Medical educators' experiences on medically unexplained symptoms and intercultural communication-an expert focus group study.

BACKGROUND: Medically unexplained symptoms (MUS) are highly prevalent and remain challenging in healthcare and medical education, along with the increase in the importance of intercultural issues regarding MUS. However, less is known about the challenges of professionally addressing patients with MUS in the interprofessional and intercultural contexts. Thus, the present study aims to provide the first exploration of the experiences of medical specialists regarding treating MUS in intercultural contexts and inputs for training development on the intercultural aspects of MUS. METHODS: Three focus groups (total n = 13) consisting of medical specialists from a Hungarian university who were teaching at the medical faculty in intercultural settings and also worked for the university health services were interviewed. The topics covered the participants' personal experiences on addressing MUS and the challenges of intercultural communication and the intercultural educational context. Thematic analysis was used to yield a qualitative account of the interviews as guided by the research questions. RESULTS: Representing the different aspects of medical specialists, the study identified three main themes in the experiences of medical specialists, namely, 1) the need to adapt to the personal world of patients and search for common frames to understand MUS, 2) the need to discover methods for adapting to cultural differences and 3) the need to enhance the interprofessional coordination of knowledge and practices. CONCLUSIONS: The results are in line with the distinct conclusions of previous studies. Moreover, an integrated educational program on the intercultural aspects of MUS may address the main themes separately and, subsequently, support their integration. Therefore, the study discusses the manner in which an integrated educational program on the intercultural aspects of MUS may address the needs recognized in these aspects.

[COVID-19 and chronic pain: online survey in the domestic population]. / Covid-19 és krónikus fájdalom: online felmérés a pandémia alatt fájdalommal élo, ellátásban nem részesülo személyek körében.

Background and purpose: The problems caused by the COVID-19 epidemic have the worst impact on chronic patient populations. People with chronic pain are one of the most vulnerable groups due to stress, disruption of daily routine, family problems, illness and difficulty in hospital care. It is therefore essential to assess the situation and mental well-being of this group. The aim of this survey was to assess chronic pain patients during the COVID-19 pandemic, addressing psychological background factors that might affect pain symptoms, such as depression, emotion regulation, alexithymia, well-being, health literacy and social support. Methods: 158 people participated in the survey, reporting pain for at least 3 months but had not received medical treatment. Data was collected at two dates: February and December 2021. Participants completed an online questionnaire due to the pandemic situation. The following six psychological questionnaires were used in the survey: Toronto Alexithymia Scale, Beck Depression Inventory 9-item version, Difficulty in Emotion Regulation Scale, Multidimensional Scale of Perceived Social Support, Chew-questions measuring health literacy, WHO Well-being Index. Results: The participants ranged from 20 to 80 years in age, of whom 140 (88%) were female. 42 participants (27%) achieved severe alexithymia. 118 people (75%) had depression, of which 72 people (46%) had mild depression, 26 (16%) had moderate depression, and 20 (13%) had severe depression. The degree of pain and alexithy-mia (r(158) = 0.16, p = 0.004), depression (r(158) = 0.41, p < 0.001), difficulties in emotion regulation (r(158) = 0.26, p = 0.004), and health literacy, and difficulties in emotion regulation (r(158) = 0.25, p = 0.001) were positively and significantly related. Conclusion: In addition to the characteristic comorbidities of people living with pain (e.g. anxiety, emotion disorder, sleep disorder), the epidemic-induced prolonged social isolation, stress and fear of illness may explain the proportion of high depression, emotion regulation difficulties or health literacy problems in the study sample which exacerbate alexithymia and the degree of pain. Based on these results it is important to draw the attention of professionals to the appropriate health care and educational needs of those affected.

ADHD symptomatology of children with congenital heart disease 10 years after cardiac surgery: the role of age at operation.

