Working paper: challenging health workers to develop a participatory approach to patient education.

In February 1992 in Nigeria the Africa-Child Survival Initiative-Combatting Childhood Communicable Diseases (ACSI-CCCD) project held a one-week workshop Communicating About Health for 7 trainers from Continuing Education Units and 2 senior staff from the Health Education Units in Plateau and Niger States. They were charged with improving patient education. The workshop helped them develop personal culturally appropriate interactive styles of patient education. Participants observed educational efforts in health facilities and returned to the workshop site to share experiences. They found few instances of client-staff communication and when it did occur the communication methods were poor. Participants identified steps for staff to communicate with individuals and with groups. The steps for communicating with individuals begin with asking questions and listening to learn followed by a physical examination to learn more identification of essential information and easy ways to explain it explanation of information to the client and assessment of understanding. The steps for communicating with groups include a discussion starter to depict health problems explore the problems in a discussion (ask questions and listen) provide more information to enhance understanding of the problem and work with the group to identify solutions summarize the discussion and evaluate learning at a later time. Participants developed a facilitators guide to use for training others. They tried the participatory approach in health facilities and found a favorable response from individual clients and groups. They considered time to be the greatest flaw of this approach (i.e. requires more time than just offering advice). With support the participants can expand the participatory approach by sharing it with colleagues enhance their understanding of client perspectives and beliefs and develop appropriate evaluation techniques.