcended the boundaries of literacy, education, gender, and prior medical knowledge. It turns out it does matter what these vulnerable people see.
Missing: the influence of everyday interpersonal communication
We are not the first to start a debate regarding the influence of the context of everyday communication about health. We like sharing our health stories and challenges with our families, friends and co-workers in a natural, comfortable environment. Our health behaviour decisions and relevant changes often occur in a relational context (Cline, 2003, 2011). In contrast, we know far less about what these conversations look like and how they impact medical encounters. This can be considered as a central research question. CHCR, as one of the leaders of health communications research in the UK, recognises the importance of interpersonal skills in providing effective communication in healthcare. A tailored approach to educating employees on the value and obvious utility of these skills is core to CHCR’s curriculum.
It hasn’t been a particularly hot topic lately: the vaccine debate. But the issue hasn’t gone away. And it typifies a common challenge for health communicators: how to persuade effectively other than by only firing barrages of robust scientific evidence?
OK, the vaccine case currently lacks the 1990s’ edge provoked by the now-discredited claim made by Andrew Wakefield of a link between MMR vaccine and autism. But (notes The Atlantic) the battle between pro- and anti-‘vaxxers’ has raged unabated since Victorian times. Today it still justifies an online folder at The Independent.
Meantime, fanned by the prevalence of ‘fake news’, the risk (to whole populations) is rising. As of 2016, for example, about 3m UK children and adolescents may have missed their MMR vaccine, according to Gillian Leng, deputy chief executive of NICE.
So, what? Well, if a sufficient proportion of a given population is vaccinated, a disease cannot spread and everyone is protected. This (explains The Conversation) is known as “herd immunity”. The World Health Organisation (WHO) considers 95% uptake necessary for protection. But it is estimated that, on average, the UK has slipped 2-3% below target. That falls much further towards 80% in areas of deprivation.
Deep belief and emotion
Campaigners against this trend confront deeply-embedded attitudes and beliefs. Online sites and other news media constantly reinforce the views of anti-vaccine, or sceptical, parents. These tend to fuse aligned, co-promoted behaviours (alternative medicine, homoeopathy) with what the scientific community regards rightly as misinformation (dangers of autism, brain injury etc).
In context, the heavy barrage of medical evidence may typically serve to create severe cognitive dissonance. Counter-intuitively, this embeds anti-beliefs even deeper.
Small consolation to win the ‘data battle’ but lose the emotional narrative and interpretation war.
To win trust among target anti-groups, pro-campaigners need to offer alternative, and compelling, sources of emotional security. As health comms scholars have identified, these will lie in organisations already trusted by the sceptical. Moran and Lucas (2016) reported that a natural health foods store, for example, may offer a secure space for a vaccine workshop and/or the distribution of promotional leaflets. In turn, in personal engagements, campaigners will likely gain more traction via anecdote and individual testimonials than hard data alone.
On another tack, the Italian Ministry of Health’s Centre for Disease Prevention and Control gained significant success with its ESCULAPIO – the acronym is a rare boy’s name meaning ‘doctor’ – project. Its strategy utilised non-threatening tools such as an educational card game (named ‘Vaccine at the Fair’), a music video and reliable information websites to promote anti-flu vaccination. Notably, campaigners in the Veneto organised meetings in safe spaces such as birth centres and at home for sceptics (Bechini et al., 2018).
These early successes should encourage more widespread testing and adoption, of an emotional approach. An easy entry point is provided by David Cowan’s discussion of the Dialogue Box (*).
(*) Cowan, D. (2014), Strategic internal communications. London UK: Kogan Page.
NHS and other healthcare employers seeking to expand their communications capability should review the new Government-approved PR and Communications Assistant Apprenticeship (PRC-AA).
Announced at Easter, the new entry-level standard was developed by a group of ‘trailblazer’ employers in collaboration with the London-based UK PRCA (Public Relations and Communications Association) and the UK Institute for Apprenticeships. A second mid-range (University Level 7) standard is also currently in progress.
The PRC-AA standard and scheme replaces the existing PR Apprenticeship programme. Launched in 2015, it has helped over 250 apprentices to train in organisations ranging from the NHS to SME PR and communications consultancies.
The new programme places more emphasis on planning and evaluation in PR and communications. It also incorporates a broader range of communications skills including latest social media channels and production of non-written content.
According to CHCR’s deputy director, Dr Bill Nichols, who contributed to the standard’s development: “Apprenticeships offer a structured and compelling way for all organisations to grow their own talent, increase diversity and stay fresh with the latest trends. We hope that the NHS, in particular, will find this a beneficial innovation.”
Approval of the new standard follows a rigorous three-year sign off process. Simon Francis, chair of the developing employers’ group and founder member of Campaign Collective, commented: “It has not been easy getting the bureaucratic process to meet the demands of employers, but I’m delighted that the PR & Communications Assistant apprenticeship is now ready for delivery by training providers.”
Details are available at: https://www.