BACKGROUND: The aim of the present study was to investigate the differences in ADHD symptomatology between healthy controls and children who underwent cardiac surgery at different ages. METHODS: Altogether, 133 children (54 patients with congenital heart disease undergoing first cardiac surgery under 3 years of age, 26 operated at the age of 3 or later, and 53 healthy controls) were examined. Patients completed the Youth Self Report (YSR), while their parents completed the Child Behaviour Checklist (CBCL) and the ADHD Rating Scale-IV. RESULTS: Children receiving surgery for the first time under the age of 3 years were more likely diagnosed with cyanotic type malformation and have undergone to a greater number of operations. However, ADHD symptoms of those treated surgically at or above 3 years of age were more severe than that of the control group or those who were treated surgically at a younger age. The control group and those treated surgically below the age of three did not differ across any of the ADHD symptom severity indicators. CONCLUSIONS: The age at the time of cardiac surgery might be associated with later ADHD symptom severity - with lower age at operation associated with better outcomes. Further, adequately powered studies are needed to confirm these exploratory findings and investigate the moderators of this relationship.

Measuring functional health literacy in Hungary: Validation of S-TOFHLA and Chew screening questions.

OBJECTIVES: The first efforts to measure health literacy have recently started in Hungary, thus there remains a need for tools that can be effectively used in the clinical setting. The goal of the present study was two-fold: to validate tools for measuring functional health literacy in Hungary using the Short Test of Functional Health Literacy (S-TOFHLA) and the Chew screening measure, and to provide an overview of the health literacy level of the Hungarian population. METHODS: The original English versions of both instruments were translated following the principles of cultural adaptation and standardized translation methods. The measures were administered to a random sample (N = 302) that was close to representative of the Hungarian population regarding age, gender and educational background. The Newest Vital Sign functional health literacy test and numerous socio-demographic variables (such as age, gender, education and income) were also administered to test convergent validity. RESULTS: The Hungarian version of the S-TOFHLA and the Chew questions showed adequate internal consistency. Lower functional health literacy scores showed the expected association with known predictors of health literacy: higher age, male gender and lower education. Especially people above 65 years of age and individuals with a low level of educational attainment or being chronically ill are vulnerable to have marginal health literacy. CONCLUSION: The Hungarian version of the S-TOFHLA is a valid and reliable measure of health literacy. Moreover, the Hungarian version of the Chew screening questions provides a valid self-reported assessment, which is particularly useful to rapidly detect patients with inadequate health literacy in hospitals. It is expected that these health literacy measurements will be used for not only scientific purposes, but also serve as tools for developing public health policy, especially health education and campaigns reducing potential health disparities in Hungary.

A clinical study of an online educational programme for chronic pain patients.

BACKGROUND AND PURPOSE: Background - The research of alexithymia - the inability to express or understand emotions - has recently become of great importance in clinical practice, mainly in the field of doctor-patient and psychologist patient communication. Many studies have proven the correlation between alexithymia and the development of functional somatic symptoms, i.e. somatization. Purpose - The aim of this clinical study was to examine the emotion-recognition and emotion communication patterns of patients suffering from chronic pain (e.g., headache, low back pain, arthralgia, neuropathy). Moreover, the participants received access to the Hungarian adaptation of a new international online educational site (www.retrainpain.org) dealing with pain management. METHODS: Data were collected from the Headache and Chronic Pain Outpatient Clinic, Department of Neurology, Faculty of Medicine, University of Szeged, Hungary (tertiary care - Group 1) and from a general practice in district 2, Budapest, Hungary (primary care - Group 2) from March, 2017 to April, 2018. Patients received a test package containing a pain-specific questionnaire, then the Difficulties in Emotion Regulation Scale (DERS), the Toronto Alexithymia Scale (TAS-20), and the shortened Hungarian version of the WHO-Well-being (WBI-5) had to be completed. After filling out the questionnaires, all patients got access to the Hungarian adaptation of the www.retrainpain.org website. RESULTS: Altogether 92 patients participated in the study (Group 1 n=50; Group 2 n=42). Based on the TAS-20 re-sults, 35 patients reached a pathological score (≥60 points), which indicates the diagnosis of alexithymia. The mean TAS-score was lower in Group 2 (primary care) than in Group 1 (tertiary care) (p=0.003). The DERS disclosed pathological results in 19 cases (p=0.009). As regards the www.retrainpain.org chapters, we received feedback only from 25 out of 92 patients (27%) (Group 1 n=20; Group 2 n=5). CONCLUSION: Although the examined patients have been suffering from different chronic pain syndromes for years and 50% of them confirmed that symptoms placed at least moderate or heavy burden on their everyday life, the available educational programme was studied only by a smaller proportion of patients than expected. Additionally, those who surveyed the Hungarian adaptation of the www.retrainpain.org website were mainly patients from primary care (Group 2), in spite of the fact that patients from specialized medical care (Group 1) had worse subjective conditions. Our future objective is to extend our database with follow-up results and to improve patients' response willingness.

