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Barello S, Anderson G, Bosio C, Lane DA, Leo DG, Lobban TCA, Trevisan C, Graffigna G. Patient engagement in multimorbidity: a systematic review of patient-reported outcome measures. Front Psychol 2024; 15:1345117. [PMID: 39100568 PMCID: PMC11294995 DOI: 10.3389/fpsyg.2024.1345117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/06/2024] [Indexed: 08/06/2024] Open
Abstract
Background People with multimorbidity are increasingly engaged, enabled, and empowered to take responsibility for managing their health status. The purpose of the study was to systematically review and appraise the psychometric properties of tools measuring patient engagement in adults with multimorbidity and their applicability for use within engagement programs. Methods PubMed, Scopus, Web of Science, and PsycInfo were searched from inception to 1 July 2021. Gray literature was searched using EBSCO host-database "Open dissertation". The reference lists of studies meeting the inclusion criteria were searched to identify additional eligible studies. The screening of the search results and the data extraction were performed independently by two reviewers. The methodological quality of the included studies was evaluated with the COSMIN checklist. Relevant data from all included articles were extracted and summarized in evidence synthesis tables. Results Twenty articles on eight tools were included. We included tools that measure all four dimensions of patient engagement (i.e., engagement, empowerment, activation, and participation). Their psychometric properties were analyzed separately. Most tools were developed in the last 10 years in Europe or the USA. The comparison of the estimated psychometric properties of the retrieved tools highlighted a significant lack of reliable patient engagement measures for people with multimorbidity. Available measures capture a diversity of constructs and have very limited evidence of psychometric properties that are vital for patient-reported measures, such as invariance, reliability, and responsiveness. Conclusion This review clarifies how patient engagement, as operationalized in measures purporting to capture this concept, overlaps with, and differs from other related constructs in adults with multimorbidity. The methodological quality of psychometric tools measuring patient engagement in adults with multimorbidity could be improved. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=259968, identifier CRD42021259968.
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Affiliation(s)
- Serena Barello
- EngageMinds HUB – Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Gloria Anderson
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Caterina Bosio
- EngageMinds HUB – Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Deirdre A. Lane
- Liverpool Centre for Cardiovascular Science and Department of Cardiovascular and Metabolic Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Donato G. Leo
- Liverpool Centre for Cardiovascular Science and Department of Cardiovascular and Metabolic Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | - Caterina Trevisan
- Department of General Psychology, University of Padua, Padua, Italy
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Guendalina Graffigna
- EngageMinds HUB – Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, Cremona, Italy
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Aujoulat I. Patient empowerment in the clinical encounter and beyond. Eur J Cardiovasc Nurs 2024:zvae086. [PMID: 38875456 DOI: 10.1093/eurjcn/zvae086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 05/28/2024] [Indexed: 06/16/2024]
Affiliation(s)
- Isabelle Aujoulat
- Institute of Health and Society, UCLouvain, Clos Chapelle-aux-Champs, 30.15, 1200 Brussels, Belgium
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Kamminga NCW, van der Veldt AAM, Wakkee M, van den Berge FR, van der Beek LAA, Joosen MCW, Joosse A, de Joode K, Nijsten TEC, Lugtenberg M. From decision to reflection: understanding the experiences and unmet care needs of patients treated with immunotherapy for melanoma in the adjuvant or metastatic setting. BMC Cancer 2024; 24:662. [PMID: 38816701 PMCID: PMC11141069 DOI: 10.1186/s12885-024-12410-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Despite increased use of immune checkpoint inhibitors (ICIs) in patients with advanced melanoma, little is known about patient experiences during this treatment. This study aimed to gain an in-depth understanding of experiences and unmet care needs of patients treated in the adjuvant or metastatic setting for advanced melanoma regarding their ICI treatment trajectory. METHODS Interviews and focus groups were conducted among 35 patients treated with ICIs in the adjuvant setting for completely resected stage III (n = 14), or in the metastatic setting for irresectable stage IV (n = 21) melanoma. A thorough thematic content analysis was conducted. RESULTS Three main themes were identified. When (1) dealing with uncertainty in the decision-making process, adjuvant patients explored the pros and cons, whereas metastatic patients considered immunotherapy their only viable option. Both groups expressed the need for additional guidance. In (2) navigating the immunotherapy course, both perceived the trajectory as intense, experienced a major impact on their and their (close) relatives' lives, and felt the need to (re)gain control. When (3) looking back on the immunotherapy experience, metastatic patients generally felt relieved, while among adjuvant patients, feelings of doubt regarding their choice for ICIs were also reported. CONCLUSIONS ICI treatment is perceived as intensive for both patient groups, facing both comparable and distinct challenges throughout the treatment trajectory, underscoring the need for stage-specific, individualised guidance. Options regarding flexible follow-ups, low-threshold contact and psychosocial support throughout the treatment trajectory should be explored.
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Affiliation(s)
- Nadia C W Kamminga
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Astrid A M van der Veldt
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marlies Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Fauve R van den Berge
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lianne A A van der Beek
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Margot C W Joosen
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Arjen Joosse
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Karlijn de Joode
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tamar E C Nijsten
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marjolein Lugtenberg
- Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
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Gotowiec S, Bennett RJ, Larsson J, Ferguson M. Development of a self-report measure of empowerment along the hearing health journey: a content evaluation study. Int J Audiol 2024; 63:275-285. [PMID: 36794384 DOI: 10.1080/14992027.2023.2174456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 12/17/2022] [Accepted: 01/18/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To conduct the first phases in the development of a self-report measure of empowerment on the hearing health journey, specifically, item generation and content evaluation of the initial pool of items generated. DESIGN A content expert panel survey and cognitive interviews were conducted. Descriptive statistics were obtained for the quantitative data, and the cognitive interviews were analysed using thematic analysis. STUDY SAMPLE Eleven researchers and clinicians participated in the content expert surveys. Sixteen experienced hearing aid users participated in the cognitive interviews, recruited from the USA and Australia. RESULTS The items underwent five iterations based on feedback from the survey and interview data. This resulted in a set of 33 quality-tested potential survey items that were rated highly for relevance (mean = 3.96), clarity (mean = 3.70) and fit to dimensions of empowerment (mean = 3.92) (scale 0-4, where 4 was the maximum rating). CONCLUSIONS Involving stakeholders in item generation and content evaluation increased relevance, clarity, fit to dimension, comprehensiveness, and acceptability of the items. This preliminary version of the 33-item measure underwent further psychometric refinement (Rasch analysis and traditional classical test theory testing) to validate it for clinical and research use (reported separately).
