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Public health
Original research
Health literacy education programmes developed for qualified health professionals: a scoping review
  1. Lauren Connell1,2,3,
  2. Yvonne Finn3,4,
  3. Jane Sixsmith1,3
  1. 1Health Promotion Research Centre (HPRC), University of Galway, Galway, Ireland
  2. 2Alliance for Research and Innvoation in Wounds (ARIW), University of Galway, Galway, Ireland
  3. 3CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway, Galway, Ireland
  4. 4School of Medicine, University of Galway, Galway, Ireland
  1. Correspondence to Lauren Connell; l.connell3{at}nuigalway.ie

Abstract

Objectives Both literature and policy have identified the need for health literacy education for qualified health professionals. This study aimed to identify and map health literacy competencies and health literacy related communication skills educational interventions for qualified health professionals. The research questions included: Of the qualified health professional education interventions identified, which are focused on diabetes care? What health literacy competencies and health literacy related communication skills are integrated into each programme? What are the characteristics of each education programme? What were the barriers and facilitators to implementation? What methods are used to evaluate intervention effectiveness, if any?

Design Scoping review, informed by the Joanna Briggs Institute guidelines.

Data sources The following databases: OVID; CINAHL; Cochrane; EMBASE; ERIC: PsycInfo; RIAN; Pro-Quest; UpToDate were searched.

Eligibility criteria Articles were included if the education programme focused on qualified health professionals, in all clinical settings, treating adult patient populations, of all study types.

Data extraction and synthesis Two authors independently screened titles, abstracts and full text articles that met the inclusion criteria. The third author mediated any discrepancies. The data were extracted and charted in table format.

Results In total, 53 articles were identified. One article referred to diabetes care. Twenty-six addressed health literacy education, and 27 addressed health literacy related communication. Thirty-five reported using didactic and experiential methods. The majority of studies did not report barriers (N=45) or facilitators (N=52) to implementation of knowledge and skills into practice. Forty-nine studies evaluated the reported education programmes using outcome measures.

Conclusions This review mapped existing education programmes regarding health literacy and health literacy related communication skills, where programme characteristics were identified to inform future intervention development. An evident gap was identified regarding qualified health professional education in health literacy, specifically in diabetes care.

  • Public health
  • Education & training (see Medical Education & Training)
  • Diabetic foot
  • Diabetes & endocrinology
  • Medical education & training

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2022-070734

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    Strengths and limitations of this study

    • This study is the first to map characteristics of education programmes in health literacy and health literacy related communication for qualified health professionals.

    • A scoping review methodology was used in order to map the current evidence; therefore, it does not assess risk of bias or reporting measures like a systematic review methodology.

    • Studies were excluded if they were not in the English language, which affects the generalisability of the study and relevance to other language speakers and cultures.

    • Student populations were not studied in this scoping review. The focus was on qualified health professionals, which is an identified limitation of this research.

    Introduction

    Literature has established the need for health literacy (HL) education for qualified health professionals (QHPs),1–3 with recognition of this need reflected in policy development in European countries4 where the goal is to improve patient outcomes.1 Although HL research has developed significantly since 1973,5 limited research has been undertaken on HL interventions and their effectiveness,6 specifically within QHP education.

    Within the ‘oral exchange’ between the QHP and the patient, interactive/communicative HL takes place.7 8 Oral literacy and social skills are integral in meeting patients’ health needs and enabling understanding. An ‘interactive communication loop’ has been recommended, whereby the QHP assesses patient understanding and recall;9 an example of this is the application of the ‘Teach-Back’ tool.10 HL education for QHPs is often directed towards this interactive domain by using a range of techniques such as ‘Teach-Back’,10 minimising jargon11 and ‘Ask Me Three’ to confirm patient understanding12 and designing health literate reading materials to improve comprehensibility.11 If the HL demand placed on individuals is reduced, by means of health literate communication from the QHPs, patient outcomes have the potential to improve.13

    In patients with chronic disease, limited HL has been associated with lower health-related quality of life14 and poorer health outcomes.15 A social gradient can be seen with a higher proportion of those with limited HL experiencing lower socioeconomic status, lower educational attainment and are of older age which mirrors the pattern of inequality of those with chronic diseases.16 17 For those with diabetes, there are complex demands put on them in navigating the health system, especially when complications exist, such as diabetic foot disease (DFD).18

    Demands on individuals, with diabetes, are characterised by a high level of complexity,19 where effective self-management relies on patients having advanced HL skills to use written education material and verbal instructions.6 Interactive HL has been found to be the most important HL domain needed within diabetes self-management,20 where a higher level of oral literacy (communication) is required to extract and discuss information with others.21

    It is suggested that when HL is considered in isolation, it is associated with greater diabetes self-efficacy,22–24 where greater self-efficacy is associated with lower glycaemic levels. Patients that are unable to effectively self-manage are at increased risk of complications. One of the most serious of which is DFD, which can result in amputation.25 Individuals living with DFD have been found to have limited comprehension of diabetic foot ulceration; lack of foot self-care; delayed ulcer detection and seeking of medical attention, which puts the foot at increased risk.26 Similarly, foot self-care was often considered of lower priority than more immediate demands such as taking medication and glycaemic control. Factors that appeared to motivate engagement in foot self-care included receipt of education and/or training from health professionals, which empowered participants to look after their feet.26 In order to maintain a supportive therapeutic relationship, health professionals must move away from simply focussing on ‘education’ and ‘advice’ and instead aim to support individuals in achieving effective self-management.27

    This current study adopted a relational concept of HL,28 focusing on organisational health literacy (OHL). The OHL approach makes health services easier for patients and their families to access, navigate and engage with so that they can make informed decisions for their health.12 Emphasis is not on the individuals’ capabilities to manage their own health but on how their environment and the health services play a central role in their successful application of their abilities to access and use services. Adopting this OHL approach places emphasis on educating qualified QHPs on health literate practice, to optimise patient-practitioner communication7 29 to ultimately empower patients.

    Training programmes have been developed for QHPs to address HL competencies and HL-related communication skills.2 30–32 The extent and nature of programmes need to be collated in order to assess the potential of undertaking a full systematic review33 and to inform future development of these complex interventions. This scoping review forms the first phase of the Medical Research Council (MRC) framework in the development phase of a complex intervention,34 where focus is on compiling evidence to inform intervention development. In this scoping review, the core concept is that of education programmes for HL competencies and HL-related communication skills for the population comprising QHPS of all backgrounds, in the context of primary, secondary or tertiary healthcare settings.33 35 These key elements comprising concept, population and context inform the primary research question which is: what HL competencies and HL-related communication skills educational interventions exist for QHPs?

