Patient CMO Theory 3: Explaining how individualized health education from an IP team of students leads to improved clinical

outcomes for patients

Box 19: Patient Programme CMO Theory 3

Resource + Context à Reasoning = Outcome

Health education from an IP team of students • Longer face-to-face interaction • Individualised health education • Sufficient knowledge

The patient feels “I have the knowledge to help myself. I feel empowered and capable” Increased engagement in self-care Leading to improved clinical outcomes When patients attend the clinic, their appointments regularly last 1 to 2 hours. The

increased time patients spend in the clinic was thought to open opportunities for students to provide them with health education (mechanism – resource). Novice students, in the early stages of their professional programme, are not able to perform as many tests and

measures as senior students and are limited in their ability to provide care services. The key roles for novice students were described as taking a health history and vitals and providing health education information to patients during their appointment. This information was described as primarily addressing diabetes management, blood pressure monitoring and control, and depression. It was suggested that health education and information on self-care options provided by an IP team of novice students (mechanism – resource) would result in increased patient engagement in self-care strategies (intermediary outcome) and such engagement would lead to measured improvement in clinical outcomes. Several contexts were identified as important in achieving these outcomes.

Context – Longer face-to-face interaction

When patients received health education information related to their problems and issues, from an IP group of students in a longer face-to-face interaction (than in a traditional primary care appointment) during which they have time to ask questions and have them addressed, they gain valuable knowledge regarding their health condition and options for self-

management. The face-to-face nature of the education was suggested to encourage patients to feel more comfortable asking questions about their condition and about what they can do to manage it.

“The patients are with us a good long time. So we have a great, a great opportunity I guess, that most people don’t get to talk with them face-to-face about their

condition. We can do some health education with them, right there and then. We have the time, to walk them through some info about their diabetes, or their hypertension or such” (Student Volunteer).

Another volunteer student talking about providing health education to patients stated the following:

“We get to do a lot of patient education, like health education and self-care ideas with them. I am always surprised when they tell us they have never had that before, or have never heard that before. They ask us a lot of questions. It’s, it’s obvious they haven’t really had someone sit down with them before and really talk things over, like how to control their blood sugar, or like their blood pressure” (Student

Volunteer).

Context – Individualized health education

Conducting the health education on an individual basis rather than in a group setting was thought to be an important contextual factor in achieving the outcome of increased

engagement in self-care. It was suggested that individualized health education provides an opportunity for the education to be specifically tailored to the unique needs, resources, and capacities of individual patients. When talking with the researcher about the students providing health education to the patients in the clinic, a faculty clinician stated the following:

Faculty Clinician: “ It’s difficult for them (the patients), they don’t have a lot of access

to care, and when they do it tends to be answer questions, do tests. So the health education piece gives them a chance to really ask questions. To talk about things they can do that will be possible within their own capabilities and resources. To find the things that might work for them. It’s individualised, which makes a big

difference”.

Researcher: “A big difference? In…”

Faculty Clinician: “ Yes, a big difference in, in finding the things that might work for

them. Not just general advice, but, well, they have a chance to talk about the possible options, what might work for them, what might not, why. Like how do you eat healthy when you only have a few dollars a day to feed your family, if that? So general ideas about nutrition are often not that helpful. But how to realistically cut back on sodium. How to get vegetables in the area at low cost, which food banks tend to carry more fresh food, things like that”.

Context – Students with sufficient knowledge of the patient’s health condition Interviewees suggested the students providing the health education needed to have sufficient knowledge regarding the particular health conditions and concerns of interest to the patient. This was necessary for the students to be capable of providing individualized

health education and to appropriately answer the patient’s questions. The health education delivered by students addressed the most common patient presentations in the clinic: diabetes management, blood pressure monitoring and control, and managing depression. This limited the required knowledge base for the students to a common set of conditions that impact a large number of the patients attending the clinic. The following quote comes from clinic manager who talked about health education within the clinic:

“ We cover the common problems that patients in the clinic present with, so

diabetes, hypertension, depression. It’s not a big list, but it covers a lot, maybe most of our patients. It helps to be a short list, means we can target it to what the new students know and what most of our patients need” (Clinic Manager).

Mechanism reasoning - Empowered and capable

Patients who receive individualised health education, including self-care strategies related to their specific problems and issues, from an IP group of novice students (mechanism – resource) under the contexts discussed above, were thought to gain valuable knowledge regarding their health condition and realistic options for their self-management. Study interviewees stated that such knowledge leads patients to believe they have increased capacity to help themselves and to feel empowered and capable to do so (mechanism – reasoning). This, in turn, leads them to engage in increased levels of self-care (intermediate outcome) and engaging in such self-care was believed to result in improvement in clinical measures associated with their condition, such as blood pressure, and blood sugar regulation (Outcome). A faculty clinician described the connections within this CMO theory as follows:

" So the new students, the first years, they don't have a lot of clinical skills yet, but they do have knowledge they can share with the patients about their condition. So they do patient education with them. A few students in a team helping the patient understand their condition and what they might be able to do themselves to help. Like how to monitor their blood pressure or some information about, about diet, like sodium intake. Things they can do to help themselves. I think it empowers them. Yes, empowers them to take care of themselves, and I think we can measure that, that impact on their hypertension, on their BP and such" (Faculty Clinician).

5.4.2. Faculty clinician and student CMO theories that seek to