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Affiliation(s)
| | - Rebecca J Bennett
- Ear Science Institute Australia, Perth, Australia
- School of Medicine, The University of Western Australia, Perth, Australia
| | | | - Melanie Ferguson
- Ear Science Institute Australia, Perth, Australia
- School of Allied Health, Curtin University, Perth, Australia
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te Braake E, Grünloh C, Tabak M. Shifting Responsibilities: Developing a Pan-European Service Model for an eHealth Technology Supporting Self-Management of People with Chronic Obstructive Pulmonary Disease and Comorbidities. Int J Chron Obstruct Pulmon Dis 2024; 19:175-192. [PMID: 38249825 PMCID: PMC10800113 DOI: 10.2147/copd.s432568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Active participation of patients in their care via self-management is an important pillar to manage chronic conditions. Self-management education and continuous support are needed to improve patients' confidence to take such active role. One way to do this is through eHealth technologies. However, those technologies can only be successful when actively used in daily practice and when integrated in overall care. Therefore, this study investigated how a self-management eHealth technology could be implemented that emphasises the active role of patients in their care. Methods The service modelling method was utilized as implementation strategy. The design process consisted of five phases with salient stakeholders and consortium members of a European project to develop the service model. Studies with salient stakeholders were carried out in three different countries (Italy, Estonia, the Netherlands). A combination between face-to-face and online methods facilitated the participatory design process. Results Due to the pan-European context, different stakeholders in the three countries were identified. Research nurses and case managers were not yet established in practice but once implemented, expected to contribute to optimal implementation. During service modelling, a crucial step was revealed: providing self-management training before technology use to let patient familiarise with the concept of taking an active role. As HCPs felt that they were not necessarily equipped to guide patients in terms of self-management, they also should have access to such self-management training. Conclusion By demonstrating a way for implementation while emphasising patients' active role, we also showed the complexity of the method in two ways. First, by demonstrating the fine line between the descriptive and prescriptive model. Thus, showcasing the need to recognize that prescriptive models may be hampered by the delay in changing work practices. Second, by highlighting the importance of identifying country-specific differences in the pan-European context, revealing that service modelling is not a one-size-fits-all approach.
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Affiliation(s)
- Eline te Braake
- Roessingh Research and Development, Enschede, the Netherlands
- University of Twente, Biomedical Signals and System Group, Faculty of Electrical Engineering, Mathematics, and Computer Science, Enschede, the Netherlands
| | - Christiane Grünloh
- Roessingh Research and Development, Enschede, the Netherlands
- University of Twente, Biomedical Signals and System Group, Faculty of Electrical Engineering, Mathematics, and Computer Science, Enschede, the Netherlands
| | - Monique Tabak
- University of Twente, Biomedical Signals and System Group, Faculty of Electrical Engineering, Mathematics, and Computer Science, Enschede, the Netherlands
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Goulding R, Birtwell K, Hann M, Peters S, van Marwijk H, Bower P. Safer Patients Empowered to Engage and Communicate about Health (SPEECH) in primary care: a feasibility study and process evaluation of an intervention for older people with multiple long-term conditions (multimorbidity). BMC PRIMARY CARE 2024; 25:12. [PMID: 38178010 PMCID: PMC10768368 DOI: 10.1186/s12875-023-02221-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/22/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Older people with multiple long-term conditions (multimorbidity) (MLTC-M) experience difficulties accessing and interacting with health and care services. Breakdowns in communication between patients and staff can threaten patient safety. To improve communication and reduce risks to patient safety in primary care, we developed an intervention: Safer Patients Empowered to Engage and Communicate about Health (SPEECH). SPEECH comprises a booklet for patients and an associated guide for staff. The booklet is designed to provide patients with information about staff and services, skills to prepare and explain, and confidence to speak up and ask. METHODS A single-arm mixed methods feasibility study with embedded process evaluation. General practices in the North West of England were recruited. Participating practices invited patients aged 65+ with MLTC-M who had an appointment scheduled during the study period. Patients were asked to complete questionnaires at baseline and follow-up (four to eight weeks after being sent the patient booklet), including the Consultation and Relational Empathy measure, Empowerment Scale, Multimorbidity Treatment Burden Questionnaire, and Primary Care Patient Measure of Safety. Staff completed questionnaires at the end of the study period. A sub-sample of patients and staff were interviewed about the study processes and intervention. Patients and the public were involved in all aspects of the study, from generation of the initial idea to interpretation of findings. RESULTS Our target of four general practices were recruited within 50 days of the study information being sent out. A fifth practice was recruited later to boost patient recruitment. We received expressions of interest from 55 patients (approx. 12% of those invited). Our target of 40 patient participants completed baseline questionnaires and were sent the SPEECH booklet. Of these, 38 (95%) completed follow-up. Patients found the intervention and study processes acceptable, and staff found the intervention acceptable and feasible to deliver. CONCLUSIONS Our findings suggest the intervention is acceptable, and it would be feasible to deliver a trial to assess effectiveness. Prior to further evaluation, study processes and the intervention will be updated to incorporate suggestions from participants. TRIAL REGISTRATION The study was registered on the ISRCTN registry (ISRCTN13196605: https://doi.org/10.1186/ISRCTN13196605 ).