    The overall aim of the scoping review was to identify and map current educational interventions to improve HL competencies and HL-related communication skills of QHPs, specifically within diabetes care. This study is situated within a larger research project entitled, Diabetic Foot Disease: from PRevention to treatment to IMproved patient Outcomes (DFD PRIMO).

    Methods

    Patient and public involvement

    None.

    Review approach

    Protocol development started with preliminary research which did not identify current literature within the population pertaining to those with either DFD or those with a diabetes diagnosis. Therefore, it was decided to expand the review to capture all QHPs practicing in primary, secondary and tertiary care settings.

    This scoping review was conducted drawing on methods and guidance from the Joanna Briggs Institute (JBI),35 which adds to earlier guidance on scoping review methodology.24 The study protocol was published on HRB Open: https://doi.org/10.12688/hrbopenres.13386.2. This study protocol can be found in online supplemental file 1. It was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.36

    Selection criteria

    The ‘PCC’ framework was employed,33 35 where the population was QHPs of all backgrounds. Concept referred to education programmes for HL competencies and HL-related communication skills. Context was primary, secondary and tertiary care settings.

    Five stages of a six-stage framework were used to structure this review,33 and the optional stage six which comprises stakeholder consultation was not adopted in the context of this current study.

    Stage 1: identifying the research question

    The primary research question was:

    What HL competencies and HL-related communication skills educational interventions exist for QHPs?

    The secondary research questions were:

    • Of the QHPs education interventions identified which are focused on diabetes care?

    • What HL competencies and HL-related communication skills are integrated into each programme?

    • What are the characteristics of each education programme?

    • What were the barriers and facilitators to implementation?

    • What methods are used to evaluate intervention effectiveness? If any.

    • What are the outcomes of the education programme on QHPs and/or patients?

    Stage 2: identifying relevant studies

    This study retrieved evidence through a comprehensive search strategy in the following databases: OVID; CINAHL Cochrane; EMBASE; ERIC: PsycInfo; RIAN; Pro-Quest; UpToDate. This search was performed in September 2021. Grey literature was searched within the references of identified articles. The search strategy was populated from a combination of free text search terms, text words, Medical Subject Headings (MeSH) terms and keywords with Boolean operators. Search terms were used in combination with search filters to tailor for each database. The search was developed with advice from a research librarian with expertise in search strategy development. The selected keywords and search string, relevant to Medline via Ovid, and developed search strategy can be found in the published protocol37 and in the online supplemental file 2, to which further details have been added.

    Stage 3: study selection

    The search was limited to the English language due to the variation in interpretations of the notion of HL from a cultural and socioeconomic perspective.38 39 All searches were limited to post-1973, due to HL research emerging at this time.5 In order to be included the educational intervention, components had to contain HL competencies or HL-related communication skills training, as previously defined40 41 in order to be included.

    In this current study, QHPs identified were not limited by profession or setting. It must be noted that this search was limited to adult patient populations as often foot screening begins in adulthood as diabetes is monitored.42 For this study and the overarching project, health professional students were not included in the population as the focus is QHPs working in diabetes care. Study selection was based on the inclusion criteria provided below:

    • QHPs.

    • Adult patient population (>18 years old).

    • Intervention: HL competencies and HL-related communication skills education containing competencies, as previously defined.40 41

    • All research methodologies.

    • All clinical settings.

    The exclusion criteria include:

    • Healthcare students.

    • Paediatric patient population.

    • Literature pre-1973.

    • Literature not in the English language

    Similar to previous research, selection of sources and evidence will take place over four steps:43

    Step 1: Initial retrieval of sources were performed by one author. Results from the search were imported into Rayyan,44 a scoping review manager software, whereby citations were collated, and duplicates removed.

    Step 2: Title screening. Titles were screened against the inclusion criteria and retained if they explicitly met the inclusion criteria. This step was performed by two blinded authors, whereby the third author was used to mediate if any disagreements arose.

    Step 3: Abstract screening. Abstracts were screened against the inclusion criteria and were retained if they met the inclusion criteria. This step was performed by two blinded authors. Disagreements were mediated by the third author through discussion.

    Step 4: Full text review. Articles were retained if compliant with inclusion criteria. This was performed by two authors of the research team and cross-checked with the third if any complications arose. This step was further developed in response to the volume of relevant results at this stage and the variability in the quality and detail of reporting in articles identified. The aim of this development was to counter any definitional drift, strengthen consistent decision making and increase reliability, specifically in relation to the inclusion criterion, ‘intervention’. This was achieved through discussion by the three authors, in two workshop style sessions over 2 days, where a unanimous decision was made on articles presented. Procedural rules were developed focusing on addressing the questions:

    1. Did the article explicitly report details of the intervention?

    2. Did the article explicitly report HL competencies OR HL-related communication skills?

    Therefore, if studies did not follow the procedural rules explicitly, then they were excluded, as ‘a single failed eligibility criterion is sufficient for a study to be excluded from a review’.45

    Numbers of articles included and excluded were documented using the PRISMA-ScR standardised template,36 as demonstrated in figure 1.

    Figure 1
    Figure 1

    PRISMA flow diagram. *Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all database/registers). †If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools.

    Stage 4: charting the data

    The extraction form was collated based on the JBI template source of evidence details, characteristics and results extraction instrument,35 training programme evaluation methods46 and insight from previous work.47 A data charting form was developed drawing on the following characteristics, as agreed by the research team, such as: Year and Author; Country; Aim; Timeframe; Setting; Patient population; Intervention; Comparator, if any; Setting; Participants; Programme mode of delivery; Course detail; Educational philosophy; Evaluation method; Kirkpatrick level of evaluation (this training evaluation model delineates four levels of outcomes such as reaction, learning, behaviour and results).46 An excel spreadsheet was used to chart these data and a full list of the characteristics charted is available in online supplemental file 3.

    Stage 5: collating, summarising and reporting of results

    Data were reported for each selected study within the agreed characteristics. Relevant findings were charted, using the data charting form developed in Stage 4. Subcategories of emerging themes were identified depending on presenting data, as seen in Results section.

    Results

    The database search yielded 17 036 search results citations post deduplication. Stage 1: Title screening resulted in 610 citations. Stage 2: Abstract Screening resulted in 207 citations where 403 citations were excluded on the basis of wrong population (N=87); not an educational intervention (N=272); no abstract (N=6); Intervention not consisting of HL or HL-related communication skills (N=34) and duplicates (N=4). The remaining 131 citations from Stage 2 moved to Stage 3 with full text screening undertaken which resulted in 53 included citations that were extracted in stage 4, Data Extraction.

