Text in English / Health Communication Campaigns are one of the strategies used in facing the challenges of the spread and effects of the HIV/AIDS epidemic, which is not only a health issue but also has sociocultural implications and consequences. Although there are some models and research tools available to guide the planning, designing, implementing, monitoring and evaluation of health communication campaigns, the premise of the study was on two assumptions. First, most available models that guide the planning and execution of HIV/AIDS communication campaigns do not sufficiently highlight sociocultural variables; and second, since most available models do not sufficiently emphasise sociocultural variables, the design of the instruments for the assessment of the campaigns are not sufficiently geared towards identifying and assessing sociocultural variables of the campaigns. In light of these assumptions, the study was undertaken for three reasons. Firstly, to construct a sociocultural health communication campaign conceptual model that incorporates and highlights sociocultural variables to guide the planning and implementation of health communication campaigns; particularly HIV/AIDS communication campaigns. Secondly to develop an assessment instrument for assessing the presence or absence of sociocultural variables in the planning and implementation of health communication campaigns. Thirdly to test the theoretical sociocultural assessment instrument developed in the study in an HIV/AIDS communication campaign of the Ekurhuleni Metropolitan Municipality’s HIV/AIDS Unit. The results indicated that the instrument is a functional sociocultural assessment tool that can be used to determine three main aspects. Firstly, whether or not and at what level there is/or was active involvement and participation of the target audience in the communication campaigns process. Secondly, whether or not and at what level in the planning and execution of a campaign, the sociocultural context was taken into consideration and the relevant elements of such context incorporated in the campaign process. Thirdly, whether or not and at what level relevant theories/models underpinned the whole process of the health communication campaigns in the planning, designing, implementation, monitoring and evaluation stages. The sociocultural assessment instrument, therefore, is not meant for assessing the effectiveness of health communication campaigns per se. It is rather meant for use to ascertain the presence or absence of those three aspects on the assumption that if they are taking care of in the planning and implementation of such campaigns, the probability is that the campaigns would be more socioculturally appropriate. The implications of this study are that for health communication campaigns to be socioculturally appropriate, they display continuous community interactivity and participative (ensuring mutual relationship between campaign planners and target audience) in their planning, implementation and evaluation/assessment; making the whole campaign process strategic and integrative – their management should be strategic, implementation creative and monitoring and evaluation continuous. / Communication Science / D. Litt. et Phil. (Communication)

There are many inequities that exist in health-care that stem from culture related communication misunderstandings. In most cases where doctors and patients from different cultural and linguistic background interact, doctors use medical language which is different from everyday language used by patients. Patients enter this communication context with anxiety because they depend on the physicians to give them accurate information concerning their health, but they do not always understand all the terms used by physicians to inform them about their conditions. In some cases interpreters are used but their expertise is often inadequate and the interpreting of the patient’s statements to the health staff is also prone to distortion by interpreter / doctor because of the lack of proper understanding of the messages / languages. This may result in a deterioration of the patient’s health condition and unavoidable complications.

South Africa's HIV prevalence rate is estimated to be 5.7 million and at the end of2007 a total of 45845 HIV/AIDS adult patients were taking antiretroviral therapy (ART). The global incidence of HIV/AIDS has been slowly decreasing over the years but is still widespread. This disease is still more prevalent in sub-Saharan Africa than in other parts of the world, with more than 60% people living with HIV/AIDS. Highly active antiretroviral therapy (HAART), the treatment of choice, slows the progression of the human immunovirus but demands a high adherence rate in excess of 95%. Patients who are poorly informed about antiretrovirals (ARVs) and misunderstand medicine-taking instructions or experience unexpected side effects may interrupt therapy, predisposing them to the development of resistance. Such patients need information but, given the poor literacy skills prevalent in South Africa, written information is often not fully comprehended and is often written at too high a reading level. The objectives of this research project were to design, modify and evaluate HIV / AIDS patient education materials for low-literate isiXhosa speaking adults residing in Grahamstown and to examine their impact on the understanding of various aspects of the disease and its treatment. Pictograms illustrating common side effects of ARVs (e.g. stavudine, efavirenz, lamivudine), as well as various sources 'for purchasing nonprescription medicines, storage and medicine-taking instructions were designed and evaluated both qualitatively, using group discussions, and quantitatively through individual interviews where interpretation of the pictograms was assessed. These pictograms were incorporated in a patient information leaflet (PIL) which had been specifically designed for people with limited reading skills and was a simple document containing the minimum of essential text. A previously developed PIL was modified in collaboration with the target population and two versions were produced, one incorporating pictograms illustrating side effects, the other with none. Pictograms were used in both to illustrate other medicine-taking instructions. The PILs were tested objectively to assess the readability, format, content, and general design. They were translated into isiXhosa prior to being qualitatively and quantitatively evaluated in a low-literate isiXhosa speaking population. Understanding of the PILs was assessed by asking a series of questions about the PIL content. Participant opinion of the readability and appearance of the PIL was recorded. The relationship between PIL understanding and selected demographic variables was investigated. Findings from this study illustrated that well designed pictograms assist in the location of information in written leaflets and they may enhance understanding of the information. It was further demonstrated that education influences total understanding of PIL content thus emphasizing the need for tailor-written information in accordance with the education level of the target population. A desire to receive PILs incorporating pictograms was expressed by the majority of participants. Collaboration with the intended target population is essential to design culturally acceptable, easily interpreted pictograms and to produce user-friendly, easy-to-read, comprehensible patient education materials. The rigorous, iterative design, modification and testing process described in this study is one that should be adopted in producing all health-related education materials.