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Affiliation(s)
- Rebecca Goulding
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, England.
| | - Kelly Birtwell
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, England.
| | - Mark Hann
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, England
| | - Sarah Peters
- Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, England
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Watson Building, Brighton, England
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, England
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Jelleryd E, Brorsson AL, Smart CE, Käck U, Lindholm Olinder A. Carbohydrate Counting, Empowerment and Glycemic Outcomes in Adolescents and Young Adults with Long Duration of Type 1 Diabetes. Nutrients 2023; 15:4825. [PMID: 38004219 PMCID: PMC10675281 DOI: 10.3390/nu15224825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
The complex treatment for diabetes type 1 (T1D) includes insulin dosing for every meal, which requires education and experience to achieve optimal outcomes. Advanced carbohydrate counting (ACC) is the recommended method. We studied ACC as part of a standard treatment with the aim to explore its associations with glycemic control and empowerment in adolescents and young adults. We used national registry data on glycemic outcomes, a study-specific questionnaire regarding the use of ACC and the Gothenburg Young Persons Empowerment Scale (GYPES) to measure empowerment. A total of 111 participants (10-28 years of age, diabetes duration >9 years, mean HbA1c of 55.4 mmol/mol) answered the questionnaire. We found that most participants (79.3%) who learn ACC, at onset or later, continue to use the method. A higher level of empowerment was associated with lower HbA1c (p = 0.021), making patient empowerment an important factor in achieving optimal glycemic outcomes. No associations were found between ACC and empowerment or glycemic outcomes. A mixed strategy, only using ACC sometimes when insulin dosing for meals, was associated with the lowest empowerment score and highest HbA1c and should warrant extra education and support from the diabetes team to reinforce a dosing strategy.
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Affiliation(s)
- Elisabeth Jelleryd
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, 11883 Stockholm, Sweden; (U.K.); (A.L.O.)
- Women’s Health and Allied Health Professionals Theme, Medical Unit Clinical Nutrition, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Anna Lena Brorsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, 14152 Stockholm, Sweden;
| | - Carmel E. Smart
- Department of Endocrinology, John Hunter Children’s Hospital, Newcastle, NSW 2305, Australia;
- School of Health Sciences, University of Newcastle, Newcastle, NSW 2300, Australia
| | - Ulrika Käck
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, 11883 Stockholm, Sweden; (U.K.); (A.L.O.)
- Sachs’ Children and Youth Hospital, Södersjukhuset, 11883 Stockholm, Sweden
| | - Anna Lindholm Olinder
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, 11883 Stockholm, Sweden; (U.K.); (A.L.O.)
- Sachs’ Children and Youth Hospital, Södersjukhuset, 11883 Stockholm, Sweden
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Norouzkhani N, Bahari A, Shirvani JS, Faramarzi M, Eslami S, Tabesh H. Expert opinions on informational and supportive needs and sources of obtaining information in patients with inflammatory bowel disease: a Delphi consensus study. Front Psychol 2023; 14:1224279. [PMID: 37809295 PMCID: PMC10557489 DOI: 10.3389/fpsyg.2023.1224279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/23/2023] [Indexed: 10/10/2023] Open
Abstract
Background The present study introduces informational and supportive needs and sources of obtaining information in patients with inflammatory bowel disease (IBD) through a three-round Expert Delphi Consensus Opinions method. Methods According to our previous scoping review, important items in the area of informational and supportive needs and sources of obtaining information were elucidated. After omitting duplicates, 56 items in informational needs, 36 items in supportive needs, and 36 items in sources of obtaining information were retrieved. Both open- and close-ended questions were designed for each category in the form of three questionnaires. The questionnaires were sent to selected experts from different specialties. Experts responded to the questions in the first round. Based on the feedback, questions were modified and sent back to the experts in the second round. This procedure was repeated up to the third round. Results In the first round, five items from informational needs, one item from supportive needs, and seven items from sources of obtaining information were identified as unimportant and omitted. Moreover, two extra items were proposed by the experts, which were added to the informational needs category. In the second round, seven, three, and seven items from informational needs, supportive needs, and sources of obtaining information were omitted due to the items being unimportant. In the third round, all the included items gained scores equal to or greater than the average and were identified as important. Kendall coordination coefficient W was calculated to be 0.344 for information needs, 0.330 for supportive needs, and 0.325 for sources of obtaining information, indicating a fair level of agreement between experts. Conclusions Out of 128 items in the first round, the omission of 30 items and the addition of two items generated a 100-item questionnaire for three sections of informational needs, supportive needs, and sources of obtaining information with a high level of convergence between experts' viewpoints.
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Affiliation(s)
- Narges Norouzkhani
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Bahari
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mahbobeh Faramarzi
- Department of General Courses, Population, Family and Spiritual Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Tabesh
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Düzel B, Saygili M, Özer Ö, Zubaroğlu Yanardağ M. The effect of patient empowerment on patient activation level: A review of individuals with cardiovascular diseases. Chronic Illn 2023; 19:665-674. [PMID: 37062944 DOI: 10.1177/17423953231170400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
OBJECTIVES The aim of this study is to examine the effect of patient empowerment on patient activation level in individuals with cardiovascular diseases. METHODS The population of the study is adult individuals receiving inpatient treatment in the Cardiology clinic of a city hospital operating in Turkey. In the study, convenience sampling method was applied, and a questionnaire was conducted from 543 patients. RESULTS As a result of the analyses made in the study, positive and low correlations were detected between the patient empowerment scale sub-dimensions and the patient activation level. According to regression analysis results, it was identified that the patient empowerment sub-dimensions together accounted for 6.4% of the total variance on the patient activation level, and the increase in the 'knowledge and understanding' levels of the patients statistically increased their perceptions of the patient activation level. DISCUSSION The results show that by providing patient empowerment in individuals with chronic diseases, their active participation can be increased in the treatment processes and consequently in the chronic disease management.