    Study characteristics

    Most studies were non-randomised, longitudinal and undertook pre-post evaluation. The timeframe ranged between immediately posteducation48 and 12 months postintervention.49 One study was a randomised controlled trial, looking at hypertension outcomes.50 Of the final 53 studies, the majority (N=32) took place in the USA, Denmark (N=5) and Japan (N=3). Intervention participants were reported as health professionals (N=25), and some reported specific professions such as doctors (N=13) and nurses (N=9). Thirty-eight out of the 53 studies did not report the patient population and 10 reported an oncology patient population.

    Educational techniques

    Didactic and experiential methods were reported to be used (N=35). The use of didactic techniques was reported explicitly (N=11). The educational technique was not reported in one study.51 Specific experiential techniques were reported such as Role-Play (N=23) and Workshops (N=15).

    Programme content

    One study mentioned diabetes care.52

    Health literacy-specific interventions

    All programmes reported educational content (N=26), where 16 reported teaching written and spoken communication best practices; 13 reported teaching an overview of HL; 5 reported self-management and empowerment and 4 reported the ‘Always Use Teach-Back’ training toolkit. Specific HL topics were addressed and charted in table 1.

    View this table:
    Table 1

    HL training programme (n=26)

    HL-related communication skills interventions

    Different HL-specific techniques were used, and four studies reported confirming understanding using Teach Back; five reported avoiding jargon; four reported using ‘Summarise’; four reported asking open questions and four reported shared decision making. Specific HL topics were addressed and charted in table 2.

    View this table:
    Table 2

    HL communication skills training programmes (n=27)

    Education philosophy

    The majority of studies (N=47) did not report using an educational philosophy in development or delivering of the intervention; however, some studies made reference to using ‘adult learning philosophies and instructional methods (eg, train-the-trainer)’;53 ‘Comfort Theory’54 and the ‘Adult Learning Theory’;55 56 ‘Bandura’s Theory of Social Learning’;57 58 ‘Calgary-Cambridge model;58–60 ‘COMSKIL conceptual framework’61 62 and ‘Interaction Adaptation Theory’.63 64

    Evaluation

    In terms of Kirkpatrick’s levels of evaluation,46 22/53 studies addressed Level 1 evaluation: Reaction; 38/53 studies assessed Level 2 evaluation: Learning and 35/53 studies addressed Level 3 evaluation: Behaviour. However, 4/53 studies did not report outcome measures therefore a Kirkpatrick Level could not be determined.65–68

    Barriers and facilitators to implementation

    The majority of studies did not report barriers (N=45) or facilitators (N=52) to implementation of knowledge and skills into practice. In this study, implementation was in terms of perceived barriers to implementing learnt knowledge, skills and practices in clinical practice.

    Barriers reported include feeling unable to translate learning into practice; overestimation of HL understanding; difficulty in changing behaviour; breaking habits and overestimation of competencies; fitting the programme into daily practice; sustainability and lack of resources.2 30 69–72 Other barriers to implementation included organisational barriers such as having an internalised or individual pressure to use technical language70 and environmental barriers (lack of faculty role modelling, time constraints and/or pressure to address multiple issues during clinic visits).71 72 Organisational issues included needing a greater shift in HL thinking by the organisation; lack of resources; limited or no funding; staff retention and not having HL identified as a priority within the organisation.51

    Facilitators identified included having organisational commitment including managerial and executive support, having someone to champion HL in the organisation and the organisation already having HL identified as a priority and the support from Primary Care Partnerships Staff.51 Importance of having individuals within the organisation who could act as innovators or early adopters of innovation to help champion the change and increase adoption of the innovation.73

    Discussion

    This scoping review maps the current HL and HL-related communication skills education programmes in existence for QHPs in all settings. Fifty-three studies were identified that addressed HL or HL-related communication skills. Within that sample, 26 studies focused on HL education, and 27 studies looked at HL communication skills.

    A HL education programme consists of a set of competencies that professionals need to master in order to appropriately address limited HL levels presenting in their patients, by ‘presenting information in ways that improve understanding and ability of people to act on the information’.74 HL-related communication is recognised to be a component of HL, from the point of view of ‘oral exchange’ and interpersonal communication between the health professional and the patient. They are not seen as synonymous but interlinked.75 HL-related communication is the process of information exchange and HL is the application of a skill set.76 This is evident when the aim of communication skills education is to develop competencies that promote HL training of health professionals.1 In other words, it is promoting the development of the skills required in the communication process. This has the potential to strengthen the patient-healthcare professional dynamic. If the HL demand placed on individuals is reduced, by means of health literate communication from the health professionals, patient outcomes have the potential to improve.13

    Initially, this scoping review aimed to look at the patient population with DFD and the education of the multidisciplinary team (MDT) involved in its management. A preliminary search revealed that there was no evidence in the area. Similarly, this was the case when broadened to diabetes care for the published protocol;37 therefore, it was decided to do a scoping review due to the inadequate volume of evidence to conduct a systematic review.33 This has been identified as both a strength and a limitation as the population chosen is specific yet broad. Therefore, this allows for the full scope of the chosen population to be explored by means of a scoping review. Similarly, this is the case with the chosen population where student health professionals were excluded. Learner needs and motivation for learning differ. If QHPs are working fulltime, their need for flexibility in learning must be accounted for.

    This scoping review found that of the 53 studies only 1 referred to diabetes.52 The goals of the curriculum did not address diabetes or allude to its applicability to diabetes care and limited reference was made in the standardised patient encounter where the patient case had diabetes. Therefore, to develop an education programme, knowledge needs to be drawn from a wider evidence base because of the lack of available literature in the area of diabetes. However, this can be identified as a limitation to the research as one could allude to the role of generalised education programmes with focus on chronic disease.

    The programmes collated in this scoping review have demonstrated the need for appropriately detailed interventions, with wider applicability as most studies focused on tertiary care or disease-specific areas where advanced HL is needed (such as genetic testing). It was noted that no studies reported evaluating education of a disease-specific MDT, which is an area of the utmost importance when working with chronic disease such as diabetes, where MDT involvement is vital for optimum patient outcomes.

