Ludmiła Marcinowicz

Patients' perceptions of GP non-verbal communication: a qualitative study

BACKGROUND During doctor-patient interactions, many messages are transmitted without words, through non-verbal communication. AIM To elucidate the types of non-verbal behaviours perceived by patients interacting with family GPs and to determine which cues are perceived most frequently. DESIGN OF STUDY In-depth interviews with patients of family GPs. SETTING Nine family practices in different regions of Poland. METHOD At each practice site, interviews were performed with four patients who were scheduled consecutively to see their family doctor. RESULTS Twenty-four of 36 studied patients spontaneously perceived non-verbal behaviours of the family GP during patient-doctor encounters. They reported a total of 48 non-verbal cues. The most frequent features were tone of voice, eye contact, and facial expressions. Less frequent were examination room characteristics, touch, interpersonal distance, GP clothing, gestures, and posture. CONCLUSION Non-verbal communication is an important factor by which patients spontaneously describe and evaluate their interactions with a GP. Family GPs should be trained to better understand and monitor their own non-verbal behaviours towards patients.

Motivations toward smoking cessation, reasons for relapse, and modes of quitting: results from a qualitative study among former and current smokers.

Background Smoking cessation plays a crucial role in reducing preventable morbidity and mortality and is a recognized public-health-policy issue in many countries. Two of the most important factors that affect the efficacy of quitting smoking are motivation and the ability to cope with situations causing relapse. Aim The objective of the study reported here was to investigate former and current smokers’ motivations for smoking cessation, reasons for relapse, and modes of quitting. Methods We arranged four focus groups with 24 participants (twelve current and twelve former smokers) and eleven semi-structured interviews (five current and six former smokers) with a view to understanding and categorizing their opinions on motivations and the course and process of smoking cessation. The data were next analyzed using descriptive qualitative methods. Results Three main themes were identified: (1) motivations to quit smoking, (2) reasons why smokers sometimes relapse, and (3) modes of quitting smoking. Within the first theme, the following six subthemes surfaced: (1) a smoking ban at home and at work due to other people’s wishes and rules, (2) the high cost of cigarettes, (3) the unpleasant smell, (4) health concern, (5) pregnancy and breastfeeding, and (6) a variety of other factors. The second theme encompassed the following subthemes: (1) stress and the need to lessen it by smoking a cigarette, (2) the need to experience the pleasure connected with smoking, and (3) the smoking environment both at home and at work. Participants presented different smoking-cessation modes, but mainly they were unplanned attempts. Conclusion Two very important motivations for smoking cessation were a smoking ban at home and at work due to other people’s wishes and rules, and the high cost of cigarettes. The most common smoking-cessation mode was a spontaneous decision to quit, caused by a particular trigger factor. Relapse causes encompassed, most notably: stress, lack of the pleasure previously obtained from smoking, and the smoking environment.

Open-ended questions in surveys of patients' satisfaction with family doctors.

Objective: To compare replies to open-ended and closed questions about patient satisfaction with family doctors. Methods: Two centres of primary health care in Białystok in northeast Poland were chosen. A self-administered questionnaire was mailed to 1000 people (500 from each centre) aged 18 years and over, randomly selected from the practices. Possible responses to the one closed question were: very good, good, bad, very bad or difficult to say. Replies to two open-ended questions were categorized as positive, neutral, negative or ambivalent. Results: The response rate was 57.9%. There were some discrepancies between the closed-question response and the open-ended question replies. Some of those who replied good or very good to the closed question expressed negative views in response to the two open-ended questions (14.0% and 12.4%). Conclusions: Answers to open-ended questions add value to a patient satisfaction survey by providing information that answers to closed questions may not elicite.