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Affiliation(s)
- Barış Düzel
- Department of Cardiology, Mersin City Hospital, Mersin, Turkey
| | - Meltem Saygili
- Department of Healthcare Management, Faculty of Health Sciences, Kırıkkale University, Kırıkkale, Turkey
| | - Özlem Özer
- Department of Healthcare Management, Faculty of Gulhane Health Sciences, University of Health Sciences Turkey, Ankara, Turkey
| | - Melek Zubaroğlu Yanardağ
- Department of Social Work, Faculty of Economics and Administrative Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
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Pflugeisen CM, Boomgaarden A, Denaro AA, Konicek D, Robinson E. Patient Empowerment Among Transgender and Gender Diverse Youth. LGBT Health 2023; 10:429-438. [PMID: 37126404 PMCID: PMC10468556 DOI: 10.1089/lgbt.2022.0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Purpose: Patient empowerment is becoming increasingly important as health care moves toward more collaborative models of care. The goal of this study was to evaluate and characterize patient empowerment in a sample of transgender/gender-diverse/nonbinary (TGDNB) youth aged 14-24 who have had at least one conversation with a medical health care provider about gender-affirming care. Methods: We adapted a health care empowerment scale for use with TGDNB young people and collected patient empowerment and sociodemographic data among TGDNB youth in the United States over an 8-week period in the spring of 2022. Overall and domain-specific empowerment (including knowledge and understanding, control, identity, decision-making, and supporting others) were assessed on a four-point scale from a low of 1 to a high of 4. Results: A total of 177 youth completed the survey. Mean age was 18.4 ± 3.0 years, the sample was 39.5% gender-diverse/nonbinary, 16.4% transfemme, 44.1% transmasc, and 81.9% White. Average empowerment was 0.22 points higher in youth with supportive caregivers than those without (99% confidence interval [CI] 0.05-0.38, p < 0.001) and 0.20 points higher in youth who sought gender-affirming mental health support (99% CI 0.04-0.36, p = 0.001). Caregiver support increased youths' sense of control over their health/health care (estimated increase 0.29, 99% CI 0.09-0.50, p < 0.001), and mental health support increased youths' decision-making agency by 0.30 points (99% CI 0.06-0.53, p = 0.001). Conclusions: This is the first study to assess patient empowerment in TGDNB youth. Several sociodemographic factors were significantly associated with overall and domain-level empowerment. Further work in this area, both longitudinal and in larger samples, is warranted.
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Affiliation(s)
| | - Anna Boomgaarden
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
| | - Aytch A. Denaro
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
| | - Danielle Konicek
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
- School of Social Work & Criminal Justice, University of Washington, Tacoma, Washington, USA
| | - Emily Robinson
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
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Winter PD, Chico TJA. Using the Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) Framework to Identify Barriers and Facilitators for the Implementation of Digital Twins in Cardiovascular Medicine. SENSORS (BASEL, SWITZERLAND) 2023; 23:6333. [PMID: 37514627 PMCID: PMC10385429 DOI: 10.3390/s23146333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
A digital twin is a computer-based "virtual" representation of a complex system, updated using data from the "real" twin. Digital twins are established in product manufacturing, aviation, and infrastructure and are attracting significant attention in medicine. In medicine, digital twins hold great promise to improve prevention of cardiovascular diseases and enable personalised health care through a range of Internet of Things (IoT) devices which collect patient data in real-time. However, the promise of such new technology is often met with many technical, scientific, social, and ethical challenges that need to be overcome-if these challenges are not met, the technology is therefore less likely on balance to be adopted by stakeholders. The purpose of this work is to identify the facilitators and barriers to the implementation of digital twins in cardiovascular medicine. Using, the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, we conducted a document analysis of policy reports, industry websites, online magazines, and academic publications on digital twins in cardiovascular medicine, identifying potential facilitators and barriers to adoption. Our results show key facilitating factors for implementation: preventing cardiovascular disease, in silico simulation and experimentation, and personalised care. Key barriers to implementation included: establishing real-time data exchange, perceived specialist skills required, high demand for patient data, and ethical risks related to privacy and surveillance. Furthermore, the lack of empirical research on the attributes of digital twins by different research groups, the characteristics and behaviour of adopters, and the nature and extent of social, regulatory, economic, and political contexts in the planning and development process of these technologies is perceived as a major hindering factor to future implementation.
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Affiliation(s)
- Peter D Winter
- School of Sociology, Politics, and International Studies (SPAIS), University of Bristol, Bristol BS8 1TU, UK
| | - Timothy J A Chico
- Department of Infection, Immunity and Cardiovascular Disease (IICD), University of Sheffield, Sheffield S10 2RX, UK
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Barbosa HC, Torres HDC, Oliveira JADQ, Santos RPDM, da Costa JM, Miranda LG, Pagano AS, Praxedes MFDS, Martins MAP. Construction and Validation of a Protocol Targeting Patients on Oral Anticoagulation with Warfarin. Arq Bras Cardiol 2023; 120:e20220576. [PMID: 37403872 PMCID: PMC10344350 DOI: 10.36660/abc.20220576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 02/03/2023] [Accepted: 04/05/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Warfarin is an oral anticoagulant that is very useful in preventing thromboembolism, though it is considered a drug with a high risk of causing adverse events. Considering the practical challenges in controlling oral anticoagulation, the patients on warfarin could benefit from educational strategies aimed at behavioral changes, active participation in self-care, and adherence to drug therapy. OBJECTIVE The aim was to construct and validate the EmpoderACO protocol for behavioral changes in warfarin patients. METHODS The methodological steps were: definition of concepts and domains of self-care, identification of objectives, construction and selection of items, assessment of content validity, and pre-test in the target population. RESULTS Relevance, adequacy, clarity, and internal reliability of the instrument's items were assessed by a multidisciplinary judges committee (JC) through the E-surv web platform, obtaining an average agreement of ≥0.91. The understanding of the instrument measured by the target population revealed adequate clarity with a coefficient average of 0.96. CONCLUSION EmpoderACO can aid in qualifying the communication process between medical professionals and patients, as well as in improving adherence to both treatment and clinical outcomes, and can be replicated in healthcare settings.