[Application of the PRISM-D drawing test to the complex examination of cancer-related emotional and cognitive representations]. / A PRISM-D rajzteszt alkalmazása a daganatos betegséggel összefüggo érzelmi és kognitív reprezentációk komplex vizsgálatára.

INTRODUCTION: Studying the psychological experience and the individual interpretation of a serious illness is an important task, as these factors can affect coping strategies and the psychological and somatic outcome of the illness. In clinical practice, to screen out maladaptive reactions and to effectively plan the psychological interventions, we need measuring tools that can be applied among a wide range of patients and can measure the illness-related emotional and cognitive representations in detail. AIM: The aim of our study was to examine the applicability of the drawing test version (PRISM-D) we developed from the Pictorial Representations of Illness and Self Measure test and its posttest in clinical practice among cancer patients. METHOD: We applied the Pictorial Representations of Illness and Self Measure drawing test and its posttest for 150 cancer patients undergoing hospital treatment. RESULTS: According to the quantitative data from the tests, patients underwent considerable suffering from illness, however, there was a large heterogeneity in the level of suffering in the sample. The majority of the patients in the sample associated negative feelings to their illness, such as distress, fear, sadness, uncertainty. As for illness representations, they interpreted their illness as a sign, a difficulty, a task to solve, a struggle, a loss, an adversity or a personal failure. The size and placement of the circle symbolizing the illness can be used to identify patient reactions to deny or understate illness as well as patients who experience their illness very seriously. This information is crucial in the understanding of illness behavior and the coping with illness. CONCLUSIONS: Our study has supported this test as a measuring tool which is well applicable to quickly gain complex information both in clinical practice and in research, to measure illness-related emotional and cognitive representations, both quantitatively and qualitatively. Orv Hetil. 2018; 159(48): 2021-2030.

[The medical psychology in Hungary: way of thinking, frame of references and applications]. / Az orvosi pszichológia fejlodése hazánkban: szemléleti keretek, határterületek és alkalmazások.

The present study aims at overviewing the different stages of the education of medical psychology in Hungary. In the perspective of the achievements of cognitive and affective neuroscience as well as developmental psychology, we intend to define the roots of doctor-patient relationship, certain determining factors of diagnosis forming and therapy efficiency as well as the essential components of empathy. We attest to the fact that the current psychosomatic medicine with its evidence-based achievements is a valid component and constitutive pillar of everyday medical care. The integrated university level instruction of medical psychology and behavioral sciences aims at consolidating this perspective. We also emphasize that the ill body hinders adequate psychological functioning and mental disorders provide risk factors concerning somatic illnesses. Through spreading health psychology perspective, we support the concept that in everyday medical care, health protection and the development of health conscious behavior relies on responsible, informed and committed decision-making patients as well as on similarly educated extended medical care teams. Orv Hetil. 2018; 159(36): 1455-1464.

[The reliability and validity of the Hungarian version of the Surgical Fear Questionnaire]. / A Sebészeti Beavatkozástól Való Félelem Kérdoív magyar nyelvu változatának reliabilitás- és validitásvizsgálata sebészeti beavatkozáson átesett páciensek körében.