    Minimal detail was reported on each intervention, affecting its reproducibility which is important in health professional education as often a programme will need to be adapted and modified according to the participant and patient demographics and cultural context. This scoping review is a component of a PhD project within a Collaborative Doctoral Award focusing on DFD, whereby the review forms the initial evidence base in creating a prototype educational intervention for the MDT working with patients in the management of DFD. The lack of detail in reporting is a significant barrier to collating the evidence base for a novel programme in disease management. Nevertheless, the evidence base is limited and underdeveloped, specifically in diabetes care. Therefore, the information reported and collated in this current study does not provide sufficient information to replicate implementation of interventions, which is a significant issue for practice development and methodological rigour. Similarly, the scoping review methodology did not allow for quality appraisal or risk of bias, therefore, it was not assessed.

    Of the 53 studies, only 35 reported using a combination of didactic and experiential methods, and 47 did not report using an education philosophy. Similarly, based on programme characteristics noted in this review, there is no detail regarding adult education and how adults learn, which may be beneficial for novel programme development. This suggests a lack of input from those with expertise such as educationalists and/or a lack of reporting. Underreporting and insufficient detail were common issues encountered throughout this review as one of the secondary research questions was to detail the ‘characteristics of each programme’. Within complex interventions, the role of theory has been identified and recognised in the MRC framework.34 In this study, chosen articles did not elaborate explicitly as to how their intervention was developed. The broader literature base will need to be referenced for detail on instructional design and educational philosophies, particularly if a novel programme is to be developed.

    Interestingly, barriers and facilitators were not reported in 85% of studies identified in this scoping review. The way in which the education is delivered is integral, as it has the potential to mitigate issues. Various studies identified barriers such as a lack of resources, environmental barriers and organisational barriers. Such barriers need to be noted and addressed by investigating long-term outcomes such as behaviour, to support the current evidence base which is lacking.

    In terms of education delivery, the reporting was vague, and no detail was given as to how the delivery method was chosen. It is difficult to determine the most preferential delivery method from the results of this review, so liaising with QHPs enables accessibility and can mitigate potential barriers.

    It was found that the majority of outcomes assessed were self-reported. This can create difficulty in determining the volume of learning that took place as often individuals can overestimate or underestimate their skills.77 Focus was placed on participant outcomes such as self-perceived knowledge, skills or attitudes and not on patient outcomes. This suggests the need for evaluation and feasibility assessment prior to integrating patient outcomes into the initial phase of a project.

    Although some studies evaluated behaviour using Level 3 evaluation,46 organisational impact was not reported using Level 4 evaluation. Most interventions only focused on levels 1, 2 and 3 of Kirkpatrick’s evaluation model. In the context of the development of organisational HL, HL education aims to address areas that QHPs can be trained to respond to and address limited levels of HL. Health professionals have an impact on overall organisational HL, in confirming understanding and interpersonal communication.8 12 Therefore, by targeting QHPs, there will be an organisational impact. In terms of professional outcomes, it is intended that if an organisation is health literate, then individuals working within it will display OHL attributes such as leadership, HL integration into planning, community engagement, use of HL strategies in communication, designing accessible resources and clear communication.78

    Conclusion

    In conclusion, future educational HL interventions need to describe in depth the methods used to develop the programme while providing a comprehensive narrative pertaining to the characteristics, including their generic or any disease-specific focus, methodologies and assessments used to enhance reproducibility. The results from this scoping review will form the basis of a Delphi consensus study where the aim will be to build consensus on the theoretical and practical elements, design, delivery and evaluation of a HL education programme aimed towards QHPs working in diabetes care.

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

    Ethics statements

    Patient consent for publication

    Ethics approval

    Not applicable.