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Affiliation(s)
- Hannah Cardoso Barbosa
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Heloisa de Carvalho Torres
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | | | | | - Josiane Moreira da Costa
- Universidade Federal dos Vales do Jequitinhonha e MucuriTeófilo OtoniMGBrasilUniversidade Federal dos Vales do Jequitinhonha e Mucuri, Teófilo Otoni, MG – Brasil
| | - Leonardo Gonçalves Miranda
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Adriana Silvina Pagano
- Universidade Federal de Minas GeraisBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Marcus Fernando da Silva Praxedes
- Universidade Federal do Recôncavo da BahiaCruz das AlmaBABrasilUniversidade Federal do Recôncavo da Bahia (UFRB), Cruz das Almas, BA – Brasil
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Grasemann C, Höppner J, Burgard P, Schündeln MM, Matar N, Müller G, Krude H, Berner R, Lee-Kirsch MA, Hauck F, Wainwright K, Baumgarten S, Atinga J, Bauer JJ, Manka E, Körholz J, Kiewert C, Heinen A, Kretschmer T, Kurth T, Mittnacht J, Schramm C, Klein C, Graessner H, Hiort O, Muntau AC, Grüters A, Hoffmann GF, Choukair D. Transition for adolescents with a rare disease: results of a nationwide German project. Orphanet J Rare Dis 2023; 18:93. [PMID: 37098531 PMCID: PMC10131406 DOI: 10.1186/s13023-023-02698-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 04/06/2023] [Indexed: 04/27/2023] Open
Abstract
PURPOSE The transition process from paediatric/adolescent to adult medical care settings is of utmost importance for the future health of adolescents with chronic diseases and poses even more difficulties in the context of rare diseases (RDs). Paediatric care teams are challenged to deliver adolescent-appropriate information and structures. Here we present a structured transition pathway which is patient-focused and adoptable for different RDs. METHODS The transition pathway for adolescents 16 years and older was developed and implemented as part of a multi-centre study in 10 university hospitals in Germany. Key elements of the pathway included: assessment of patients' disease-related knowledge and needs, training/educational and counselling sessions, a structured epicrisis and a transfer appointment jointly with the paediatric and adult specialist. Specific care coordinators from the participating university hospitals were in charge of organization and coordination of the transition process. RESULTS Of a total of 292 patients, 286 completed the pathway. Deficits in disease-specific knowledge were present in more than 90% of participants. A need for genetic or socio-legal counselling was indicated by > 60%. A mean of 2.1 training sessions per patient were provided over a period of almost 1 year, followed by the transfer to adult care in 267 cases. Twelve patients remained in paediatric care as no adult health care specialist could be identified. Targeted training and counselling resulted in improved disease-specific knowledge and contributed to empowering of patients. CONCLUSION The described transition pathway succeeds to improve health literacy in adolescents with RDs and can be implemented by paediatric care teams in any RD specialty. Patient empowerment was mainly achieved by individualized training and counselling.
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Affiliation(s)
- Corinna Grasemann
- Division of Rare Diseases, Department of Paediatrics, St. Josef-Hospital Bochum, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany.
- Centre for Rare Diseases Ruhr CeSER, Ruhr-University Bochum and Witten/Herdecke University, Bochum, Germany.
| | - Jakob Höppner
- Division of Rare Diseases, Department of Paediatrics, St. Josef-Hospital Bochum, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
| | - Peter Burgard
- Centre for Child and Adolescent Medicine and and Centre for Rare Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael M Schündeln
- Department of Paediatrics III, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Nora Matar
- Division of Rare Diseases, Department of Paediatrics, St. Josef-Hospital Bochum, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
- Centre for Rare Diseases Ruhr CeSER, Ruhr-University Bochum and Witten/Herdecke University, Bochum, Germany
| | - Gabriele Müller
- Centre for Evidence-Based Healthcare, Carl Gustav Carus Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Heiko Krude
- Institute for Experimental Paediatric Endocrinology and Centre for Rare Diseases, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Reinhard Berner
- Children's Department and University Centre for Rare Diseases (USE), University Hospital Dresden, Dresden, Germany
| | - Min Ae Lee-Kirsch
- Children's Department and University Centre for Rare Diseases (USE), University Hospital Dresden, Dresden, Germany
| | - Fabian Hauck
- Dr von Hauner Children's Hospital, University Hospital and Munich Centre for Rare Diseases (M-ZSELMU), Ludwig-Maximilians-University Munich, Munich, Germany
| | - Kerstin Wainwright
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sylvana Baumgarten
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Janet Atinga
- Division of Rare Diseases, Department of Paediatrics, St. Josef-Hospital Bochum, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
- Centre for Rare Diseases Ruhr CeSER, Ruhr-University Bochum and Witten/Herdecke University, Bochum, Germany
| | - Jens J Bauer
- Division of Rare Diseases, Department of Paediatrics, St. Josef-Hospital Bochum, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
- Centre for Rare Diseases Ruhr CeSER, Ruhr-University Bochum and Witten/Herdecke University, Bochum, Germany
| | - Eva Manka
- Department of Paediatrics II and Essener Centre for Rare Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Julia Körholz
- Children's Department and University Centre for Rare Diseases (USE), University Hospital Dresden, Dresden, Germany
| | - Cordula Kiewert
- Department of Paediatrics II and Essener Centre for Rare Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - André Heinen
- Children's Department and University Centre for Rare Diseases (USE), University Hospital Dresden, Dresden, Germany
| | - Tanita Kretschmer
- Children's Department and University Centre for Rare Diseases (USE), University Hospital Dresden, Dresden, Germany
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Janna Mittnacht
- Centre for Child and Adolescent Medicine and and Centre for Rare Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Schramm
- Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Klein
- Dr von Hauner Children's Hospital, University Hospital and Munich Centre for Rare Diseases (M-ZSELMU), Ludwig-Maximilians-University Munich, Munich, Germany
| | - Holm Graessner
- Institute for Medical Genetics and Applied Genomics, University of Tuebingen, Tübingen, Germany
| | - Olaf Hiort
- Departments of Paediatrics, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ania C Muntau
- University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Annette Grüters
- Institute for Experimental Paediatric Endocrinology and Centre for Rare Diseases, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Georg F Hoffmann
- Centre for Child and Adolescent Medicine and and Centre for Rare Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniela Choukair
- Centre for Child and Adolescent Medicine and and Centre for Rare Diseases, University Hospital Heidelberg, Heidelberg, Germany
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The longitudinal association between patient empowerment and patient-reported outcomes: What is the direction of effect? PLoS One 2022; 17:e0277267. [DOI: 10.1371/journal.pone.0277267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/21/2022] [Indexed: 11/12/2022] Open
Abstract
Background
Theoretical literature and cross-sectional studies suggest empowerment is associated with other patient-reported outcomes (PROs). However, it is not known if patient empowerment is leading to improvements in other PROs or vice versa.
Aims
The present study aimed to examine the direction of effects between patient empowerment and PROs in young persons with congenital heart disease (CHD).
Methods
As part of the STEPSTONES-CHD trial, adolescents with CHD from seven pediatric cardiology centers in Sweden were included in a longitudinal observational study (n = 132). Data were collected when patients were 16 (T0), 17 (T1) and 18 ½ years old (T2). The Gothenburg Young Persons Empowerment Scale (GYPES) was used to measure patient empowerment. Random intercepts cross-lagged panel models between patient empowerment and PROs (communication skills; patient-reported health; quality of life; and transition readiness) were undertaken.