This thesis concluded that offering physicians an appropriate Web-based transcription service should be well received and improve their medical record management and patient care.

Indiana University-Purdue University Indianapolis (IUPUI) / Physicians were interviewed and asked about their perspectives on communicating with patients, media, and the ways in which the biomedical and biopsychosocial models function in the practice of medicine. Fisher’s Narrative Paradigm was the primary critical method applied to themes that emerged from the interviews. Those emergent themes included the importance of a team approach to patient care; perspectives on physicians as bad communicators; and successful communication strategies when talking to patients. Physicians rely on nurses and other support staff, but the most important partnership is that between the physician and patient. Narrative fidelity and probability are satisfied by strategies physicians use in communicating with patients: using understandable language when talking to patients; engaging in nonverbal tactics of sitting down with patients, making eye contact with patients, and making appropriate physical contact with them in the form of a handshake or a light touch on the arm. Physicians are frustrated by media’s reporting of preliminary study results that omit details as well as media’s fostering of expectations for quick diagnostic processes and magical cures within the public. Furthermore, physicians see the biomedical and biopsychosocial models becoming increasingly interdependent in the practice of medicine, which carries the story of contemporary medicine further into the realm of partnership, revealing its humanity as well as its fading paternalism.

This research was aimed at listening to the care stories of people living with cancer in remission. The participants spoke about relationships with their families, medical professionals and their spirituality, thereby giving a voice to personal experiences of cancer as part of family life. Postmodern social construction discourse guided the explaining of how cancer invades and affects people's Jives and relationships. This participatory action research was situated in a contextual practical theology. Narrative conversations with the participants spoke about experiences of both care and communication by medical professionals, their struggles in communicating with their partners and families, their spiritual search and longing for pastoral care to sustain and guide them. / Practical Theology / M.Th. (Pastoral Therapy)

This research was aimed at listening to the care stories of people living with cancer in remission. The participants spoke about relationships with their families, medical professionals and their spirituality, thereby giving a voice to personal experiences of cancer as part of family life. Postmodern social construction discourse guided the explaining of how cancer invades and affects people's Jives and relationships. This participatory action research was situated in a contextual practical theology. Narrative conversations with the participants spoke about experiences of both care and communication by medical professionals, their struggles in communicating with their partners and families, their spiritual search and longing for pastoral care to sustain and guide them. / Philosophy, Practical and Systematic Theology / M.Th. (Pastoral Therapy)

Indiana University-Purdue University Indianapolis (IUPUI) / Background: Recent literature on medical professionalism claims that self-awareness and the ability to reflect upon one’s experiences is a critical component of professionalism; however there is a paucity of empirical evidence to support this claim. This study employed a mixed methods approach to explore the utility of reflective writing and self- and peer assessments in explaining professionalism lapses among medical students. Methods: A retrospective case-control study was conducted using students from Indiana University School of Medicine (IUSM) who had been disciplined for unprofessional behavior between 2006-2013 (case group; n=70). A randomly selected control group (n=230) was used for comparison. Reflective ability was assessed using a validated rubric to score students’ professionalism journals. Mean reflection scores and assessment scores were compared using t-tests. Logistic regression analysis was used to determine the impact of reflection scores and self- and peer assessment scores on the likelihood of having been disciplined for unprofessional behavior. Subsequent qualitative analysis further explored when and how students learned professionalism during their clinical experiences. Results: The study found that students in the case group exhibited lower reflective ability than control students. Furthermore, reflective ability was a significant factor in explaining the odds that a student had been cited for professionalism lapses. There were no differences in self-assessment scores between the two groups, but students in the case group had significantly lower peer assessment scores than control students. Peer assessment scores also had the greatest influence on the odds that a student had been cited for professionalism deficiencies during medical school. Qualitative analysis revealed that students learn professionalism from role models who demonstrated altruism and respect (or lack thereof). Conclusions: These findings suggest that students should be provided with guidance and feedback on their reflective writing to promote higher levels of reflection, which may reduce the number of students who are cited for professionalism lapses. These findings also indicate that peer assessments can be used to provide students with insightful feedback regarding their professional development. Finally, role models have a strong influence on students’ professional development, and therefore must be cognizant of the implicit messages their behaviors convey.

Indiana University-Purdue University Indianapolis (IUPUI) / Reducing medical error remains in the forefront of healthcare reform. The use of health information technology, specifically the electronic health record (EHR) is one attempt to improve patient safety. The implementation of the EHR in the Emergency Department changes physician workflow, which can have negative, unintended consequences for patient safety. Inaccuracies in clinical documentation can contribute, for example, to medical error during transitions of care. In this quasi-experimental comparison study, we sought to determine whether there is a difference in document quality, error rate, error type, cognitive load and time when Emergency Medicine (EM) residents use paper charts versus the EHR to complete physician documentation of clinical encounters. Simulated patient encounters provided a unique and innovative environment to evaluate EM physician documentation. Analysis focused on examining documentation quality and real-time observation of the simulated encounter. Results demonstrate no change in document quality, no change in cognitive load, and no change in error rate between electronic and paper charts. There was a 46% increase in the time required to complete the charting task when using the EHR. Physician workflow changes from partial documentation during the patient encounter with paper charts to complete documentation after the encounter with electronic charts. Documentation quality overall was poor with an average of 36% of required elements missing which did not improve during residency training. The extra time required for the charting task using the EHR potentially increases patient waiting times as well as clinician dissatisfaction and burnout, yet it has little impact on the quality of physician documentation. Better strategies and support for documentation are needed as providers adopt and use EHR systems to change the practice of medicine.