    References

    1. ↵
      1. Nutbeam D,
      2. Lloyd JE
      . Understanding and responding to health literacy as a social determinant of health. Annu Rev Public Health 2021;42:159–73. doi:10.1146/annurev-publhealth-090419-102529
      OpenUrlCrossRefPubMed
    2. ↵
      1. Mackert M,
      2. Ball J,
      3. Lopez N
      . Health literacy awareness training for healthcare workers: improving knowledge and intentions to use clear communication techniques. Patient Educ Couns 2011;85:e225–8. doi:10.1016/j.pec.2011.02.022
      OpenUrlCrossRefPubMed
    3. ↵
      1. Saunders C,
      2. Palesy D,
      3. Lewis J
      . Systematic review and conceptual framework for health literacy training in health professions education. Health Professions Education 2019;5:13–29. doi:10.1016/j.hpe.2018.03.003
      OpenUrl
    4. ↵
      1. Okan O,
      2. Bauer U,
      3. Levin-Zamir D, et al
      . International handbook of health literacy: research, practice and policy across the lifespan. Policy Press, 2019. doi:10.51952/9781447344520
    5. ↵
      1. Simonds SK
      . Health education as social policy. Health Education Monographs 1974;2:1–10. doi:10.1177/10901981740020S102
      OpenUrlCrossRef
    6. ↵
      1. White RO,
      2. Wolff K,
      3. Cavanaugh KL, et al
      . Addressing health literacy and numeracy to improve diabetes education and care. Diabetes Spectr 2010;23:238–43. doi:10.2337/diaspect.23.4.238
      OpenUrlFREE Full Text
    7. ↵
      1. Nouri SS,
      2. Rudd RE
      . Health literacy in the oral exchange: an important element of patient-provider communication. Patient Educ Couns 2015;98:565–71. doi:10.1016/j.pec.2014.12.002
      OpenUrlCrossRefPubMed
    8. ↵
      1. Brach C,
      2. Harris LM
      . Healthy people 2030 health literacy definition tells organizations: make information and services easy to find, understand, and use. J Gen Intern Med 2021;36:1084–5. doi:10.1007/s11606-020-06384-y
      OpenUrl
    9. ↵
      1. Schillinger D,
      2. Piette J,
      3. Grumbach K, et al
      . Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med 2003;163:83–90. doi:10.1001/archinte.163.1.83
      OpenUrlCrossRefPubMedWeb of Science
    10. ↵
      1. Farris C
      . The teach back method. Home Healthc Now 2015;33:344–5. doi:10.1097/NHH.0000000000000244
      OpenUrl
    11. ↵
      1. DeWalt DA,
      2. Broucksou KA,
      3. Hawk V, et al
      . Developing and testing the health literacy universal precautions toolkit. Nurs Outlook 2011;59:85–94. doi:10.1016/j.outlook.2010.12.002
      OpenUrlCrossRefPubMedWeb of Science
    12. ↵
      1. Brach C
      . The journey to become a health literate organization: a snapshot of health system improvement. Stud Health Technol Inform 2017;240:203–37.
      OpenUrl
    13. ↵
      1. U.S. Department of Health and Human Services
      . National action plan to improve health literacy. Washington, DC; 2010.
    14. ↵
      1. Wang C,
      2. Kane RL,
      3. Xu D, et al
      . Health literacy as a moderator of health-related quality of life responses to chronic disease among chinese rural women. BMC Womens Health 2015;15:34. doi:10.1186/s12905-015-0190-5
    15. ↵
      1. Chen PY,
      2. Elmer S,
      3. Callisaya M, et al
      . Associations of health literacy with diabetic foot outcomes: a systematic review and meta-analysis. Diabet Med 2018;35:1470–9. doi:10.1111/dme.13694
      OpenUrl
    16. ↵
      1. Gazmararian JA,
      2. Williams MV,
      3. Peel J, et al
      . Health literacy and knowledge of chronic disease. Patient Educ Couns 2003;51:267–75. doi:10.1016/s0738-3991(02)00239-2
      OpenUrlCrossRefPubMedWeb of Science
    17. ↵
      1. Gibney S,
      2. Bruton L,
      3. Ryan C, et al
      . Increasing health literacy may reduce health inequalities: evidence from a national population survey in Ireland. Int J Environ Res Public Health 2020;17:5891. doi:10.3390/ijerph17165891
    18. ↵
      1. Harding JL,
      2. Pavkov ME,
      3. Magliano DJ, et al
      . Global trends in diabetes complications: a review of current evidence. Diabetologia 2019;62:3–16. doi:10.1007/s00125-018-4711-2
      OpenUrlCrossRefPubMed
    19. ↵
      1. Lippa KD,
      2. Klein HA,
      3. Shalin VL
      . Everyday expertise: cognitive demands in diabetes selfmanagement. Hum Factors 2008;50:112–20. doi:10.1518/001872008X250601
      OpenUrlCrossRefPubMed
    20. ↵
      1. Heijmans M,
      2. Waverijn G,
      3. Rademakers J, et al
      . Functional, communicative and critical health literacy of chronic disease patients and their importance for self-management. Patient Educ Couns 2015;98:41–8. doi:10.1016/j.pec.2014.10.006
      OpenUrlCrossRefPubMed
    21. ↵
      1. Nutbeam D
      . The evolving concept of health literacy. Soc Sci Med 2008;67:2072–8. doi:10.1016/j.socscimed.2008.09.050
      OpenUrlCrossRefPubMedWeb of Science
    22. ↵
      1. Osborn CY,
      2. Cavanaugh K,
      3. Wallston KA, et al
      . Self-efficacy links health literacy and numeracy to glycemic control. J Health Commun 2010;15 Suppl 2:146–58. doi:10.1080/10810730.2010.499980
      OpenUrl
    23. ↵
      1. Cavanaugh K,
      2. Huizinga MM,
      3. Wallston KA, et al
      . Association of numeracy and diabetes control. Ann Intern Med 2008;148:737–46. doi:10.7326/0003-4819-148-10-200805200-00006
      OpenUrlCrossRefPubMedWeb of Science
    24. ↵
      1. Bohanny W,
      2. Wu S-FV,
      3. Liu C-Y, et al
      . Health literacy, self-efficacy, and self-care behaviors in patients with type 2 diabetes mellitus. J Am Assoc Nurse Pract 2013;25:495–502. doi:10.1111/1745-7599.12017
      OpenUrl
    25. ↵
      1. Valk GD,
      2. Kriegsman DMW,
      3. Assendelft WJJ
      . Patient education for preventing diabetic foot ulceration. a systematic review. Endocrinol Metab Clin North Am 2002;31:633–58. doi:10.1016/s0889-8529(02)00021-x
      OpenUrlCrossRefPubMedWeb of Science
    26. ↵
      1. Coffey L,
      2. Mahon C,
      3. Gallagher P
      . Perceptions and experiences of diabetic foot ulceration and foot care in people with diabetes: a qualitative meta-synthesis. Int Wound J 2019;16:183–210. doi:10.1111/iwj.13010
      OpenUrlPubMed
    27. ↵
      1. Bullen B,
      2. Young M,
      3. McArdle C, et al
      . Overcoming barriers to self-management: the person-centred diabetes foot behavioural agreement. Foot (Edinb) 2019;38:65–9. doi:10.1016/j.foot.2019.01.004
      OpenUrl
    28. ↵
      1. Zumbo B,
      2. Kelly K,
      3. Begoray D, et al
      . The development and validation of measures of “health literacy” in different populations. UBC Institute of Health Promotion Research and UVic Community Health Promotion Research: University of British Columbia, 2006.