Results
We found a significant cross-lagged effect of transition readiness over patient empowerment between T1 and T2, signifying that a higher level of transition readiness predicted a higher level of patient empowerment. No other significant cross-lagged relationships were found.
Conclusion
Feeling confident before the transition to adult care is necessary before young persons with CHD can feel in control to manage their health and their lives. Clinicians interested in improving patient empowerment during the transitional period should consider targeting transition readiness.
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15
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Montt-Blanchard D, Dubois-Camacho K, Costa-Cordella S, Sánchez R. Domesticating the condition: Design lessons gained from a marathon on how to cope with barriers imposed by type 1 diabetes. Front Psychol 2022; 13:1013877. [PMID: 36420398 PMCID: PMC9677098 DOI: 10.3389/fpsyg.2022.1013877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/04/2022] [Indexed: 11/03/2023] Open
Abstract
Through analytical autoethnographic analysis of marathon preparation, this study examines challenges faced by people with Type 1 Diabetes (T1D) who engage in high-performance sports. Autoethnographer and second-person perspectives (T1D runners, family members, and health providers) were collected through introspective activities (autoethnographic diary and in-depth interviews) to understand the T1D runner's coping experience. Six insights involved in T1D self-management were identified and analyzed with reference to related design tools (prototyping, archetyping and journey mapping). Finally, we conclude with a discussion of how endurance physical activity (PA) such as running helps to "domesticate" T1D, a term coined to reflect the difficulties that T1D presents for PA accomplishment and how T1D runners' experiences give them an opportunity to overcome PA barriers promoting physical culture and enriching further health psychology studies.
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Affiliation(s)
| | - Karen Dubois-Camacho
- Faculty of Medicine, Institute of Biomedical Sciences, Universidad de Chile, Santiago, Chile
| | - Stefanella Costa-Cordella
- Faculty of Psychology, Universidad Diego Portales, Santiago, Chile
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
| | - Raimundo Sánchez
- Faculty of Engineering and Sciences, Universidad Adolfo Ibañez, Santiago, Chile
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16
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Acuña Mora M, Raymaekers K, Van Bulck L, Goossens E, Luyckx K, Kovacs AH, Andresen B, Moon JR, Van De Bruaene A, Rassart J, Moons P. Gothenburg Empowerment Scale (GES): psychometric properties and measurement invariance in adults with congenital heart disease from Belgium, Norway and South Korea. Health Qual Life Outcomes 2022; 20:145. [PMID: 36266608 PMCID: PMC9583060 DOI: 10.1186/s12955-022-02056-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/05/2022] [Indexed: 11/24/2022] Open
Abstract
Background Patient empowerment is associated with improvements in different patient-reported and clinical outcomes. However, despite being widely researched, high quality and theoretically substantiated disease-generic measures of patient empowerment are lacking. The few good instruments that are available have not reported important psychometric properties, including measurement invariance. The aim of this study was to assess the psychometric properties of the 15-item Gothenburg Empowerment Scale (GES), with a particular focus on measurement invariance of the GES across individuals from three countries. Methods Adults with congenital heart disease from Belgium, Norway and South Korea completed the GES and other patient-reported outcomes as part of an international, cross-sectional, descriptive study called APPROACH-IS II. The scale’s content (missing data) and factorial validity (confirmatory factor analyses), measurement invariance (multi-group confirmatory factor analyses), responsiveness (floor and ceiling effects) and reliability (internal consistency) were assessed. Results Content validity, responsiveness and reliability were confirmed. Nonetheless, metric but not scalar measurement invariance was supported when including the three countries, possibly because the scale performed differently in the sample from South Korea. A second set of analyses supported partial scalar invariance for a sample that was limited to Norway and Belgium. Conclusion Our study offers preliminary evidence that GES is a valid and reliable measure of patient empowerment in adults with congenital heart disease. However, cross-country comparisons must be made with caution, given the scale did not perform equivalently across the three countries.
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Affiliation(s)
- Mariela Acuña Mora
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Koen Raymaekers
- School Psychology and Development in Context, Leuven, KU, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium
| | - Liesbet Van Bulck
- Research Foundation Flanders (FWO), Brussels, Belgium.,Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, B-3000, Leuven, Box 7001, Belgium
| | - Eva Goossens
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, B-3000, Leuven, Box 7001, Belgium.,Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, Division of Nursing and Midwifery, University of Antwerp, Antwerp, Belgium
| | - Koen Luyckx
- School Psychology and Development in Context, Leuven, KU, Belgium.,UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Adrienne H Kovacs
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Brith Andresen
- Department of Cardiothoracic Surgery, Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Ju Ryoung Moon
- Department of Nursing, Samsung Medical Center, Seoul, South Korea
| | - Alexander Van De Bruaene
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jessica Rassart
- School Psychology and Development in Context, Leuven, KU, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium
| | - Philip Moons
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden. .,Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, B-3000, Leuven, Box 7001, Belgium. .,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
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17
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González-Fajardo KD, Ortiz-León MC, Zenteno-Cuevas R. Adaptación y validación del instrumento EMPODERA-TB para evaluar el empoderamiento en pacientes con tuberculosis pulmonar. Rev Panam Salud Publica 2022; 46:e168. [PMID: 36245906 PMCID: PMC9553021 DOI: 10.26633/rpsp.2022.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 07/15/2022] [Indexed: 11/24/2022] Open
Abstract
Objetivo.
Adaptar y validar el instrumento EMPODERA-TB para medir el empoderamiento en pacientes con tuberculosis pulmonar.
Métodos.
Se adaptó y validó un instrumento, diseñado inicialmente para medir el empoderamiento en pacientes con enfermedades crónicas, para medir el empoderamiento en pacientes con tuberculosis. Para ello, se seleccionaron y adaptaron los ítems aplicables a los pacientes con tuberculosis. La validación se realizó mediante análisis factorial exploratorio y confirmatorio, y la consistencia interna mediante el coeficiente alfa de Cronbach, con base en los datos de una muestra de 49 pacientes de origen mexicano con diagnóstico de tuberculosis pulmonar.
Resultados.