INTRODUCTION: Interdisciplinary studies confirm that surgical fear experienced by patients can have a substantial effect on the outcome of the surgery and the healing process after surgery. AIM: The aim of this study was to assess the reliability and validity of the Hungarian version of the Surgical Fear Questionnaire in cancer patients. METHOD: 149 patients were assessed using the Spielberger Anxiety Inventory, the Beck Depression Inventory, the Visual Analogue Scale and the Surgical Fear Questionnaire. RESULTS: The scale showed excellent internal consistency (Cronbach-alfa = 0.878; 0.885). The Surgical Fear Questionnaire scores moderately correlated with anxiety, depression and anticipated pain after surgery. CONCLUSION: The reliability and validity of the Hungarian version of the Surgical Fear Questionnaire in the sample were excellent. The questionnaire turned out to be a useful psychometric tool in the measurement of surgical fear. Orv Hetil. 2018; 159(47): 1988-1993.

What contributes to long-term quality of life in breast cancer patients who are undergoing surgery? Results of a multidimensional study.

PURPOSE: This study aims to examine the key determinants of long-term quality of life in breast cancer patients who are undergoing surgery using a multidimensional approach and taking into account preoperative and post-operative psychological characteristics such as anxiety, depression, posttraumatic growth, body image, and physical activity as well as medical parameters. METHODS: The study involved 63 breast cancer patients from the Department of Surgery at the University of Szeged. Assessments occurred 1 day before surgery as well as 3 days and 18 months after surgery using the Spielberger State and Trait Anxiety Inventory (STAI), Beck's Depression Inventory (BDI), Functional Assessment of Cancer Therapy-Breast Cancer Scale (FACT-B), Posttraumatic Growth Inventory (PTGI) and Breast Impact of Treatment Scale (BITS). Data relating to physical activity, medical parameters and sociodemographic characteristics were also collected. RESULTS: The level of depression did not change over time. State anxiety decreased 18 months after the surgery compared to before the surgery; however, there was a greater decrease immediately after the surgery and then anxiety increased again 18 months later. Trait anxiety was associated with quality of life, posttraumatic growth and body image. Posttraumatic growth and the level of depression were found to be possible contributing factors to the increase in long-term quality of life. CONCLUSIONS: The results show that the timely detection and proper management of psychological distress and the enhancement of posttraumatic growth are of great value, as they might be important contributing factors to long-term quality of life in breast cancer patients.

[Types of conflicts and conflict management among Hungarian healthcare workers]. / Konfliktustípusok és konfliktuskezelés magyar egészségügyi dolgozók körében.

INTRODUCTION: Efficient communication, conflict management and cooperation are the key factors of a successful patient care. AIM: This study is part of an international comparative research. The aim of this study is to unfold conflicts among healthcare workers. METHOD: 73 healthcare workers were interviewed using a standardized interview protocol. The in-person interviews used the critical incident method. 30 interviews (15 doctors, 15 nurses) were analysed with the Atlas.ti 7 content analysis software. The sources, types, effects of conflicts and conflict management strategies were investigated. RESULTS: The content analysis unfolded the specificities of conflicts in healthcare based on personal experiences. Organizational hierarchy was a substantial source of conflict, especially among physicians, which originates from implicit rules. As a result of the avoiding conflict management the conflicts remain partly unresolved which has negative individual and group effect. CONCLUSIONS: Our conceptual framework helps to develop a proper intervention specific to healthcare. Orv. Hetil., 2017, 158(16), 625-632.

[The role of psychological representations in kidney transplantation. The reliability and validity of the Hungarian version of Transplanted Organ Questionnaire]. / A pszichológiai reprezentációk szerepe a vesetranszplantációban. A Transzplantált Szerv Kérdoív magyar változatának reliabilitás- és validitásvizsgálata.