    29. ↵
      1. Aldoory L
      . The status of health literacy research in health communication and opportunities for future scholarship. Health Commun 2017;32:211–8. doi:10.1080/10410236.2015.1114065
      OpenUrl
    30. ↵
      1. Kaper MS,
      2. Sixsmith J,
      3. Koot JAR, et al
      . Developing and pilot testing a comprehensive health literacy communication training for health professionals in three European countries. Patient Educ Couns 2018;101:152–8. doi:10.1016/j.pec.2017.07.017
      OpenUrlPubMed
    31. ↵
      1. Pagels P,
      2. Kindratt T,
      3. Arnold D, et al
      . Training family medicine residents in effective communication skills while utilizing promotoras as standardized patients in osces: a health literacy curriculum. Int J Family Med 2015;2015:129187. doi:10.1155/2015/129187
    32. ↵
      1. Coleman CA,
      2. Fromer A
      . A health literacy training intervention for physicians and other health professionals. Fam Med 2015;47:388–92.
      OpenUrlPubMed
    33. ↵
      1. Arksey H,
      2. O’Malley L
      . Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005;8:19–32. doi:10.1080/1364557032000119616
      OpenUrlCrossRef
    34. ↵
      1. Skivington K,
      2. Matthews L,
      3. Simpson SA, et al
      . A new framework for developing and evaluating complex interventions: update of medical Research Council guidance. BMJ 2021;374:n2061. doi:10.1136/bmj.n2061
    35. ↵
      1. Peters MD,
      2. Godfrey C,
      3. McInerney P, et al
      . Chapter 11: scoping reviews (2020 version). In: Aromataris E, Munn Z, eds. JBI Manual for Evidence Synthesis. JBI, 2020.
    36. ↵
      1. Tricco AC,
      2. Lillie E,
      3. Zarin W, et al
      . PRISMA extension for scoping reviews (PRISMA-scr): checklist and explanation. Ann Intern Med 2018;169:467–73. doi:10.7326/M18-0850
      OpenUrlCrossRefPubMed
    37. ↵
      1. Connell L,
      2. Finn Y,
      3. Dunne R, et al
      . Health literacy education programmes developed for qualified health professionals: a scoping review protocol. HRB Open Res 2021;4:97. doi:10.12688/hrbopenres.13386.2
      OpenUrl
    38. ↵
      1. Choi TST,
      2. Walker KZ,
      3. Ralston RA, et al
      . Diabetes education needs of Chinese Australians: a qualitative study. Health Education Journal 2015;74:197–208. doi:10.1177/0017896914523276
      OpenUrlCrossRef
    39. ↵
      1. Walker C,
      2. Weeks A,
      3. McAvoy B, et al
      . Exploring the role of self-management programmes in caring for people from culturally and linguistically diverse backgrounds in Melbourne, Australia. Health Expect 2005;8:315–23. doi:10.1111/j.1369-7625.2005.00343.x
      OpenUrlCrossRefPubMedWeb of Science
    40. ↵
      1. Coleman CA,
      2. Hudson S,
      3. Maine LL
      . Health literacy practices and educational competencies for health professionals: a consensus study. J Health Commun 2013;18 Suppl 1:82–102. doi:10.1080/10810730.2013.829538
      OpenUrlPubMed
    41. ↵
      1. Karuranga S,
      2. Sørensen K,
      3. Coleman C, et al
      . Health literacy competencies for European health care personnel. Health Lit Res Pract 2017;1:e247–56. doi:10.3928/24748307-20171005-01
      OpenUrlPubMed
    42. ↵
      1. Hurley L,
      2. Kelly L,
      3. Garrow AP, et al
      . A prospective study of risk factors for foot ulceration: the West of Ireland diabetes foot study. QJM 2013;106:1103–10. doi:10.1093/qjmed/hct182
      OpenUrlCrossRefPubMed
    43. ↵
      1. Weller CD,
      2. Team V,
      3. Probst S, et al
      . Health literacy in people with venous leg ulcers: a protocol for scoping review. BMJ Open 2021;11:e044604. doi:10.1136/bmjopen-2020-044604
    44. ↵
      1. Ouzzani M,
      2. Hammady H,
      3. Fedorowicz Z, et al
      . Rayyan-a web and mobile APP for systematic reviews. Syst Rev 2016;5:210. doi:10.1186/s13643-016-0384-4
      OpenUrlCrossRefPubMed
    45. ↵
      1. Lefebvre C,
      2. Glanville J,
      3. Briscoe S, et al
      . Searching for and selecting studies. In: Cochrane Handbook for systematic reviews of interventions 2019. n.d.: 67–107.
    46. ↵
      1. Kirkpatrick D,
      2. Kirkpatrick J
      . Evaluating training programs: the four levels. Berrett-Koehler Publishers, 2006.
    47. ↵
      1. Shen N,
      2. Sockalingam S,
      3. Abi Jaoude A, et al
      . Scoping review protocol: education initiatives for medical psychiatry collaborative care. BMJ Open 2017;7:e015886. doi:10.1136/bmjopen-2017-015886
    48. ↵
      1. Kripalani S,
      2. Jacobson KL,
      3. Brown S, et al
      . Development and implementation of a health literacy training program for medical residents. Med Educ Online 2006;11:4612. doi:10.3402/meo.v11i.4612
    49. ↵
      1. van der Giessen JAM,
      2. van Dulmen S,
      3. Velthuizen ME, et al
      . Effect of a health literacy training program for surgical oncologists and specialized nurses on disparities in referral to breast cancer genetic testing. Breast 2021;58:80–7. doi:10.1016/j.breast.2021.04.008
      OpenUrl
    50. ↵
      1. Tavakoly Sany SB,
      2. Peyman N,
      3. Behzhad F, et al
      . Health providers’ communication skills training affects hypertension outcomes. Med Teach 2018;40:154–63. doi:10.1080/0142159X.2017.1395002
      OpenUrl
    51. ↵
      1. Finlay S,
      2. Meggetto E,
      3. Robinson A, et al
      . Health literacy education for rural health professionals: shifting perspectives. Aust Health Rev 2019;43:404–7. doi:10.1071/AH18019
      OpenUrl
    52. ↵
      1. Green JA,
      2. Gonzaga AM,
      3. Cohen ED, et al
      . Addressing health literacy through clear health communication: a training program for internal medicine residents. Patient Educ Couns 2014;95:76–82. doi:10.1016/j.pec.2014.01.004
      OpenUrlCrossRefPubMed
    53. ↵
      1. Evans KH,
      2. Bereknyei S,
      3. Yeo G, et al
      . The impact of a faculty development program in health literacy and ethnogeriatrics. Acad Med 2014;89:1640–4. doi:10.1097/ACM.0000000000000411
      OpenUrl
    54. ↵
      1. Kolcaba K,
      2. Tilton C,
      3. Drouin C
      . Comfort theory: a unifying framework to enhance the practice environment. J Nurs Adm 2006;36:538–44. doi:10.1097/00005110-200611000-00010
      OpenUrlPubMed
    55. ↵
      1. Knowles MS
      . Andragogy: adult learning theory in perspective. Community College Review 1978;5:9–20. doi:10.1177/009155217800500302
      OpenUrlCrossRef
    56. ↵
      1. Wilson C
      . Improving health literacy with clear communication. Walden University, 2016.
    57. ↵
      1. Bandura A,
      2. Walters RH
