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Purpose: The purpose of the study was to provide a critical review and synthesis of the best available evidence of communication strategies used to accomplish effective health dialogue in adults with chronic diseases in low and middle income countries.
Review question: The following review question guided the review process: “Which communication strategies are used during effective health dialogue with adults with chronic diseases in low and middle income countries in terms of: 1) how communication is conducted; 2) when communication is conducted; 3) what is communicated 4) where communication is conducted; and 5) by whom communication is conducted?”
Methods:
Review method: The methodology of a systematic review was used since it is the broadest type of research review (De Souza, Da Silva, & De Carvalho, 2010:103). Multiple databases and search methods were used to identify studies relevant to the review question. Research citations from 2000 to 2014 from platforms such as EBSCOhost, ProQuest, Scopex, Nexus and Google Scholar were used and search methods included reference list checking and contacting the authors of studies. The systematic search strategy identified 3464 records and followed a filtering process guided by the following inclusion criteria: adults living with chronic diseases; literature that reflect health dialogue between the patient and the healthcare provider; literature from low- and middle-income countries; literature from 1 January 2000 to 31 December 2014; and literature in English, as well as studies written in other languages with an English abstract. Eight studies were selected for critical appraisal after filtering by four reviewers that subsequently appraised the eight studies in a round table consensus discussion using standardised critical appraisal tools to determine the methodological quality of the studies.
Results: Seven studies were included in the review and due to the heterogeneity of the sample which consisted of five randomised controlled trials, one case-study and one qualitative study and consequently, a meta-analysis was not feasible.
Conclusion: After data extraction and data analysis by thematic summaries, the synthesis process led to the formulation of the following concluding statements and recommendations related to the review question: Which effective communication strategies are used during health dialogue with adults with chronic diseases in LMICs in terms of: 1) how communication is conducted? Conclusion: A variety of communication strategies such as small group targeted communication, one-on-one tailored communication, mobile cellular communication and computed communication can be used to accomplish effective health dialogue in adults with chronic disease in low and middle income countries. Recommendation: Since healthcare providers are mostly involved in one-on-one and small-group health dialogue with adults affected by chronic diseases in low and middle income countries, a greater sensitivity needs to be created towards the benefits of tailoring such communication. This goes hand in hand with equipping these healthcare providers with the necessary skills to conduct such tailored communication. Skills training in tailored communication ideally should form part of undergraduate education, but also be included in in-service training of qualified healthcare providers.
2) when is communication conducted? Conclusion: Frequently scheduled communication strategies such as weekly, bi-weekly or monthly sessions, can be used to accomplish effective health dialogue in adults with chronic disease in low and middle income countries. Recommendation:Since the frequency of communication reported differs from study to study, the healthcare provider should take the information needs of the patient into consideration and plan communication sessions according to the information needs of the patients.
3) what is communicated? Conclusion: A communication strategy that provides focused and specific information to the individual or group can be used to accomplish effective health dialogue in adults with chronic disease in low and middle income countries. Recommendation:Since the focus of the communication was unique to each study reported, it is recommended that the healthcare providers who decides to make use of the strategy, should provide communication according to the condition and needs of the patient(s) involved. The healthcare provider should use a multi-strategy approach, for example, one-on-one communication augmented by brochures or mobile messages to re-enforce the message. A dedicated national and provincial health communication unit focusing on such a multi-strategy would strengthen healthcare providers’ hands to implement such a strategy.
4) where is communication conducted? Conclusion: A communication strategy that accomplishes effective health dialogue in adults with chronic disease in low and middle income countries, takes place in a convenient and private setting, such as a private room or where the patient can access his/her mobile phone or log onto the internet. Recommendation: The use of private rooms within nearby community facilities need to be actively pursued by healthcare providers, especially in the light of the challenges faced by public healthcare facilities – space being one such a challenge. Involving community members when creating clinic committees could be an example of how to go about securing such facilities.
5) by whom communication is conducted? Conclusion: A communication strategy that accomplishes effective health dialogue in adults with chronic disease in low and middle income countries, is provided by trained lay persons and/or healthcare professionals as well as automated computer systems. Recommendation:Since ‘trained’ volunteers and peer leaders may not always be readily available, such groups should be purposefully involved in the health activities of the health facilities. The groups may be identified from patients, non-governmental organisations, or non-profit organisations in the community. Healthcare providers should become involved in the training of these groups. Training could involve disease management, but could also include communication skills.
The comprehensive synthesis of the literature has led to the creation of new knowledge and perspectives that might be of great value in developing and using communication strategies in patients with chronic disease in low and middle income countries.
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