STRATEGIES FOR HEALTH-EDUCATION FOR ADOLESCENT PATIENTS - A PRELIMINARY INVESTIGATION

Objective: To determine the effect of unidirectional and bidirectional health education strategies on the amount of patient participation in the discourse between adolescent patients and physicians. Methods: Videotapes of medical interviews between physician and adolescent patients that had been made in an earlier study of the efficacy of a self-report questionnaire were reviewed. An inductive method of content analysis from a small sample of videotapes was used to develop mutually exclusive categories of health education communication strategies from the variety of strategies employed by physicians. Seven different strategies were identified and grouped into two categories, unidirectional and bidirectional. Thirty videotapes were randomly selected (from the 79 available videotapes) and health education segments were identified, categorized, and coded for the amount of time the patient and physician spent talking. Paired student's t-tests were used to compare the time spent talking by patients and physicians in the two health education strategy categories. Results: The patients consisted of 17 females and 13 males (mean age = 19.3). Two hundred thirty five individual health education strategies were identified, of which 183 (78%) were unidirectional and 52 (22%) were bidirectional. Physicians spent an average of 44.4 seconds talking in the unidirectional strategies, and 11.4 seconds in the bidirectional strategies (p = 0.0001). Patients spent 10.9 seconds and 26.1 seconds talking, respectively, in response to these strategies, (p = 0.07). The ratio of the time spent talking by patients to physicians was 0.14 for the unidirectional strategies and 1.06 for the bidirectional strategies (p = 0.004). Conclusions: Bidirectional health education communication strategies increase the amount of participation of adolescent patients in physician-patient discourse when compared to unidirectional strategies. The implications of these data for health education with adolescent patients are discussed.