Understanding patient satisfaction with family doctor care

RATIONALE, AIMS AND OBJECTIVES Patient satisfaction is receiving increased attention in the evaluation of health care quality. However, qualitative methods have seldom been used to study patient satisfaction. The purpose of this study was to explore how satisfaction is understood from the perspective of patients receiving care from family doctors. METHOD We used a qualitative approach consisting of in-depth interviews with 36 patients attending clinics in Poland. Interviews were audiotaped and transcribed, and content analysis performed. RESULTS There was no single definition of satisfaction among study participants; however, some core characteristics of satisfaction emerged. These characteristics were: (1) good doctor-patient interaction; (2) health improvement or resolution of health problems; (3) fulfillment of prior expectations; (4) availability of health care; (5) combination of multiple characteristics; and (6) absence of dissatisfaction. CONCLUSION Because patients have differing concepts of satisfaction with health care provided by family doctors, quality assessments should focus on components of satisfaction whereas questions about satisfaction itself should be avoided.

What do older people value when they visit their general practitioner? A qualitative study

Older patients see their general practitioners (GPs) relatively often and so recognition of their preferences can lead to improvement of quality of care in general practice. This study aimed to identify which aspects of GPs’ behaviour are the most important for older people in their assessment of the quality of their visits and to explore the application of Jung’s taxonomy differentiating task and affective behaviour in this context. A qualitative approach to generating data was chosen. We conducted semi-structured interviews with a sample of 30 patients aged 65 and older using GP services in two demographically diverse big cities in Poland. Participants were interviewed in 2010 according to a pre-determined topic guide. This research showed that older people assess both ‘task performance’ and ‘affective performance’ behaviours of general practitioners. There were nearly twice as many patient comments concerning affective performance behaviour relative to task performance behaviour. Older people expect that their physicians will be demonstrably friendly, kind, able to joke and have enough time for the consultation.

Exploring negative evaluations of health care by Polish patients: an attempt at cross-cultural comparison.

Understanding patient dissatisfaction is essential as it provides information on how to improve the relationship between healthcare users and medical professionals. The aim of this paper is to determine how Polish patients verbally express negative opinions of their healthcare services, and to compare the patterns of opinion-giving behaviour between patients in Poland and Western Europe. A qualitative approach employing in-depth interviews was used. Nine primary healthcare centres were chosen in various regions of Poland, taking into account both type of practice, i.e. small and large, and location of residence, i.e. urban (small and large towns) and rural. In every centre, interviews were performed with four patients coming consecutively to their family physician. Thirty-six patients aged 20-78 years were interviewed. Their views could be categorised into eight reasons for avoiding expressing negative opinions: unpleasant emotions induced by giving a negative evaluation; avoiding offending healthcare providers; fear that their utterances could have a negative effect on their further medical care; fear of giving a hasty evaluation based on their own inexpert medical knowledge; determinants from recent Polish history; prestige of the medical profession; entrusting the most important aspect of life, i.e. health, to a doctor; and lack of faith that their opinions could cause change for the better. The respondents used certain rhetorical tricks to soften their criticisms. Patients face cultural barriers to expressing dissatisfaction about their health care. In the Polish context, these are the high social status of the physician and the low position of the patient. In their spontaneous utterances, the respondents gave detailed suggestions for raising the level of patient satisfaction with health care.

Involvement of family nurses in home visits during an 8‐year period encompassing primary healthcare reforms in Poland

Home visits by doctors and nurses are considered an important indicator of the quality of healthcare. Published data are scarce regarding the role of family nurses in providing professional home care in Central and Eastern European countries that have recently introduced reforms to their primary care systems. The objective of the present study was to describe the involvement of family nurses in home visits in the context of organizational and legal changes in service provision, that is, to analyse the role of the family nurses employed by family doctors (1998) versus family nurses working in autonomous positions (2002 and 2006). The proportion of patients in the community receiving a home visit from a family nurse, the purpose of the family nurses home visit and patient expectations towards the family nurse were studied. A series of cross-sectional studies were conducted in a small town in northeastern Poland, based on three consecutive surveys taken at 4-year intervals (1998, 2002, 2006, surveys I, II and III, respectively). During each survey, 1000 patients were interviewed (face to face) with structured questionnaires. In 1998, family nurses were employed by family doctors, but by 2002, nurses had established their own practices and held direct contracts with the National Health Fund. A significant increase in the percentage of patients receiving home visits from a family nurse was observed between surveys I and II (12.8% and 30.0%); however, the number of respondents reporting a home visit in survey III decreased to 23.9%. Patients over 75 years of age were the major demographic group receiving family nursing at home. This study suggests that reform of the primary healthcare system in Poland has produced changes in the family nursing system. Independence, contractual obligations and self-employment of Polish family nurses have resulted in their greater participation in home visits.

