COMMUNICATION AND COUNSELING

Anna Wahyuni W., S.Farm., MPH., Apt.

References :• Rantucci, M.J., 1997, Pharmacist Talking with

Patients, A Guide to Patient Counseling, 1th Ed, Williams & Winkins, Baltimore, Maryland.

• Rickles, N.M., Wertheimer, A.I., Smith, M.C., Social and Behavioral Aspect of Pharmaceutical Care, 2010, 2nd Ed., Jones and Bartlett Publisher, MA.

• Beardsley, R.S., Kimberlin, C.L., Tindall, W.N., 2007, Communication Skills in Pharmacy Practice, 5th Ed., Lippincott Williams & Wilkins, Baltimore.

• Glanz, K., Rimer, B.K., Viswanath, K., 2008, Health Behavior and Health Education : theory, research and practice, 4th 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 = SenderR = receiver

= messages/feedback loop= barriers

S

R

S

R

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 messagesIncluding 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 componentThe 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 :distance Appropriate relationship

and activities

< 46 cm Intimate 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 m Formal 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

27

Health

28

Illness as social concept

If you feel any symptoms of illness,

what will you do?

???

29

Illness as social concept

Illness :Individual responses

to symptom

s

Disease :Pathologi

cal or biologica

l 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 HBHow 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 2010/2011

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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