      . Social learning theory: englewood cliffs. Prentice Hall, 1977.
    58. ↵
      1. Ammentorp J,
      2. Kofoed PE
      . Research in communication skills training translated into practice in a large organization: a proactive use of the RE-AIM framework. Patient Educ Couns 2011;82:482–7. doi:10.1016/j.pec.2011.01.002
      OpenUrlPubMed
    59. ↵
      1. Munson E,
      2. Willcox A
      . Applying the calgary-cambridge model. Practice Nursing 2007;18:464–8. doi:10.12968/pnur.2007.18.9.27158
      OpenUrl
    60. ↵
      1. Wolderslund M,
      2. Kofoed PE,
      3. Ammentorp J
      . The effectiveness of a person-centred communication skills training programme for the health care professionals of a large hospital in Denmark. Patient Educ Couns 2021;104:1423–30. doi:10.1016/j.pec.2020.11.018
      OpenUrl
    61. ↵
      1. Kissane DW,
      2. Bylund CL,
      3. Banerjee SC, et al
      . Communication skills training for oncology professionals. J Clin Oncol 2012;30:1242–7. doi:10.1200/JCO.2011.39.6184
      OpenUrlAbstract/FREE Full Text
    62. ↵
      1. Korc-Grodzicki B,
      2. Alici Y,
      3. Nelson C, et al
      . Addressing the quality of communication with older cancer patients with cognitive deficits: development of a communication skills training module. Palliat Support Care 2020;18:419–24. doi:10.1017/S1478951520000218
      OpenUrl
    63. ↵
      1. Burgoon JK,
      2. Hubbard AE
      . Cross-cultural and intercultural applications of expectancy violations theory and interaction adaptation theory. In: Theorizing about intercultural communication. 2005: 149–71.
    64. ↵
      1. Wittenberg E,
      2. Ferrell B,
      3. Goldsmith J, et al
      . COMFORT(SM) communication for oncology nurses: program overview and preliminary evaluation of a nationwide train-the-trainer course. Patient Educ Couns 2018;101:467–74. doi:10.1016/j.pec.2017.09.012
      OpenUrlPubMed
    65. ↵
      1. O’Leary KJ,
      2. Darling TA,
      3. Rauworth J, et al
      . Impact of hospitalist communication-skills training on Patient-satisfaction scores. J Hosp Med 2013;8:315–20. doi:10.1002/jhm.2041
      OpenUrlCrossRefPubMed
    66. ↵
      1. Seiler A,
      2. Knee A,
      3. Shaaban R, et al
      . Physician communication coaching effects on patient experience. PLoS One 2017;12:e0180294. doi:10.1371/journal.pone.0180294
    67. ↵
      1. Nørgaard B,
      2. Ammentorp J,
      3. Ohm Kyvik K, et al
      . Communication skills training increases self-efficacy of health care professionals. J Contin Educ Health Prof 2012;32:90–7. doi:10.1002/chp.21131
      OpenUrlPubMed
    68. ↵
      1. Nørgaard B,
      2. Kofoed P-E,
      3. Ohm Kyvik K, et al
      . Communication skills training for health care professionals improves the adult orthopaedic patient’s experience of quality of care. Scand J Caring Sci 2012;26:698–704. doi:10.1111/j.1471-6712.2012.00982.x
      OpenUrlPubMed
    69. ↵
      1. Kaper MS,
      2. de Winter AF,
      3. Bevilacqua R, et al
      . Positive outcomes of a comprehensive health literacy communication training for health professionals in three European countries: a multi-centre pre-post intervention study. Int J Environ Res Public Health 2019;16:3923. doi:10.3390/ijerph16203923
    70. ↵
      1. Joseph G,
      2. Lee R,
      3. Pasick RJ, et al
      . Effective communication in the era of precision medicine: a pilot intervention with low health literacy patients to improve genetic counseling communication. Eur J Med Genet 2019;62:357–67. doi:10.1016/j.ejmg.2018.12.004
      OpenUrlCrossRef
    71. ↵
      1. Coleman C,
      2. Peterson-Perry S,
      3. Sachdeva B, et al
      . Long-term effects of a health literacy curriculum for family medicine residents. PRiMER 2017;1:22. doi:10.22454/PRiMER.2017.703541
    72. ↵
      1. van Rijssen M,
      2. Veldkamp M,
      3. Meilof L, et al
      . Feasibility of a communication program: improving communication between nurses and persons with aphasia in a peripheral Hospital. Aphasiology 2019;33:1393–409. doi:10.1080/02687038.2018.1546823
      OpenUrl
    73. ↵
      1. Pickerel A
      . Addressing health literacy needs of the older adult focused on improving medication adherence: an online education program for nurse practitioners. University of Northern Colorado, 2019.
    74. ↵
      1. Coleman C
      . Teaching health care professionals about health literacy: a review of the literature. Nurs Outlook 2011;59:70–8. doi:10.1016/j.outlook.2010.12.004
      OpenUrlPubMed
    75. ↵
      1. Ishikawa H,
      2. Kiuchi T
      . Health literacy and health communication. Biopsychosoc Med 2010;4:1–5. doi:10.1186/1751-0759-4-18
      OpenUrlCrossRefPubMed
    76. ↵
      1. Lowell A,
      2. Schmitt D,
      3. Ah Chin W, et al
      . Provider health literacy, cultural and communication competence: towards an integrated approach in the northern territory. 2014.
    77. ↵
      1. Mahmood K, University of the Punjab
      . Do people overestimate their information literacy skills? A systematic review of empirical evidence on the dunning-kruger effect. Comminfolit 2016;10:199. doi:10.15760/comminfolit.2016.10.2.24
      OpenUrl
    78. ↵
      1. Brach C,
      2. Keller D,
      3. Hernandez L, et al
      . Ten attributes of health literate health care organizations. In: NAM Perspectives. 2012.
      1. Feinberg I,
      2. Ogrodnick MM,
      3. Hendrick RC, et al
      . Perception versus reality: the use of teach back by medical residents. Health Lit Res Pract 2019;3:e117–26. doi:10.3928/24748307-20190501-01
      OpenUrl
      1. Komondor K,
      2. Choudhury R
      . Assessing teach-back utilization in a downtown medical center. Health Lit Res Pract 2021;5:e226–32. doi:10.3928/24748307-20210719-01
      OpenUrl
      1. Mihalopoulos CC,
      2. Powers MF,
      3. Lengel AJ, et al
      . Impact of a health literacy training course on community pharmacists’ health literacy knowledge and attitudes. J Pharm Technol 2013;29:283–9. doi:10.1177/8755122513502455
      OpenUrlCrossRef
      1. Miller-Scott C
      . An evidence-based health literacy training program for occupational therapy professionals: program development and evaluation. Nova Southeastern University, 2014.
      1. Scott C,
      2. Andrews D,
      3. Bulla S, et al
      . Teach-back method: using a nursing education intervention to improve discharge instructions on an adult oncology unit. Clin J Oncol Nurs 2019;23:288–94. doi:10.1188/19.CJON.288-294
      OpenUrlPubMed
      1. Smallwood SR
      . Improving nurse-patient communication using the teach-back method. Gardner-Webb University, 2018.
      1. Spence A
