Transforming health professionals

attitudes toward patients and clients by

Caf-style health communication
Daisuke Son
1
, Kazuhiro Nakayama
2
1) The University of Tokyo, Graduate School of Medicine,
International Research Center for Medical Education, Tokyo, Japan
2) St. Luke's International University, Department of Nursing
Informatics, Tokyo, Japan
1
Background
Good communication between patients/clients
and health professionals influences not only
patient satisfaction but also desired health care
outcomes (Bensing et al., 2001).
However, communication in medical settings has
many limitations, due to lack of time, an
institutional style of conversation (Heritage &
Clayman, 2010), asymmetrical interaction (West,
1983), etc.
2
Background
Cafe-style health communication using a
dialogue-based approach such as World-Caf
can help health professionals and patients or
clients understand each other in a relaxed
setting.
It is an interactive activity where health
professionals and patients/clients have an open
conversation in a small group with facilitators,
and learn from each others' perspectives.
3
Background
Some studies have shown the effectiveness of
Caf-style communication for adult education in
health care (Fallon, 2012; McAndrew, 2012),
however, little is known about the effects on health
professionals.
Previous research suggests that positive
consciousness transformation (transformative
learning) occurs in health professionals, because
encountering patients/clients opinions leads to self-
reflection (Otoyama, 2012).
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Objectives
The main objectives of this study is to evaluate:
1. how the transformative learning process occurs
in participants of Caf-style health
communication.
2. how it results in a change of health
professionals consciousness about patients
and clients.
5
conceptual framework
6
disorienting
dilemma
perspective
transformation
self
reflection
understanding
of others
encountering
diverse
values
narratives of
clients
formative
learning
health literacy
improvement
consciousness
change toward
clients/patients
transformative learning
experiences in
health communication
learning process
consequences
of learning
*for health professions only
17
th
MlncleCafe
"Towardahomecare-frlendlysoclety"Aprll2012
7
24
th
MlncleCafe
"End-of-llfecareathome"May2013
8
Methods
A questionnaire to measure relevant concepts including
components of transformative learning and
consequences of learning was developed and validated.
The questionnaire consisted of 72 items, written in
Japanese, and used a 5-point Likert-type scale
(1=strongly disagree, 3=neutral, 5=strongly agree).
The survey was conducted using online questionnaire
software (SurveyMonkey

), distributed to 357 people

who participated in Caf-style health communication in
Tokyo over the 3-year period (from August 2010 through
September 2013).
9
Methods
To evaluate the validity and reliability of concept
measurement, we conducted exploratory factor
analysis and confirmatory factor analysis.
To study the relationships between various
concepts, we conducted structural equation
modeling (SEM), which enables multivariate analysis
including latent variables.
Statistical analyses were done using SPSS

22.0,
Amos

22.0.
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Results
The valid response rate was 39.5% (141/357).
80 people (57%) were health professionals and 61 (43%)
were patients and citizens.
Male : female = 34% : 61%
Health professionals (80) included physicians (16),
nurses (10), pharmacists (3), occupational therapists (5),
physiotherapists (2), nutritionists (3), etc.
Among patients and citizens (61), 19 people had disease
experience, and 27 were family or supporters of patients
or clients.
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Results
Exploratory factor analysis (Promax rotation) for 17 items
relating transformative learning revealed 4 factors. 3
items were omitted because of double loadings.
The four factors were named self reflection,
perspective transformation, disorienting dilemma and
formative learning.
Confirmatory factor analysis was conducted with the 4
factors using SEM, and the model fit indices were
satisfactory (GFI= .89, CFI= .93, RMSEA= .084).
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SEM of all participants (n=141)
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disorienting
dilemma
understanding
of others
perspective
transformation
self
reflection
health literacy
improvement
formative
learning
narratives
of clients
encountering
diverse
values
GFI= .80
CFI= .93
RMSEA= .058

significant
not siginificant
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SEM of health professionals (n=80)
disorienting
dilemma
perspective
transformation
self
reflection
understanding
of others
encountering
diverse
values
narratives
of clients
formative
learning
consciousness
change toward
clients/patients
GFI= .67
CFI= .82
RMSEA= .093

significant
not siginificant
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SEM of citizens/patients (n=61)
disorienting
dilemma
perspective
transformation
self
reflection
understanding
of others
encountering
diverse
values
narratives
of clients
formative
learning
GFI= .66
CFI= .85
RMSEA= .088

significant
not siginificant
health literacy
improvement
Discussion
Caf-style health communication, in which health
professionals learn diverse patients/clients
values and narratives, can change
consciousness towards patients/clients, possibly
leading to attitudinal change, via self reflection
and perspective transformation.
This psychometric analyses has several
limitations, e.g., it studies only self perceptions,
and it is a cross-sectional survey.
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