Master of Medicine Family Medicine

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    Effective Communication And Appropriate Lifestyle Behavior:
    (International Health Sciences University., 2015-12) Musisi, Theresa Frances
    Background Current Ugandan health policy guidelines have incorporated non-pharmacological lifestyle interventions such as healthy diet and physical exercise as an effective way both clinically and economically for preventing and slowing progression of Type 2 diabetes. This can significantly reduce costs of clinical care and limit new incidences of type 2 diabetes complications by more than 50%. Despite adoption of the current Ugandan diabetic care guidelines, it is not clear to what extent adherence to the effective lifestyle interventions is being advised and adopted for such patients. Globally patient centered approaches are recognized as an ideal way of effectively influencing behavior change in patients. Appropriate use of such skills can significantly empower patients to learn to modify their lifestyle behaviors in a practical manner and eventually change their health seeking patterns towards more inexpensive supportive services as opposed to clinical crises care. Objectives: The study sought to determine the sources of information for diet and exercise advice, whether diet and exercise advice is being delivered in an effective manner to Type 2 diabetic patients during health worker consultations at IHK and the current diet and exercise behavior of the same Type 2 diabetic patients. The findings of the study will contribute to clinical knowledge and practice in terms of designing appropriate communication approaches in supporting Type 2 diabetic patients in Uganda. Methodology: The researcher used a mixed methods cross sectional design among Type 2 diabetic patients attending care at International Hospital Kampala. Dependent variable: Effective communication between the heath worker and the patient. Independent variable: Diet and physical exercise behavior of Type 2 diabetic patients at IHK. A validated interviewer guided semi structured questionnaire was used to capture quantitative data from 154 patients. A focus group discussion and one key informant interview were held to capture qualitative data from health workers. Quantitative data analysis was done using SPSS version 16 for Windows and manual thematic methods were used for the qualitative data. Qualitative data was categorized and graded according to strength of evidence and usability of sources of information. Quantitative data was categorized and grading according to degree of communication experienced, diet and exercise behavior. These results were presented in form of figures and tables. An overall assessment of proportion of patients who practiced appropriate lifestyle was stated as well. Results: Strong sources of information included in house training sessions, lifestyle guidelines, lifestyle seminars and the internet. Effective communication was experienced by 58.4% of the Type 2 diabetic patients attending IHK. Of these same patients 7.1% of them practiced healthy diets, 50% practiced recommended exercises and 49% had an overall appropriate lifestyle behavior. Conclusion: The study has highlighted insights into sources of information used during health worker consultations, effective communication and practice of appropriate lifestyle behavior of type 2 diabetic patients which have not been documented in these recent years. The most preferred choice was the use of updated international guidelines and evidence based research. According to the strength of evidence the use of reputable websites and international guidelines, peer reviewed continuous medical education and lifestyle seminars are the ideal sources to provide these health workers with the correct information. Generally more than 50% of type 2 diabetic patients attending IHK experienced effective communication meaning that the communication style used by the health workers is above average. However 41.5% of patients are not getting the right message from the health workers at IHK meaning that the communication gap is still big. If the goals of non- pharmacological management are to be realized the average score for effective communication should be above 90%. Therefore there is much to be done to improve this situation. Appropriate diet modification is generally very poor at 7.1% and practice of recommended exercise is average at 50%. If health worker communication can be improved to above 90% it would create an opportunity for such patients to be better empowered to self manage their lifestyle practice. It is recommended that the use of reputable international guidelines tailored to the Ugandan context, CMEs and lifestyle seminars be the preferred and easily accessible sources of information on lifestyle modification. Any new sources of information should be evidence based and peer reviewed by an in house clinical committee at IHK. It is urgent that the health workers of IHK receive this feedback about how their patients rate the quality of their communication. This will prepare the foundation for in- house trainings on how to improve and maintain effective communication to above 90%. Future studies should do a prospective study looking at the direct relationship between effective communication and appropriate lifestyle behavior.
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    The Perspectives Of Health Workers On The Role Of Family Physicians:
    (International Health Sciences University., 2015-12) Ndahura, Duncan
    Background Family medicine is the specialist discipline of primary care with family physicians at the helm. Family physicians in a multidisciplinary team approach can cost-effectively manage most common conditions in the primary care setting 1,2,3 and the strengthening of primary care through incorporating more family medicine in the health care system has been shown to be the best way to address the current glaring health inequities1.However the role of family physicians is not well articulated by other health workers. Objectives The main objective of the study was to understand the perspectives of health workers at IHK on the role of family physicians. Health workers’ understanding of a Family Physician and their perceived skill set of Family Physicians made up the specific objectives. Methods This was a qualitative study that incorporated key informant interviews and focus group discussions. Twenty six participants took part in the study. They represented the various health cadres working at IHK. Interviews were done with the aid of interview guides and were digitally recorded. Interviews were then transcribed verbatim and thematic content analysis was done manually. Results Family physicians were perceived by most health workers to provide comprehensive health care to families, though confusion on the terminology was noted. Clinical, administrative , research and a limited role in policy were mentioned. Attributes of a multidisciplinary practitioner, counselling , communication, interpersonal and leadership skills were ascribed to their skill set. Benefits of reduced hospital visits, specialist visits, hospital admissions and reduced overall health care costs were attributed to Family Physicians by many respondents. However Family Physicians were relatively unknown, few in practice and their roles lacked clarity Conclusion There needs to be more sensitization of health workers on Family Physicians and Family Medicine. There needs to be clarification of their roles in the health care system.