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Health Literacy

Gathering information addressing functional HL �micro level

Challenges in Anamnesis

CC-BY-SA 4.0 License, except the images 1 - 9

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Learning outcomes

You are able to:

select and describe effective communication techniques to

identify the level of HL
gather information

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How to introduce anamnesis ��

Mentioning your name and first name

Listen to the name of the patient

Ask if this is the first visit to the physiotherapist

Explain procedure 1st consultation

Explain your role as physiotherapist in training

Ask for permission for your part in the session

Image 1. Anamnesis

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How to introduce anamnesis �

Ask for the doctor’s referral

Ask if there are any questions or remarks about the referral

Ask open question about the reason for coming � (initial request for help)

Image 2. Senior male patient meet therapist

More information to plain language: https://plainlanguagenetwork.org/plain-language/what-is-plain-language/

5. I ask the patient what he/she hopes to achieve by attending therapy.

6. I attempt to elicit all of the patient’s concerns

7. I show interest in how the problem is affecting the patient’s life

8. I encourage patients to ask additional questions

9. I consider working with a (professional) interpreter, if necessary.

10. I use instruments/ questionnaires to identify patients with limited hl

11. I identify behavior typically exhibited by people with limited hl

12. I consider limited health literacy: do you need help to fill in forms? Cues: missed appointments, excuses, and inconsistent information.

13. I encourage the patient to discuss his/her concerns by using active listening techniques (e.g., using various continuers such as Aha, tell me more, go on).

14. I observe non-verbal cues to gather information about (not) understanding information

15. I create a shame-free environment.

16. I am sensitive to and capable of gathering information about the illness beliefs and the possible influence of personal/ environmental problems on physical problems (and I explain these facts to the patient)

17. I ask about the (cultural) background and taboos of the patient which may influence their (illness)believes about cause and treatment and their coping style

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Anamnesis: Somatic factors

Localisation

Where is the pain/burden/restriction located?
Is the pain superficial or deep? Is there any radiation?

Origin

How did the complaint arise?
Acute (what caused it?) or gradual?
If acute: Can you indicate what kind of movement, you made at the time?
What did you do immediately afterwards/ with what effect?

Image 3. Location of symptoms

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Anamnesis: Somatic factors

Functional impairment

Which movements/activities can you no longer perform well?
Why is this no longer possible?

(loss of strength, pain, loss of sensation or endurance?)

More information to plain language: https://plainlanguagenetwork.org/plain-language/what-is-plain-language/

Image 4. Somatic factors - functional impairment

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Anamnesis: Somatic factors

Time lapse

When did the complaint start?
How has the pain/restriction progressed since the onset?

When does the pain decrease/increase?

What is the current situation?
Have you had these complaints before? If so, what happened then?

If necessary, ask further questions

- What is the course during quiet periods such as weekends and holidays?

- How does it develop during the week/ day?

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Anamnesis: Somatic factors

Intensity

How bad is the pain when you experience it at its most intense/ during the most taxing activity (scale 0-10)?
How often do you suffer?
Is the pain always equally severe? How is the severity in relation to the activity/exertion (grading)?

Image 5. Pain scale level

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Anamnesis: Somatic factors

History

Have you had this complaint before (in the same region)?
What was the diagnosis? What was done with it then? With what result?
Does this complaint occur more often in your family?

Closing summary before you continue with:

Cognitions Emotions Behaviour Social Impact

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�Cognitions: �patient's ideas about the origin & persistence of the complaints�

5 questions from Leventhal

What do you yourself think is going on?
What do you think could be the cause?
What are your expectations about how long it will take?
What do you think you need to pay attention to?
What do you expect physiotherapy to do for you?

[Leventhal et al., 2003]

Image 6. Questions

5. I ask the patient what he/she hopes to achieve by attending therapy.

6. I attempt to elicit all of the patient’s concerns

7. I show interest in how the problem is affecting the patient’s life

8. I encourage patients to ask additional questions

9. I consider working with a (professional) interpreter, if necessary.

10. I use instruments/ questionnaires to identify patients with limited hl

11. I identify behavior typically exhibited by people with limited hl

12. I consider limited health literacy: do you need help to fill in forms? Cues: missed appointments, excuses, and inconsistent information.

13. I encourage the patient to discuss his/her concerns by using active listening techniques (e.g., using various continuers such as Aha, tell me more, go on).