INTRODUCTION: According to interdisciplinary research the transplanted organ representations play an important role in successful transplantation. AIM: The aim of the study was to assess the reliability and validity of the Hungarian version of Transplanted Organ Questionnaire in kidney transplant recipients. METHOD: 151 patients were assessed using the Spielberger Anxiety Inventory, the Beck Depression Inventory, the Posttraumatic Growth Inventory and the Transplanted Organ Questionnaire. Serum creatinine levels from routine clinical blood tests were collected. RESULTS: The scale showed good internal consistency (Cronbach-alpha = 0.89; 0.87; 0.80), and the test-retest reliability was excellent. The Transplanted Organ Questionnaire scores moderately correlated with depression, anxiety and posttraumatic growth. The "Psychological rejection" scale correlated with higher serum creatinine level (p = 0.001, t = 5.17). CONCLUSIONS: The reliability and validity of the Hungarian version of Transplanted Organ Questionnaire in the studied sample were excellent. The questionnaire is a useful psychometric tool in the exploration of transplant patients' representations about the donor and the organ.

["So that each patient may comprehend": measuring health literacy in Hungary]. / "Hogy minden beteg megértse!" - Az egészségmuveltség (health literacy) mérése Magyarországon.

INRODUCTION: The efficiency of healing is determined by the ability of the patients to comprehend and to apply properly the information provided by the doctors. This ability is influenced by age, intelligence and social background, but above all by health literacy. AIM: The aim of the present study was to translate and adapt the Hungarian version of the Short-Test of Functional Health Literacy, which is a performance based measure and the perception-based Chew screening questions for health literacy in Hungary. METHOD: The sample consisted of 302 people, and it was closely representative for the Hungarian population. RESULTS: The reliability of the reading part of the Short-Test of Functional Health Literacy was excellent, and it was also acceptable regarding the Chew screening questions, but it showed low internal consistency concerning the numeracy part of the Short-Test of Functional Health Literacy. Based on the Short-Test of Functional Health Literacy reading scores, participants were categorized into three groups: 8% had inadequate, 6% marginal and 86% adequate health literacy levels. Regarding participants without a chronic illness tended to possess higher health literacy levels based on all the three measurments. CONCLUSIONS: The availability of these measures of health literacy in Hungary can play a crucial role in doctor-patient communication as well as health promotion, that can contribute to develop health literacy policies leading to reduced health care costs in the future.

Health Psychology Services for People in Disadvantaged Regions of Hungary: Experiences from the Primary Health Care Development Model Program.

BACKGROUND: The importance of community health psychology in providing complex bio-psycho-social care is well documented. We present a mixed-method outcome-monitoring study of health psychology services in the public-health-focused Primary Health Care Development Model Program (2012-2017) in four disadvantaged micro-regions in northeast Hungary. METHODS: Study 1 assessed the availability of the services using a sample of 17,003 respondents. Study 2 applied a follow-up design to measure the mental health outcomes of the health psychology services on a sample of 132 clients. In Study 3, we conducted focus-group interviews to assess clients' lived experiences. RESULTS: More mental health issues and higher education predicted a higher probability of service use. Follow-up showed that individual and group-based psychological interventions resulted in less depression and (marginally) higher well-being. Thematic analysis of the focus-group interviews indicated that participants deemed topics such as psychoeducation, greater acceptance of psychological support, and heightened awareness of individual and community support important. CONCLUSIONS: The results of the monitoring study demonstrate the important role health psychology services can play in primary healthcare in disadvantaged regions in Hungary. Community health psychology can improve well-being, reduce inequality, raise the population's health awareness, and address unmet social needs in disadvantaged regions.

[Relationship between cardiovascular risk assessment and health behavior in the light of psychosocial factors.] / A cardiovascularis rizikóbecslés és az egészségmagatartás kapcsolata pszichoszociális tényezok tükrében.