      . Integrating health literacy and ethnogeriatric training for anesthesia providers to improve perioperative care of the geriatric patient. 2018.
      1. Szwajcer A,
      2. Macdonald K,
      3. Kvern B
      . Health literacy training for family medicine residents. J Can Health Libr Assoc 2014;35:128. doi:10.5596/c14-033
      OpenUrl
      1. Wittenberg E,
      2. Goldsmith J,
      3. Ferrell B, et al
      . Enhancing communication related to symptom management through plain language. J Pain Symptom Manage 2015;50:707–11. doi:10.1016/j.jpainsymman.2015.06.007
      OpenUrl
      1. Koenig VE,
      2. Provident IM
      . Workshop series for occupational therapists using the US agency for healthcare research and quality’s health literacy universal precautions toolkit and other supported tools. Health Education Journal 2019;78:451–63. doi:10.1177/0017896918820067
      OpenUrl
      1. Holman CK,
      2. Weed LD,
      3. Kelley SP
      . Improving provider use of the teach-back method. J Nurses Prof Dev 2019;35:52–3. doi:10.1097/NND.0000000000000521
      OpenUrl
      1. Allenbaugh J,
      2. Corbelli J,
      3. Rack L, et al
      . A brief communication curriculum improves resident and nurse communication skills and patient satisfaction. J Gen Intern Med 2019;34:1167–73. doi:10.1007/s11606-019-04951-6
      OpenUrlPubMed
      1. Banerjee SC,
      2. Haque N,
      3. Bylund CL, et al
      . Responding empathically to patients: a communication skills training module to reduce lung cancer stigma. Transl Behav Med 2021;11:613–8. doi:10.1093/tbm/ibaa011
      OpenUrl
      1. Eid A,
      2. Petty M,
      3. Hutchins L, et al
      . Breaking bad news: standardized patient intervention improves communication skills for hematology-oncology fellows and advanced practice nurses. J Cancer Educ 2009;24:154–9. doi:10.1080/08858190902854848
      OpenUrlCrossRefPubMed
      1. Fujimori M,
      2. Oba A,
      3. Koike M, et al
      . Communication skills training for Japanese oncologists on how to break bad news. J Cancer Educ 2003;18:194–201. doi:10.1207/s15430154jce1804_6
      OpenUrlCrossRefPubMedWeb of Science
      1. Møller JE,
      2. Malling BV
      . Workplace-based communication skills training in clinical departments: examining the role of collegial relations through positioning theory. Med Teach 2019;41:309–17. doi:10.1080/0142159X.2018.1464647
      OpenUrl
      1. Shaw DJ,
      2. Davidson JE,
      3. Smilde RI, et al
      . Multidisciplinary team training to enhance family communication in the ICU. Crit Care Med 2014;42:265–71. doi:10.1097/CCM.0b013e3182a26ea5
      OpenUrlCrossRefPubMedWeb of Science
      1. Shen MJ,
      2. Manna R,
      3. Banerjee SC, et al
      . Incorporating shared decision making into communication with older adults with cancer and their caregivers: development and evaluation of a geriatric shared decision-making communication skills training module. Patient Educ Couns 2020;103:2328–34. doi:10.1016/j.pec.2020.04.032
      OpenUrl
      1. Tanzi S,
      2. De Panfilis L,
      3. Costantini M, et al
      . Development and preliminary evaluation of a communication skills training programme for hospital physicians by a specialized palliative care service: the teach to talk programme. BMC Med Educ 2020;20:363. doi:10.1186/s12909-020-02275-2
      1. Wittenberg E,
      2. Ferrell B,
      3. Goldsmith J, et al
      . Assessment of a statewide palliative care team training course: comfort communication for palliative care teams. J Palliat Med 2016;19:746–52. doi:10.1089/jpm.2015.0552
      OpenUrl
      1. Wu DS,
      2. Kern DE,
      3. Dy SM, et al
      . Narrative approach to goals of care discussions: a novel curriculum. J Pain Symptom Manage 2019;58:1033–9. doi:10.1016/j.jpainsymman.2019.08.023
      OpenUrlPubMed
      1. Wuensch A,
      2. Tang L,
      3. Goelz T, et al
      . Breaking bad news in China -- the dilemma of patien’s' autonomy and traditional norms. A first communication skills training for Chinese oncologists and caretakers. Psychooncology 2013;22:1192–5. doi:10.1002/pon.3112
      OpenUrlCrossRefPubMed
      1. Fukui S,
      2. Ogawa K,
      3. Ohtsuka M, et al
      . Effect of communication skills training on nurses’ detection of patients’ distress and related factors after cancer diagnosis: a randomized study. Psychooncology 2009;18:1156–64. doi:10.1002/pon.1429
      OpenUrlPubMed
      1. Fukui S,
      2. Ogawa K,
      3. Yamagishi A
      . Effectiveness of communication skills training of nurses on the quality of life and satisfaction with healthcare professionals among newly diagnosed cancer patients: a preliminary study. Psychooncology 2011;20:1285–91. doi:10.1002/pon.1840
      OpenUrlCrossRefPubMed
      1. Kim YM,
      2. Davila C,
      3. Tellez C, et al
      . Evaluation of the world Health organization’s family planning decision-making tool: improving health communication in Nicaragua. Patient Educ Couns 2007;66:235–42. doi:10.1016/j.pec.2006.12.007
      OpenUrlCrossRefPubMedWeb of Science
      1. Shama ME,
      2. Meky FA,
      3. Abou El Enein NY, et al
      . The effect of a training program in communication skills on primary health care physicians’ knowledge, attitudes and self-efficacy. J Egypt Public Health Assoc 2009;84:261–83.
      OpenUrlPubMed
      1. Sullivan MF,
      2. Ferguson W,
      3. Haley H-L, et al
      . Expert communication training for providers in community health centers. J Health Care Poor Underserved 2011;22:1358–68. doi:10.1353/hpu.2011.0129
      OpenUrl
      1. Papadakos CT,
      2. Stringer T,
      3. Papadakos J, et al
      . Effectiveness of a multiprofessional, online and simulation-based difficult conversations training program on self-perceived competence of oncology healthcare provider trainees. J Cancer Educ 2021;36:1030–8. doi:10.1007/s13187-020-01729-x
      OpenUrl

    Supplementary materials

    Footnotes

    • Twitter @laurenconnell13

    • Contributors LC, YF and JS have contributed to the conception and design of the study. LC, YF and JS have contributed to the establishment of search and scoring criteria. Article reviewing and data analysis has been performed by LC, YF and JS. LC, YF and JS have made contributions to the drafting and revising of the article. LC, YF and JS have approved the final version to be published and its accuracy and integrity.

      The guarantor (LC) accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding Health Research Board (HRB). CDA Diabetic Foot Disease: from PRevention to Improved Patient Outcomes (CDA DFD PRIMO) programme, University of Galway. The funder had no role.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.