14. I observe non-verbal cues to gather information about (not) understanding information

15. I create a shame-free environment.

16. I am sensitive to and capable of gathering information about the illness beliefs and the possible influence of personal/ environmental problems on physical problems (and I explain these facts to the patient)

17. I ask about the (cultural) background and taboos of the patient which may influence their (illness)believes about cause and treatment and their coping style

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Emotions

Effect on feelings

"Now that you have those complaints, how do you feel about them?"
"Does it ever get too much for you, since you have these complaints?

Be aware of catastrophising or trivialising:

"Do you have any concerns about it?"

Image 7. Emotions

5. I ask the patient what he/she hopes to achieve by attending therapy.

6. I attempt to elicit all of the patient’s concerns

7. I show interest in how the problem is affecting the patient’s life

8. I encourage patients to ask additional questions

9. I consider working with a (professional) interpreter, if necessary.

10. I use instruments/ questionnaires to identify patients with limited hl

11. I identify behavior typically exhibited by people with limited hl

12. I consider limited health literacy: do you need help to fill in forms? Cues: missed appointments, excuses, and inconsistent information.

13. I encourage the patient to discuss his/her concerns by using active listening techniques (e.g., using various continuers such as Aha, tell me more, go on).

14. I observe non-verbal cues to gather information about (not) understanding information

15. I create a shame-free environment.

16. I am sensitive to and capable of gathering information about the illness beliefs and the possible influence of personal/ environmental problems on physical problems (and I explain these facts to the patient)

17. I ask about the (cultural) background and taboos of the patient which may influence their (illness)believes about cause and treatment and their coping style

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Behaviour

Coping

"What do you do when it bothers you?”

“How does that help?"

"What have you tried yourself? What was the effect?"

Restraint/avoidance

"To what extent are you limited by your symptoms?"
" What do you no longer do or do much less since experiencing this?"

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Social impact

1) Do people at home notice that you have complaints/ reduced fitness? What is your home situation like? How do they react? How do you feel about that?

2) What are the consequences of the symptoms/impaired condition for work/study? What kind of work/study do you do? (Duration, working conditions, reaction of colleagues etc.)

3) Does the complaint/condition influence what you used to do in your free time (content, intensity, reaction of (sports) friends etc.)?

Image 8. social impact

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Questionnaire/Self-reflection

Image 9. Self-reflection

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Questionnaire/Self-reflection

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Questionnaire/Self-reflection

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Questionnaire/Self-reflection

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Image 1. Anamnesis designed by macrovector, free license by freepik

Image 2. Senior male patient meet therapist designed by fizkes from shutterstock, free license by shutterstock

Image 3. Location of symptoms designed by kolonko, free license by freepik

Image 4. Somatic factors - functional impairment designed by freepik, free license by freepik

Image 5. Pain scale level designed by brgfx, free license by freepik

Image 6. Questions designed by lyuden, free license by freepik

Image 7. Emotions designed by rawpixel, free license by freepik

Image 8. social impact designed by freepik, free license by freepik

Image 9. Self-reflection designed by storyset, free licence by freepik

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References

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Coleman CA, Hudson S, Maine LL. Health literacy practices and educational competencies for health professionals: A consensus study. J Health Commun. 2013;18(SUPPL. 1):82–102.
Coleman CA, Fromer A. A Health Literacy Training Intervention for Physicians and Other Health Professionals.
Kaper MS, de Winter AF, Bevilacqua R, Giammarchi C, McCusker A, Sixsmith J, et al. Positive outcomes of a comprehensive health literacy communication training for health professionals in three European countries: A multi-centre pre-post intervention study. Int J Environ Res Public Health. 2019;16(20).
Leventhal, H., Brisette, I. & Leventhal, E.A. (2003). The common-sense model of self regulation of health and illness. In: Cameron LD, Leventhal H, eds. The Self-Regulation of Health and Illness Behaviour. London: Routledge, 42-65.

Literature

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Murugesu, L., Heijmans, M., Fransen, M., & Rademakers, J. (2018). Beter omgaan met beperkte gezondheidsvaardigheden in de curatieve zorg: Kennis, methoden en tools. Nivel. https://www.nivel.nl/sites/default/files/bestanden/Beter_omgaan_met_beperkte_gezondheidsvaardigheden_in_de_curatieve_zorg.pdf
https://www.ahrq.gov/health-literacy/improve/precautions/index.html Page 102 general communication tips
Wittink, H., & Oosterhaven, J. (2018). Patient education and health literacy. Musculoskeletal Science and Practice, 38, 120-127.

Literature