Communication in Smoking Cessation and Self-management : a study at Nurse-led COPD-clinics in Primary Health Care

ABSTRACTThe general aim of this thesis was to investigate behavioral change communication at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary health care, focusing on communication in self-management and smoking cessation for patients with COPD.Designs: Observational, prospective observational and experimental designs were used.Methods: To explore and describe the structure and content of self-management education and smoking cessation communication, consultations between patients (n=30) and nurses (n=7) were videotaped and analyzed with three instruments: Consulting Map (CM), the Motivational Interviewing Treatment Integrity (MITI) scale and the Client Language Assessment in Motivational Interviewing (CLAMI). To examine the effects of structured self-management education, patients with COPD (n=52) were randomized in an intervention and a control group. Patients’ quality of life (QoL), knowledge about COPD and smoking cessation were examined with a questionnaire on knowledge about COPD and smoking habits and with St. George’s Respiratory Questionnaire, addressing QoL. Results: The findings from the videotaped consultations showed that communication about the reasons for consultation mainly concerned medical and physical problems and (to a certain extent) patients´ perceptions. Two consultations ended with shared understanding, but none of the patients received an individual treatment-plan. In the smoking cessation communication the nurses did only to a small extent evoke patients’ reasons for change, fostered collaboration and supported patients’ autonomy. The nurses provided a lot of information (42%), asked closed (21%) rather than open questions (3%), made simpler (14%) rather than complex (2%) reflections and used MI non-adherent (16%) rather than MI-adherent (5%) behavior. Most of the patients’ utterances in the communication were neutral either toward or away from smoking cessation (59%), utterances about reason (desire, ability and need) were 40%, taking steps 1% and commitment to stop smoking 0%. The number of patients who stopped smoking, and patients’ knowledge about the disease and their QoL, was increased by structured self-management education and smoking cessation in collaboration between the patient, nurse and physician and, when necessary, a physiotherapist, a dietician, an occupational therapist and/or a medical social worker.Conclusion The communication at nurse-led COPD clinics rarely involved the patients in shared understanding and responsibility and concerned patients’ fears, worries and problems only to a limited extent. The results also showed that nurses had difficulties in attaining proficiency in behavioral change communication. Structured self-management education showed positive effects on patients’ perceived QoL, on the number of patients who quit smoking and on patients’ knowledge about COPD.

Machine Translation and the Disruption of Foreign Language Learning Activities

This study examines the question of how language teachers in a highly technologyfriendly university environment view machine translation and the implications that this has for the personal learning environments of students. It brings an activity-theory perspective to the question, examining the ways that the introduction of new tools can disrupt the relationship between different elements in an activity system. This perspective opens up for an investigation of the ways that new tools have the potential to fundamentally alter traditional learning activities. In questionnaires and group discussions, respondents showed general agreement that although use of machine translation by students could be considered cheating, students are bound to use it anyway, and suggested that teachers focus on the kinds of skills students would need when using machine translation and design assignments and exams to practice and assess these skills. The results of the empirical study are used to reflect upon questions of what the roles of teachers and students are in a context where many of the skills that a person needs to be able to interact in a foreign language increasingly can be outsourced to laptops and smartphones.

Machine translation and the disruption of foreign language learning activities

This study examines the question of how language teachers in a highly technology-friendly university environment view machine translation and the implications that this has for the personal learning environments of students. It brings an activity-theory perspective to the question, examining the ways that the introduction of new tools can disrupt the relationship between different elements in an activity system. This perspective opens up for an investigation of the ways that new tools have the potential to fundamentally alter traditional learning activities. In questionnaires and group discussions, respondents showed general agreement that although use of machine translation by students could be considered cheating, students are bound to use it anyway, and suggested that teachers focus on the kinds of skills students would need when using machine translation and design assignments and exams to practice and assess these skills. The results of the empirical study are used to reflect upon questions of what the roles of teachers and students are in a context where many of the skills that a person needs to be able to interact in a foreign language increasingly can be outsourced to laptops and smartphones.