Delivery Methods
Didactic presentations/CMEs
Small-group discussion
Guided role play
Written materials
Coaching Activities
Observe demonstration of communication skills
Practice communication skills with simulated parent and adolescent and receive feedback
Complete self-assessment exercises
Review written information on treatment guidelines for health condition (if applicable)
Review written summaries of research on culturally-specific health beliefs and perceived barriers to adherence among minority parents and adolescents
Communication Training Targets
Asking open-ended questions to
Elicit parent and adolescent concerns about the health condition and its treatment
Understand parent and adolescent knowledge and beliefs about the health condition; monitor adherence
Understand parent and adolescent perceptions of barriers to adherence
Providing information about the health condition and treatment in short, clear statements (followed up with brief written materials)
Being supportive by making emotional connections and supportive statements
Building a partnership by engaging both the parent and the adolescent in problem-solving and shared treatment decision-making
Training may also need to concentrate on helping providers assess the health literacy of parents and adolescents, and strategies to tailor health information to their literacy level. For example, successful strategies may include adding video to verbal narratives to deliver important health information. Emerging studies suggest that web-based communication skills training may be a cost-effective and scalable alternative to in-person communication skills training for providers. Specifically, meta-analysis of research in provider medical education suggests that web-based interventions are equivalent to traditional in-person methods for improving knowledge and skill acquisition (Cook et al. 2008).
Coaching for Parents and Adolescents
Coaching interventions for adolescents and parents are also encouraged to increase effective communication with providers to prevent nonadherence. Table 9.2 provides an overview of activities that can be completed during coaching sessions with parents and adolescents and the communication skills that can be the focus of sessions. Coaching interventions for parents provide information about the chronic health condition, encourage parental empowerment and active involvement in care, and teach specific strategies for communicating with providers. Coaching sessions teach parents and adolescents effective communication techniques to promote collaborative communication and shared decision making with providers using modeling and role play.
Table 9.2
Communication skills training for patients and parents
Delivery Methods |
In clinic |
20 min face-to-face pre-encounter coaching session |
10 min face-to-face post-encounter debriefing session |
Follow-Up |
20–30 min phone follow-up session prior to the child’s next scheduled appointment |
Written materials |
Coaching Activities |
Discussion of any parent concerns regarding previous interaction with provider and changes they would like to make |
Discussion of parent and adolescent concerns and perceived barriers to the management of the chronic condition |
Parents and adolescents write down appointment information, treatment regimen, and questions they will ask provider |
Parents and adolescents practice disclosing concerns, asking questions, and stating preferences with communication coach |
Coach provides reinforcement and reminders about preparing for upcoming visits |
Discussion of ways parents and adolescents can obtain support for preparing for upcoming visits with their provider |
Parents and adolescents review written stories with graphics (e.g., photo-novels) that depict parent and adolescents using communication skills |
Communication Training Targets |
Disclosing concerns about health condition and barriers to engaging in treatment regimen |
Asking questions to obtain information about health condition and treatment |
Stating treatment preferences |
Given the roles of health literacy and culturally related health beliefs (e.g., perceptions of competing demands, medication concerns) in parent-provider communication among minority families, it is important that coaching interventions also address these elements. For example, information about chronic health conditions during coaching sessions may be tailored to the health literacy level of parents and adolescents. Culturally related health beliefs or perceptions can be elicited during coaching sessions, and parents and adolescents can be encouraged to discuss these beliefs with their providers.
Researchers focused on coaching interventions with minority adults have noted the need to ensure coaching interventions are delivered by culturally-competent staff to enhance the credibility, relevance, cultural appropriateness, and effectiveness of such interventions among minority patients (Cooper et al. 2013). One way to do this is through the use of lay health workers, individuals who do not have formal healthcare training but receive on the job training. Interventions delivered by lay health workers to families of children with chronic conditions have shown improvements in urgent care use and family psychosocial functioning (Raphael et al. 2013), and there is evidence that coaching sessions delivered by lay health workers may enhance the cultural appropriateness of coaching for minority parents and adolescents. Encouragingly, coaching interventions to enhance partnerships between families and providers as a strategy to promote adherence align with opportunities available through the Patient Protection and Affordable Care Act, which promotes the development of healthcare teams that include lay health workers.
Summary and Conclusions
Racial/ethnic minority children experience disparities in outcomes of chronic conditions that are costly to the health care system and place a significant burden on families. Higher rates of nonadherence to treatment regimens among minority children across a range of chronic conditions contribute to these disparities. Enhancing parent- and adolescent-centered communication and collaborative decision-making between minority families and providers has been shown to increase adherence in adult care among minority adults. Improving communication and collaborative decision making also holds promise for preventing nonadherence in pediatrics.
Recommendations for improving communication among vulnerable families include communication skills training for providers, and coaching interventions for parents and adolescents. Such strategies should emphasize tailoring communication to the health literacy level of vulnerable families, and addressing culturally-related health beliefs. Opportunities available through the Patient Protection and Affordable care Act that focus on wellness and care delivered by lay health workers can serve as a catalyst for strategies to improve healthcare providers’ communication with vulnerable minority families.
References
Alegria M, Carson N, Flores M, Li X, Shi P, Lessios AS, et al. Activation, self-management, engagement, and retention in behavioral health care: a randomized clinical trial of the DECIDE intervention. JAMA Psychiatry. 2014;7:557–65.CrossRef
Ashton CM, Haidet P, Paterniti DA, Collins TC, Gordon HS, O’Malley K, et al. Racial and ethnic disparities in the use of health services: bias, preferences, or poor communication? J Gen Intern Med. 2003;18(2):146–5.CrossRefPubMedCentralPubMed
Berry JG, Bloom S, Foley S, Palfrey JS. Health inequity in children and youth with chronic health conditions. Pediatrics. 2010;126(Suppl 3):S111–9.CrossRefPubMed
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