EVALUATION OF EFFECTIVENESS OF INTERPERSONAL COMMUNICATION OF HEALTH EDUCATION PROVIDERS WORKING AT PRIMARY HEALTH CARE CENTERS

Results: There was a positive linearcorrelationbetween communication skills of and


Methods:-
Assessment of the effectiveness of interpersonal communication skills of health providers in PHC centers, was carried out by using a structured checklist adopted from communication skills assessment tool(CAT) (14) , it was modified by the researcher. Three main domains wereevaluated; the skills of communication,competency and information of health provider beside three other domains; the tools used, place and time of conducting the session were also assessed.
The researcher attended both the individual and group sessions of health education carried out by the health providers and a specified check list for everyone wascompleted through watching them during these sessions.
The questionnaire was administered in English and consist of two parts:part one; Include information related to the demographic characteristics (gender, age,profession) and training course of health providers. And part two consist of six domains: three of them were expressed by several themes.
According to Likert scale a scores of (1-3) was given for each theme reflecting specific skill, competency and information, those not done given the score (1), imperfectly done score (2), and those perfectly done were given the score (3). Then a total score for each main domain was calculated and accordingly the minimum and maximum total scoring was ranged as follows 1. Communication skills consists of 9 themes: the scores range 9-27 2. Health provider competency consists of 3 themes: the scores range 3-9 3. Health provider information consists of 3 themes: the scores range 3-9 The other three domains: time, place and the tools used in conducting the session, each was reflectedby one theme so the total score was ranged from (1-3). The time of conducting the session in this study regarded to be perfect when it was not less than five minutes for individual sessions and 15 minutes for group sessions.

Statistical analysis:
The collected data were introduced into micro soft office excel 2010 and were analyzed using SPSS version (20). Descriptive analysis using, frequencies and percentages had been used to describe different variables,while (mean ± SD) was calculated for the allocated scores of different domains of interpersonal communication. Analytic statistical test (t-test) was used to study the association between different variables and the reported scores, while Pearson linear correlation had been assessed to detect the correlation between different domains of interpersonal communication. P-value ≤ 0.05 regarded the level of significance in this study.

Ethical issues:
An approval of the scientific and ethical committee at Al-kidney college of Medicine had been taken initially, then an official request for facilitation of the omission of conducting the study was delivered from Al-kindy college of medicine and administered to all PHC centers that included in the study. Anone verbal consent also had been taken from all the health providers participant in the study.

Results:-
Health providers included in this studywere 43 individuals (table-1). (55.8%) were female and 44.2% were male, while 53.5% were doctor and 46.5% paramedical. Only 25.6% of the study sample had training course while 74.5% had no training course. The distribution of age group of health provider found to be 34.9% of the participants were in age group (20-34) years, 32.6% in age group (35-44) years and 32.6% were 45 years and more. Regarding thestatements that reflect the domain of health provider information found to be perfectly done in 58.1% (depend on specific guideline) while not done in regard to (Gave much information about the subject), (the content is relevant) in 39.5%, 16.3%respectively. The remaining domain which reflect the effectiveness of interpersonal communication of health provider during health education sessionfound to be imperfectly done in regard to time in 79.1% of the sessions, while perfect place and tools was applied in 51.2%, 53.5% of the sessions respectively.     (7) was higher than that of the female(6.8).
Another domain of effective interpersonalcommunication related to health provider (place, tools) shows no significant differences between male and female and their mean scores reflect these aspects to be good in place, tool (> 2-3) while neutral in time.  (7)were higher than that of paramedical mean score (16),(4.7) and(6.7) respectively, yet the differenceswere not significant (p-value=0.1, 0.1,0.4) respectively.The mean scores of both of them were within the scale of neutral for communication skills and competency while it was good for information.
Again, there were no significant differences had been found inother themes reflecting the effectiveness of interpersonal communication of health provider whether they were doctors or paramedical in regard to (place,tools) since the mean scores of both of them were within the range of good (>2-3) while neutral in time.  Table-6showed that the mean score of health providers who had participated in trainingcourse were(19.7±5.7,6.3±2,7.1±1)in communication skills,competency and information respectively which were higher than that of those withouttraining courses (16.5±4.7,4.8±1.7,6.8±1.4) respectively,The difference was only significant (p-value =0.02) in competency.The mean scores of both of them were within the scale of good for communication skills, information and competency in those with training, while neutral in communication, competency and good ininformationin those without training. No significant differences had been foundin otherthemes reflecting the effectiveness of interpersonal communication of health provider whether they were trained or not regarding place and tools since the mean scores of both of them were within the range of good (>2-3) while neutral in time.

Discussion:-
Physician patient communication is a basic skill and is considered as a permanent factor in presenting health services (15) .
This study showedthat about half of the health providers have good communication skillsin relation to (talking using understandable language) this mean that health providers participating in health education at PHC center had the ability to use simple language that could easily reach the clientsthat could help in effective communication (16) .

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There was a significant associationbetween the effectiveness of interpersonal communication of health provider with their participation in training courses whether these courses were specified for enhancements of communication skills or other common topicsandaccording to Silvermanet alcommunication skills are mostly an acquirable and learnable skills that exhibited by training courses rather than clinical experience only (31) . A study done by Baker et al showed that when communication training is limited to a single session without follow-up reinforcement training, learned skills tend to fade over time (32) ,this might recommend a continuous and in job training programs to be applied for all health providers concerned with health education at primary health care level to maximizetheir performance.On the other hand, training clients in communication skills could be considered as a new concept in improving client-health provider relationship since it seems to be potentially effective for facilitating health outcomes that were important for physician and patients (33) .
Interpersonal communication skills of health provider with older age>45 year found to be more effective than those of younger age group 20-30 year this might be due to the fact thatskills were acquired during daily work, experience,training, the finding of this study contradicted other studyconducted at 2012 in Iran by Parviziet al showed that graduated person motivated to reach job stability so do bettercommunication,but among older age because of lack of motivation,confidence and job stability they showed weaker communication performance (29) .