INTRODUCTION: Even though preventive measures have been taken to reduce cardiovascular risk, cardiovascular mortality is increasing. Cardiovascular screening can be a population strategy that contributes to the reduction of mortality over the long term when implemented in a systematic, protocol-based, expanded manner. OBJECTIVE: In this study, we examine changes in participants' health behavior between 2012 and 2019 as a follow-up to the Budakalász Epidemiological Study (BEV). METHOD: A cardiovascular health index was developed to enable effective follow-up. This study included subjects with medium and high cardiovascular risks who participated in the BEV complex cardiovascular risk assessment in 2012 (n = 502). Besides the basic data from the BEV baseline study (demographics, healthy lifestyle, risk behavior, diseases treated by medicine), the 2019 follow-up questionnaire included newly added psychological questionnaires (Perceived Stress, WHO Well-being, Beck Hopelessness Scale, Health-Related Social Support, ABCD Risk Questionnaire). RESULTS: All factors of the cardiovascular health index created in our analysis showed an improvement of over 70% between 2012 and 2019. 37.6% of the participants did something for their health, according to their confession, by 30.3%, BEV had a big or very big impact on their lives from the 2012 BEV test in the year after the test, and by 24.7%, BEV had and still has a big or very big impact on their lives. The improving health indices show a significant correlation with psychological factors. Psychological factors showed a positive correlation with well-being (tau_b = 0.344) and a negative correlation with perceived stress (tau_b = -0.225) and hopelessness (tau_b = -0.206). CONCLUSION: The participants in the study showed a significant change in health behavior seven years after the BEV cardiovascular risk assessment. A higher level of mental well-being is associated with improved values. By analyzing the impact of BEV on the health behavior change and the lifestyle, we can conclude that the cardiovascular risk assessment facilitates health behavior change. Orv Hetil. 2023; 164(4): 119-131.

Education on medically unexplained symptoms: a systematic review with a focus on cultural diversity and migrants.

BACKGROUND: Health care providers often struggle with the management of patients with medically unexplained symptoms (MUS), especially in case of a different ethnicity and/or cultural background. These challenges are insufficiently addressed in their training. OBJECTIVES: A systematic review on education in the field of MUS in a diverse context to improve MUS healthcare provider-patient interaction focused on intercultural communication. METHODS: Screening of PubMed, Web of Science, Cinahl and Cochrane Library on the keywords 'Medical unexplained (physical) symptoms (MUS)', 'Somatoform disorder', 'Functional syndrome', 'Diversity', 'Migrants', 'Ethnicity', 'Care models', 'Medical education', 'Communication skills', 'Health literacy'. RESULTS: MUS patients, especially with a different ethnic background, often feel not understood or neglected. Health care providers experience feelings of helplessness, which may provoke medical shopping and resource consumption. Attitudes and perceptions from undergraduate trainees to senior physicians tend to be negative, impacting on the quality of the patient/health care provider relationship and subsequently on health outcomes, patient satisfaction and therapeutic adherence. Current undergraduate, graduate and postgraduate education and training does not prepare health care providers for diagnosing and managing MUS patients in a diverse context. A continuum of training is necessary to achieve a long term and lasting change in attitudes towards these patients and trainers play a key role in this process. Hence, education should pay attention to MUS, requiring a specific competency profile and training, taken into account the variety in patients' cultural backgrounds. CONCLUSIONS: This systematic review identified significant gaps and shortcomings in education on MUS in a diverse context. These need to be addressed to improve outcomes.

Improving disease management of patients with inflammatory bowel disease: the potential role of self-concordant health goals.

Inflammatory bowel diseases (IBD) are chronic gastrointestinal conditions that significantly impact patients' quality of life. Previous research indicates that patients with IBD have a higher prevalence of anxiety compared to the general population and other chronic diseases. This pilot study aimed to investigate the relationships between goal integration, positive and negative emotions, goal self-efficacy, and trait anxiety as the outcome variable, focusing on patients' self-management strategies. Drawing from the Self-Concordance Model (SCM) of Self-Determination Theory (SDT), the study explored how goal integration is associated with more fulfilling and enjoyable experiences and fewer negative emotions, ultimately improving psychological well-being. Health-related goals were evaluated using the Personal Project Analysis technique, while the State-Trait Anxiety Inventory was utilized to measure general anxiety levels. Among the 141 participants with inflammatory bowel disease, 96 reported having health-related goals. Of these, 66 were female (68.75%), and 30 were male participants (31.25%). Path analysis revealed a moderate negative association between self-concordance (SC) and negative emotions, which, in turn, predicted higher levels of trait anxiety. Furthermore, the alternative model tested indicated that trait anxiety predicted a lower level of self-concordance. Setting well-integrated health goals involves an internal capacity, enabling patients to experience less negative emotions during self-management activities. Anxiety can hinder individuals from accessing their inner needs, resulting in less self-concordant aspirations and more negative emotions. These findings may contribute to developing prevention and intervention programs to enhance IBD patients' adherence to lifestyle changes, ultimately improving their overall well-being.