A short questionnaire for measuring the quality of patient visits to family practices

OBJECTIVE To describe a short questionnaire for measuring the quality of patient visits to family physician practices, and to assess the questionnaires validity and reliability. DESIGN Multi-stage research was carried out in three phases: Phase I--qualitative research based on 36 in-depth interviews; Phase II--quantitative research using a questionnaire to survey 360 respondents; and Phase III--quantitative research using a shortened version of the questionnaire to survey 1330 respondents. The reliability of the questionnaire was measured by using Cronbachs alpha coefficient. SETTING Family physician practices in Poland. PARTICIPANTS Adult patients of family physicians. INTERVENTION None. MAIN OUTCOME MEASURES The patient-doctor relationship and primary health care availability. RESULTS A final questionnaire was produced with 16 items in three components: (1) patient-doctor relationship and consultation outcome; (2) barriers and difficulties; and (3) accessibility of care. For each component, the Cronbachs alpha values were 0.92, 0.82 and 0.64, respectively. The overall reliability for all 16 items was 0.92. CONCLUSIONS The Quality of Visit to Family Physician questionnaire is a reliable tool that can be used by family physicians to obtain feedback from patients about patient-doctor relationships and visit outcomes, barriers and difficulties experienced by patients in seeking family physician care, and the availability of care.

What Do Children with Chronic Diseases and Their Parents Think About Pediatricians? A Qualitative Interview Study

Objectives The aim of this study was to determine how pediatric patients and their parents perceive health care during hospital stays, what are their expectations of doctor behaviors, and which components of care do they consider to be the most important. Methods A qualitative descriptive study was carried out using the open interview technique. Twenty-six parents and 22 children undergoing hospital treatment participated. Results Our analysis identified two major themes: (1) doctor verbal and non-verbal behaviors, which included informing and explaining, conversations on topics other than the illness, tone of voice and other behaviors; and (2) perceived strategies used by doctors. This category included claims of doctors’ intentional use of medical jargon to avoid addressing parental questions directly. Parents admitted that they did not understand medical vocabulary, but they also thought they might understand more of the medical issues if the doctor spoke using terms comprehensible to them. Conlcusions Our study shows the importance of interpersonal relationship affecting patient perception of quality of pediatric care. Parents of pediatric patients perceive that doctors behave in ways that deflect parents’ questions and avoid providing them with medical information. Such behaviors include doctors excusing themselves by saying they are busy and using medical jargon. Medical students and doctors should be trained to communicate effectively with patients and their parents and develop skills to convey information in a simple and comprehensible way.

Choice and perception of the nursing profession from the perspective of Polish nursing students: a focus group study

BackgroundAlthough previous quantitative studies provide important information on the factors which influence the choice of nursing as a career, qualitative analysis makes it possible to study the subject more thoroughly. The purpose of this study was to conduct an in-depth analysis of the reasons why Polish students choose nursing as a profession and their later perception of the job based on experiences acquired during the nursing course.MethodsA qualitative descriptive study was designed. We organized 8 focus group discussions with third-year nursing students. A total of 76 students participated in the study.ResultsSeveral reasons why students had chosen the nursing profession were identified: desire to help others, family tradition, desire to work abroad, failure to get into another course, pure chance, and low admission requirements (relative to medical studies). The participants’ views of the nursing profession were based on their own personal experiences or observations of nurses at work. Often these observations were superficial, concerning only selected fragments of nursing work. The participants also identified reasons for there being low regard for the nursing profession.ConclusionThe decision about choosing nursing is mainly determined by practical aspects, e.g., the opportunity for employment. Although young people are aware of the low prestige of the nursing profession in Poland, they believe it is possible to improve its image and enhance its prestige.