Grants and Research Committee: Abstract Annotation – October 2013

By Cate Nicholas

Title:  “Impact of Repeated Health Behavior Counseling on Women Portraying an Overweight Standardized Patient”

Introduction:  Qualitative research using focus groups with overweight or obese standardized patients who had participated in health behavior counseling (HBC) cases.  Research question was “How has your participation as a standardized patient changed your real life attitudes and behaviors toward nutrition and physical activity habits?” The research team sought to build on the following:

  1. Examine the influence of the role on an SP
  2. How the role modified real life behaviors and/or perceptions of health and wellness.

Review

Author(s): Heather Wagenschutz, Paula T Ross, Carrie K Bernat, Monica Lypson

Year:       2013

Article:    “Impact of Repeated Health Behavior Counseling (HBC) on Women Portraying an Overweight Standardized Patient”         

Publication:        Journal of Nutrition, Education and Behavior (Article in Press)

Annotation:

Authors are from the Family Centered Experience Program, Office of Student Medical Education, Standardized Patient Program, and the Office of Graduate Medical Education of the University of Michigan.

For this educational program, 10 SPs with body mass index (BMI) equal or greater than 27 were recruited to play patients who were overweight or obese single parents struggling with 2 teenagers working full time and battling a weight problem.  Third year medical students were taught HBC and then practiced enhancing patient motivation, promoting realistic health behavior goals setting and establishing a collaborative relationships with the SP.  The exercise involved 25 minute interview; SP and student checklists and 15-20 minutes of feedback.   During 12 hours of in-house and at-home training, SPs were standardized to play patients with high level of conviction but low level of confidence.

Two focus groups, with five SPs each, discussed whether their exposure via SP work in this case had an impact on their real-life decisions.  Sessions lasted up to 2 hours using open ended questions.  Additionally, BMI were calculated before for 8 of the 10 and after for 10 of the 10.

The following themes emerged from the themes supported by participant quotes

  1.  Insights gained:
    1. Small % of weight loss results in significant health benefits
    2. One can achieve exercise goals in small daily increments
    3. Making a commitment to ongoing lifestyle change as opposed to a program
    4. Important to exercise more and eat less
    5. Important to learn about caloric intake and nutritious food
    6. Optimistic that participation in this work would incite personal weight loss
  2. Emotional connections between SP and role
    1. Connection between personal lives and SP role
    2. Connection between physical and behavioral characteristics in the role and emotions ranging from guilt and pain to embarrassment and pain and discomfort with weight
    3. Coming to acceptance
    4. Wanting medical student to learn how to counsel with empathy and tact
  3. Lifestyle changes since participating in the role
    1. All had positive changes
    2. Small steps showed improvement

Key findings:  While SPs did experience some level of distress or psychological impact, they also experienced positive lifestyle changes.  Experience as an SP in this role served as a source of motivation for changing health behaviors.

Unanticipated findings and questions: Should role playing be used in clinical settings to assist patients with raising levels of convictions and confidence?  Conclusion: HBC model can be an effective method in helping patients recognize the need to take action.

Strengths:  I am always looking for research done with SPs as participants. At ASPE Nashville, 2011, keynote
speaker Jenny Rudolph stated that we were sitting on a gold mine of data if we just knew what questions to ask.  SPs are a wonderful resource in so many ways. For instance, they interact with our learners in ways that we cannot as they experience the educational process first hand. They have so much to tell us if we just ask.  I applaud the authors for taking the time to wonder and to ask the question.

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