[Psychological factors of successful kidney transplantations. The effects of anxiety and intrapsychic integration of the organ on recovery]. / A vesetranszplantáció sikerességének pszichológiai tényezoi. A szorongásszint és a szerv intrapszichés integrációjának hatása a gyógyulási folyamatra.

UNLABELLED: Transplant patients' attitudes and representations related to their illness, their body, and the healing process have a significant impact on their recovery. AIMS: The study involved 51 patients from the Department of Surgery, University of Szeged, Hungary. The primary aim was to examine the possible connections between emotional and mood factors, illness and body representations, and the successful onset of renal functions after surgery. METHODS: Patients were tested with a combination of 4 instruments: Spielberger's anxiety scale and Beck depression scale, self and organ drawings, and a questionnaire designed by the authors. RESULTS: Our data suggest that high distress correlates with kidney disfunction after transplantation. Patients with higher anxiety drew the kidney larger in their projective drawing test. It was a remarkable result that post-transplant blood test on Day 10 showed significantly lower creatinine and urea levels in those patients who had drawn the kidney smaller in their projective drawing test. This might indicate that the organ's normal intrapsychic integration and the related kidney functions are disturbed. CONCLUSIONS: The results of this study provide useful information about the psychological background, which has received relatively little attention so far. It can also give important clues for further research on clinical health psychology in supporting the healing process.

Medical students on the stage: an experimental performative method for the development of relational skills.

BACKGROUND: Development of therapeutic relational skills is a relatively neglected area of medical education. Conventional teaching techniques are mostly unsuitable for the realization of experience-based learning. AIMS: To develop a training method which enables lived self-experiences of the therapeutic relationship in class. To help students understand that illness and the doctor-patient relationship are integrated in the network of life histories and other relationships. METHODS: Our Integrated Performative Action Method is based on the elaboration of a short story of an illness in a student group. Through the 5 phases of the process, students write their own version of the story, build up characters, scenarios and enact the play. We have tested the method with 6 groups of students (n = 70) in a 10-week course. Video-recordings and minutes of sessions were analysed by two independent observers. RESULTS: Through elaborating the characters and playing the roles, students could speak about their own problems and act out feelings in the name of the characters. All groups had strong involvement throughout the process. CONCLUSIONS: The method helps to experience the ways in which therapeutic relationships and professional identities are constructed, reflected upon and communicated in a group of medical students.

The reliability and validity of the Hungarian version of the Brief Illness Perception Questionnaire / A Rövid Betegségpercepció Kérdoív magyar változatának megbízhatósági vizsgálata.

