RIAS Works

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Mexico

Garcia de Alba-Garcia JE, Rubel AJ, Moore CC, Marquez-Amezcua M, Casasola S, Von Glascoe C. [Article in Spanish]. Gac Med Mex 2002 Mar-Apr;138(2):211-6.
(Primary Care, Mexico)
The present work has as its purpose a description of the information exchanged during doctor-patient encounters immediately following diagnosis of pulmonary tuberculosis. To accomplish this nine such encounters were audiotape at two public health clinics in Guadalajara, Mexico. Communication of information and affect was evaluated by adapting the Roter interactional process analysis. Results show that the physician instructed the patient to behave in ways to prevent disease transmission while assuring patient recovery. Virtually lacking from these recordings is evidence of physician concern with the struggle patients experience to incorporate this regimen of directly observed therapy in to their daily lives. Because these sessions are managed by clinicians to encourage a unidirectional flow of information from physician to patient, the former fail to attain either patient cultural understanding of his/her disease process or comprehensive understanding of how he is affected she by the illness.

Kim YM, Figueroa ME, Martin A, Silva R, Acosta SF, Hurtado M, Richardson P, Kols A. Impact of supervision and self-assessment on doctor-patient communication in rural Mexico. Int J Qual Health Care. 2002 Oct;14(5):359-67.
(Primary Care, Communication Skills, Mexico)
OBJECTIVE: To determine whether supervision and self-assessment activities can improve doctor-patient communication. SETTING AND PARTICIPANTS: Six supervisors, 60 doctors in their last year of training, and 232 primary health care patients at rural health clinics in Michoacan, Mexico. DESIGN: The main evaluation compared post-intervention measures in control and intervention groups. A small panel study also examined changes from baseline to post-intervention rounds in both groups. INTERVENTION: Over a 4-month period, specially trained supervisors added 1 hour of supervision on interpersonal communication and counseling (IPC/C) to regular site visits. Doctors, who had received prior IPC/C training, periodically audiotaped and assessed their own consultations. MAIN OUTCOME MEASURES: These comprised frequency of doctors' facilitative communication, doctors' biomedical information-giving, and patients' active communication. RESULTS: The performance of all doctors improved markedly over the study period, but gains in facilitative communication and information-giving were significantly greater in the intervention than the control group. No single component of the intervention was responsible for the improvement; it resulted from the combination of activities. The doctors appreciated the more supportive relationship with supervisors that resulted from the intervention and found listening to themselves on audiotape a powerful, although initially stressful, experience. CONCLUSION: Supportive supervision and self-assessment activities can reinforce IPC/C training, prompt reflection and learning, and help novice doctors improve their interpersonal communication skills.

Kim YM, Kols A, Martin A, Silva D, Rinehart W, Prammawat S, Johnson S, Church K. Promoting informed choice: evaluating a decision-making tool for family planning clients and providers in Mexico. Int Fam Plan Perspect. 2005 Dec;31(4):162-71.
(Family Planning, Decision-Making, Mexico) CONTEXT: The World Health Organization (WHO) has developed a decision-making tool to be used by providers and clients during family planning visits to improve the quality of services. It is important to examine the tool's usability and its impact on counseling and decision-making processes during family planning consultations. METHODS: Thirteen providers in Mexico City were videotaped with family planning clients three months before and one month after attending a training session on the WHO decision-making tool. The videotapes were coded for client-provider communication and eye contact, and decision-making behaviors were rated. In-depth interviews and focus group discussions explored clients' and providers' opinions of the tool. RESULTS: After providers began using the decision-making tool, they gave clients more information on family planning, tailored that information more closely to clients' situations and more often discussed HIV/AIDS prevention, dual protection and condom use. Client involvement in the decision-making process and client active communication increased, contributing to a shift from provider-dominated to shared decision making. Clients reported that the tool helped them understand the provider's explanations and made them feel more comfortable talking and asking questions during consultations. After one month of practice with the decision-making tool, most providers felt comfortable with it and found it useful; however, they recommended some changes to the tool to help engage clients in the decision-making process. CONCLUSIONS: The decision-making tool was useful both as a job aid for providers and as a decision aid for clients.

Kim YM, Kols A, Prammawat S, Rinehart W. Sequence analysis: responsiveness of doctors to patient cues during family planning consultations in Mexico. Patient Educ Couns. 2005 Jul;58(1):114-7.
(Interaction Analysis, Family Planning, Mexico)
(Abstract not available.)

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