El instrumento se integró por 19 ítems agrupados en tres dimensiones: adquisición de conocimientos, habilidades para compartir información y para la toma de decisiones. Se observó un ajuste aceptable (SRMR: 0,124; CD: 0,999), mientras que la consistencia interna para las dimensiones fue de 0,878; 0,879 y 0,808, respectivamente, y para el instrumento completo fue de 0,885.
Conclusiones.
El instrumento mostró índices de ajuste de bondad aceptables y consistencia interna adecuada, por lo que permite medir el empoderamiento en pacientes con tuberculosis pulmonar. Este instrumento será de utilidad en la práctica clínica y epidemiología de tuberculosis en países latinoamericanos de habla hispana, y permitirá implementar estrategias que mejoren el conocimiento y el apego al tratamiento, así como la interacción con pacientes o individuos en riesgo de contagio y, con ello, establecer estrategias de prevención.
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Affiliation(s)
- Krystal Dennicé González-Fajardo
- Programa de Doctorado en Ciencias de la Salud, Instituto de Ciencias de la Salud de la Universidad Veracruzana, Veracruz, México
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18
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Van Bulck L, Kovacs AH, Goossens E, Luyckx K, Zaidi A, Wang JK, Yadeta D, Windram J, Van De Bruaene A, Thomet C, Thambo JB, Taunton M, Sasikumar N, Sandberg C, Saidi A, Rutz T, Ortiz L, Mwita JC, Moon JR, Menahem S, Mattsson E, Mandalenakis Z, Mahadevan VS, Lykkeberg B, Leye M, Leong MC, Ladouceur M, Ladak LA, Kim Y, Khairy P, Kaneva A, Johansson B, Jackson JL, Giannakoulas G, Gabriel H, Fernandes SM, Enomoto J, Demir F, de Hosson M, Constantine A, Coats L, Christersson C, Cedars A, Caruana M, Callus E, Brainard S, Bouchardy J, Boer A, Baraona Reyes F, Areias ME, Araujo JJ, Andresen B, Amedro P, Ambassa JC, Amaral F, Alday L, Moons P. Rationale, design and methodology of APPROACH-IS II: International study of patient-reported outcomes and frailty phenotyping in adults with congenital heart disease. Int J Cardiol 2022; 363:30-39. [PMID: 35780933 DOI: 10.1016/j.ijcard.2022.06.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND In recent years, patient-reported outcomes (PROs) have received increasing prominence in cardiovascular research and clinical care. An understanding of the variability and global experience of PROs in adults with congenital heart disease (CHD), however, is still lacking. Moreover, information on epidemiological characteristics and the frailty phenotype of older adults with CHD is minimal. The APPROACH-IS II study was established to address these knowledge gaps. This paper presents the design and methodology of APPROACH-IS II. METHODS/DESIGN APPROACH-IS II is a cross-sectional global multicentric study that includes Part 1 (assessing PROs) and Part 2 (investigating the frailty phenotype of older adults). With 53 participating centers, located in 32 countries across six continents, the aim is to enroll 8000 patients with CHD. In Part 1, self-report surveys are used to collect data on PROs (e.g., quality of life, perceived health, depressive symptoms, autonomy support), and explanatory variables (e.g., social support, stigma, illness identity, empowerment). In Part 2, the cognitive functioning and frailty phenotype of older adults are measured using validated assessments. DISCUSSION APPROACH-IS II will generate a rich dataset representing the international experience of individuals in adult CHD care. The results of this project will provide a global view of PROs and the frailty phenotype of adults with CHD and will thereby address important knowledge gaps. Undoubtedly, the project will contribute to the overarching aim of improving optimal living and care provision for adults with CHD.
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Affiliation(s)
- Liesbet Van Bulck
- KU Leuven - University of Leuven, Leuven, Belgium; Research Foundation Flanders (FWO), Brussels, Belgium
| | | | - Eva Goossens
- KU Leuven - University of Leuven, Leuven, Belgium; University of Antwerp, Antwerp, Belgium
| | - Koen Luyckx
- KU Leuven - University of Leuven, Leuven, Belgium; UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Ali Zaidi
- Mount Sinai Heart, New York, NY, USA
| | - Jou-Kou Wang
- National Taiwan University Hospital, Taipei City, Taiwan
| | | | | | | | - Corina Thomet
- Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | | | | | | | - Arwa Saidi
- University of Florida Health, Gainesville, FL, USA
| | - Tobias Rutz
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Lucia Ortiz
- Hospital San Juan De Dios De La Plata, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | - Yuli Kim
- Penn Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | | | | | | | | | - Susan M Fernandes
- Lucile Packard Children's Hospital and Stanford Health Care, Stanford, CA, USA
| | - Junko Enomoto
- Chiba Cerebral and Cardiovascular Center, Chiba, Japan; Toyo University, Tokyo, Japan
| | - Fatma Demir
- Ege University Health Application and Research Center, Bornova/İZMİR, Turkey
| | | | - Andrew Constantine
- Royal Brompton Hospital, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Louise Coats
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Ari Cedars
- University of Southwestern Medical Center, TX, Dallas, USA; Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Edward Callus
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; University of Milan, Milan, Italy
| | - Sarah Brainard
- Boston Children's Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Judith Bouchardy
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Anna Boer
- University Medical Center Groningen, Groningen, the Netherlands
| | - Fernando Baraona Reyes
- Pontificia Universidad Católica de Chile and Instituto Nacional Del Torax, Santiago, Chile
| | - Maria Emília Areias
- UnIC@RISE, University of Porto, Porto, Portugal; Centro Hospitalar Universitário de S. João, Porto, Portugal
| | | | | | - Pascal Amedro
- Hôpital cardiologique Haut-Leveque, Bordeaux, France; Montpellier University Hospital, Montpellier, France
| | | | | | | | - Philip Moons
- KU Leuven - University of Leuven, Leuven, Belgium; University of Gothenburg, Gothenburg, Sweden; University of Cape Town, Cape Town, South Africa.