Összefoglaló. Bevezetés: Interdiszciplináris kutatásokkal igazolták, hogy a páciensnek a betegségérol kialakított elképzelései meghatározó szerepet játszanak a gyógyulási folyamat sikerességében. Célkituzés: Vizsgálatunk célja az ezen elképzelések felmérésére kifejlesztett Rövid Betegségpercepció Kérdoív magyar nyelvu változatának megbízhatósági és validitási vizsgálata krónikus betegségben szenvedo, daganattal küzdo és transzplantált páciensek körében. Módszer: Keresztmetszeti vizsgálatunkban 490 páciens vett részt. A kérdoív validitásának vizsgálatára a Spielberger-féle Állapot- és Vonásszorongás Kérdoívet, a Beck Depresszió Kérdoívet és a Poszttraumás Növekedésérzés Kérdoívet alkalmaztuk, illetve felmértük a betegcsoportok életminoségét. Eredmények: A kérdoív belso megbízhatósága, a teszt-reteszt megbízhatósága kiváló. A konstruktumvaliditást vizsgálva közepesen eros összefüggést találtunk a szorongás, a depresszió, a poszttraumás növekedésérzés, az életminoség és a Rövid Betegségpercepció Kérdoív között. A prediktív validitást vizsgálva igazolást nyert, hogy a betegségpercepció összefüggésben áll a vesemuködést jelzo eGFR-szinttel (p = 0,027). A kérdoív diszkrimináns validitását igazolta, hogy képes különbséget tenni a különbözo betegcsoportok között. Következtetés: A Rövid Betegségpercepció Kérdoív magyar verziójának reliabilitása és validitása a vizsgált populáción jónak mutatkozott. A kérdoív megbízható információt ad a pácienseknek a betegségükrol kialakított elképzeléseirol. Orv Hetil. 2021; 162(6): 212-218. INTRODUCTION: Interdisciplinary studies confirm that patients' illness perception can have a substantial effect on the healing process. OBJECTIVE: The aim of this study was to assess the reliability and validity of the Hungarian version of the Brief Illness Perception Questionnaire in chronic disease, cancer, and transplant patients. METHOD: 490 patients were assessed using the Spielberger Anxiety Inventory, the Beck Depression Inventory, Posttraumatic Growth Inventory and quality of life questionnaires. RESULTS: The scale showed good internal consistency, and the test-retest reliability was excellent. The Brief Illness Perception Questionnaire scores moderately correlated with anxiety, depression, posttraumatic growth and quality of life. Examining predictive validity, the questionnaire correlated with eGFR level (p = 0.027). The discriminant validity of the questionnaire was supported by its ability to distinguish between different patient groups. CONCLUSION: The reliability and validity of the Hungarian version of the Brief Illness Perception Questionnaire in the sample were excellent. The questionnaire turned out to be a useful psychometric tool in the measurement of illness perception. Orv Hetil. 2021; 162(6): 212-218.

Generation Gaps in Digital Health Literacy and Their Impact on Health Information Seeking Behavior and Health Empowerment in Hungary.

Background: Today the internet is a major source of health information, and younger generations have more confidence in their digital information seeking skills and awareness of online resources than older generations. Older generations, however, are more in demand of health services. The aim of our study was to explore these generational differences as related to self-perceived eHealth literacy and health care system utilization. Methods: A cross-sectional survey study with 522 subjects was done in Hungary. Every subject belonged to one of four generations (Baby boomers, X, Y, and Z). The Web-based survey was designed and tested in English-speaking countries and translated into Hungarian for the present study. Variables include Internet health information seeking, eHealth literacy (measured by eHeals score), the self-perceived gain in empowerment by that information, and the number of health care appointments. One-way ANOVA was used for comparing the scores of the generations, and correlational and linear regression analysis was employed within the generations for further data analysis. Results: We found significant differences among the generations in eHealth literacy as well as in the self-perceived gain in empowerment: while Boomers were the generation with the lowest eHeals scores, they showed the highest empowerment. Internet health information seeking behavior showed no differences. While subjects who use the Internet more frequently to search for health information have worse self-rated health status, the ones with higher eHeals scores report better subjective health status. We also identified the associations of the above variables within the older generations (Boomers and X) with the frequency of using health-care services: within the generation of Boomers the number of health care appointments was only associated with Internet health information seeking, while in Generation X with eHeals. Conclusions: Baby boomers seek Internet health information as often as the younger generations, which provides a solid motivation for developing their eHealth literacy skills. We find it crucial to plan the Hungarian health promotion programmes utilizing this high frequency of Internet health information seeking, since the eHealth literacy skills of older generations have an effect on their subjective health status, and they are the most capable of applying information in making decisions.