COMMUNICATION AND COUNSELING Anna Wahyuni W., S.Farm., MPH., Apt.

References : Rantucci, M.J., 1997, Pharmacist Talking with Patients, A Guide to Patient Counseling, 1 th Ed, Williams & Winkins, Baltimore, Maryland. Rickles, N.M., Wertheimer, A.I., Smith, M.C., Social and Behavioral Aspect of Pharmaceutical Care, 2010, 2 nd Ed., Jones and Bartlett Publisher, MA. Beardsley, R.S., Kimberlin, C.L., Tindall, W.N., 2007, Communication Skills in Pharmacy Practice, 5 th Ed., Lippincott Williams & Wilkins, Baltimore. Glanz, K., Rimer, B.K., Viswanath, K., 2008, Health Behavior and Health Education : theory, research and practice, 4 th Ed., John Wiley and Sons Inc., San Francisco.

Counseling counseling Good communication skills Educational process Psychological approach

COMMUNICATION Definition : A process of transmission of information, in which occur the emission, reception and comprehension of messages, both verbal (written and spoken) and nonverbal.

INTERPERSONAL COMMUNICATION

THE MODEL S = Sender R = receiver = messages/feedback loop = barriers

Component The sender The messages The receiver The feedback The barriers

Responsibility of pharmacist in the model As sender : assuring that the messages is transmitted in the clearest form, in terminology understood, in an environment condusive to clear transmission  need ask feedback and clarify misunderstanding Speaking clearly, speaking slowly, using appropriate language, checking understanding.

Responsibility of pharmacist in the model As receiver : listening  provide feedback to assured accurate communication Listen carefully, ask for clarification, write it down, repeat the message back in order to check the message received is the one given.

The messages Including thoughts, ideas, emotions, information, or other factors. Consists of : Factual information transmitted verbally, in written form or some combination. Feeling information transmitted nonverbally.

The critical component The receiver assign the same meanings to messages as intended by sender : Words and their context Congruence between verbal and nonverbal Preventing misunderstanding Using feedback to check the meaning of messages

Perception and communication Perceptions : perception of meaning messages and perception of individuals Sharing the same perception : prevent misunderstanding  use lay language Using feedback to check perceptions Perception, credibility and persuation  trustworthiness, competence and personal dynamism

Barriers includes : Environmental Personal Patient Administrative and financial Time

Environmental barriers Crowded, noisy area Privacy The counter separating the sender and receiver messages

Personal barriers (pharmacist’s perspective) Lack of confidence Personal shyness Internal monologue  prejudging Tendency to transfer problems to another person Cross cultural factors Fear of being in situation that is sensitive or difficult to handle

Patient barriers Patient perceptions of pharmacist as not being knowledgeable. Patient belief that health care system is impersonal Perception of their medical condition

Administrative and financial Pharmacist are not paid directly The mechanism of dispensing prescriptions TIME BARRIERS Inappropriate time

NONVERBAL COMMUNICATION

Nonverbal communication involves a complete mix of behaviors, psychological responses and environmental interactions through which consciously and unconciously related to another person Concentrate on our own nonverbal communications and the various nonverbal cues provided by others.

Element Kinesics (body movement) Proxemics (distance between persons when they communicate) The physical environment Paralanguage Potential distracting nonverbal element.

Kinesics Open posture : varied eye contact (consistent but not stare) Relaxed posture : how people sit, stand or lie Appropriate, comfortable gestures Frontal appearance Slight lean toward other person Erect body position (head up, shoulders back)

Proxemics The distance between two interacting persons Approximate distance of the proxemity we generally accept in our day to day life : distanceAppropriate relationship and activities < 46 cmIntimate contact Personal distance : 46 cm – 1.22 m Close friends or acquaintances Social distance : 1.22 m – 3.66 m Impersonal, businesslike contact Public distance : > 3.66 mFormal contact

Environmental nonverbal factors Private area consultation The color used in pharmacy’s décor The lighting The use of space The general appearance

Paralanguage Tone Volume Inflection

Concept of health and illness

Health 27

Illness as social concept 28 If you feel any symptoms of illness, what will you do? ???

29 Illness as social concept Illness : Individual responses to symptoms Disease : Pathological or biological condition It is possible to feel ill without suffering a disease and to suffer a disease without feeling ill.

Individual and interpersonal models of health and illness behavior

“ dokter memberi tahu saya bahwa saya membutuhkan obat ini, tetapi saya merasa baik-baik saja. Bapak dan ibu saya hidup sampai usia 90 tahun dan tidak pernah menggunakan obat ini. Mungkin saya juga tidak memerlukannya”. “ saya tahu bahwa tekanan darah saya tinggi dan saya harus meminum obat dengan teratur tetapi saya sangat sibuk dan seringkali terlupa meminum obatnya”.

Theories? What for? Help in designing intervention to address problem by identifying : Why people are experiencing the health problem What information is needed before developing intervention to address the health problem How best to develop interventions to address the health problem What to measure to determine whether the intervention is effective

Theories in individual HB The Health Belief Model Theory of Reasoned Action, Theory of Planned Behavior Transtheoretical Model of change

Interpersonal model of HB How individual, environment and health behavior interaction with others within their social circles Social cognitive theory Theory clinician-patient communication

The Health Belief Model

Theory of reasoned action and theory of planned behavior

Transtheoretical Model of Change

Komunikasi dan Konseling 2010/ The stage of change (transtheoretical) model (Prochaska and DiClemente, 1984) Relapse: Return to previous pattern of behavior Precontemplation: Client sees no problem but others disapprove Contemplation: Weighing up pros and cons of changing Active changes: Putting decision into practice Maintenance: Actively maintaining change Optimal recovery Change conslidated Premature way-out start

Social Cognitive Theory

Patient-centered communication function