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19
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Baaleman DF, Wegh CAM, Hoogveld MTA, Benninga MA, Koppen IJN. Transanal Irrigation in Children: Treatment Success, Quality of Life, Adherence, Patient Experience, and Independence. J Pediatr Gastroenterol Nutr 2022; 75:166-172. [PMID: 35675698 PMCID: PMC9278699 DOI: 10.1097/mpg.0000000000003515] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/08/2022] [Indexed: 12/10/2022]
Abstract
OBJECTIVES To investigate the clinical effectiveness and patient experience of transanal irrigation (TAI) in children with constipation or fecal incontinence. METHODS Combined retrospective and cross-sectional study including pediatric patients who used a Navina TAI system. We retrospectively collected baseline characteristics and data on treatment success at 1- and 6-month follow-up (FU). Treatment success was defined as defecating at least 3 times per week and having less than 1 episode of fecal incontinence per week. We cross-sectionally assessed health-related quality of life (HRQoL), treatment adherence, treatment satisfaction (Treatment Satisfaction Questionnaire for Medication [TSQM]), illness perceptions, medication beliefs, and patient empowerment with validated questionnaires. RESULTS Thirty-four patients were included (median age at start TAI: 11 years old [range, 6-18]), 32 in the retrospective review, and 26 in the cross-sectional survey (median of 3 years after initiation). Most patients were diagnosed with functional constipation (n = 26; 76%) or a neurogenic bowel disorder (n = 6; 18%). Treatment success rates significantly improved at each FU compared with baseline (baseline: 4/25 [16%]; 1-month FU: 12/16 [75%], P = 0.008; 6-month FU: 11/18 [61%], P = 0.016; cross-sectional FU: 13/26 [50%], P = 0.008). HRQoL scores were high (PedsQL median, 73 [IQR, 54-85]). Adherence (defined as Medication Adherence Report Scale [MARS] ≥ 23) was low (36%), whereas TSQM effectiveness scores were high (median, 69 [IQR, 47-86]). The majority of children (61%) reported an increase in independence since TAI treatment. Patient empowerment (GYPES) levels were similar to those reported in children with other chronic conditions. CONCLUSIONS TAI with a Navina system is an effective bowel management system for children with intractable constipation or fecal incontinence.
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Affiliation(s)
- Desiree F. Baaleman
- From the Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- the Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Carrie A. M. Wegh
- From the Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- the Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
- the Laboratory of Microbiology, Wageningen University & Research, Wageningen, The Netherlands
| | - Maxime T. A. Hoogveld
- From the Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc A. Benninga
- From the Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ilan J. N. Koppen
- From the Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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20
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Molin B, Zwedberg S, Berger AK, Sand A, Georgsson S. Disempowering women-a mixed methods study exploring informational support about pain persisting after childbirth and its consequences. BMC Pregnancy Childbirth 2022; 22:510. [PMID: 35739466 PMCID: PMC9229078 DOI: 10.1186/s12884-022-04841-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/16/2022] [Indexed: 12/03/2022] Open
Abstract
Background Access to information is essential to achieving individual empowerment; meaning the ability to exercise control, manage one’s own condition and make informed decisions. However, studies have shown that information provided to women regarding physiological changes during the postpartum period and postpartum health was inadequate, incorrect, or inconsistent. Methods The aim of this study was to explore informational support about pain persisting after childbirth and its consequences. A sequential explanatory mixed methods design was used. In the first, quantitative phase, 1,171 women, who gave birth eight months earlier, completed a self-administered questionnaire. In the second, qualitative phase, 20 women who experienced chronic pain were interviewed. Descriptive statistics and qualitative content analysis were used to analyse the data. Results The majority of the women did not receive information about pain persisting after childbirth, or the information was insufficient or incorrect. They did not know when and where to seek help and did not consult health care professionals. In addition, the lack of information had a negative impact on women’s psychological well-being. All women expressed the need to be informed by health care professionals, irrespective of the individual risk of developing chronic pain. Conclusions Health services should ensure availability of information to give the women opportunity to achieve empowerment to make good health decisions, increase control over their health and well-being as well as to enhance their self-efficacy. We propose that a booklet or leaflet with relevant information about the risk of developing chronic pain, symptoms and treatment, along with advice about appropriate health care settings should be provided as part of antenatal or postnatal care.
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Affiliation(s)
- Beata Molin
- Department of Clinical Science Intervention and Technology (CLINTEC), Division of Obstetrics and Gynaecology, Karolinska Institutet, Karolinska University Hospital, 141 86, Stockholm, Huddinge, Sweden. .,Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.
| | - Sofia Zwedberg
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.,Theme Children's & Women's Health, PA Pregnancy Care and Delivery, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anna Sand
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Georgsson
- Department of Clinical Science Intervention and Technology (CLINTEC), Division of Obstetrics and Gynaecology, Karolinska Institutet, Karolinska University Hospital, 141 86, Stockholm, Huddinge, Sweden.,The Swedish Red Cross University, Stockholm, Sweden
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21
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Reliability and Validation of the Japanese Version of the Patient Empowerment Scale. Healthcare (Basel) 2022; 10:healthcare10061151. [PMID: 35742202 PMCID: PMC9223124 DOI: 10.3390/healthcare10061151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/26/2022] [Accepted: 06/19/2022] [Indexed: 12/02/2022] Open
Abstract
Empowerment scales for inpatients have been developed worldwide, but their validity and reliability have not been adequately tested and applied to the health promotion and care among older adults during hospitalization. In this study, the Patient Empowerment Scale developed by Faulkner was translated into Japanese, and Japanese patients were surveyed to test its clinical applicability. To test its applicability, 151 patients in rehabilitation wards were surveyed in four municipalities. After considering ceiling/floor effects and validating the structure, the Patient Empowerment Scale—Japanese comprised 37 items and six factors: subject−staff interaction, environmental adjustment through collaboration, necessary information gathering and problem awareness, proactive behavioral practices, self-disclosure, and self-management of activities. Criteria-related validity assessment confirmed the scale’s correlation with the Health Locus of Control Scale, General Self-Efficacy Scale, 13-item Sense of Coherence Scale, Rosenberg Self-Esteem Scale, and Philadelphia Geriatric Center Morale Scale. Regarding internal consistency, the Cronbach’s alpha was 0.93 for all 37 items. The Cronbach’s alphas for the six factors were 0.93, 0.91, 0.92, 0.92, 0.91, and 0.75, respectively. In our test/re-test of reliability, Spearman’s rank correlation coefficient between the first and second total scores was ρ = 0.96, p < 0.01. These results confirm the scale’s validity and reliability, and its applicability to older hospitalized patients.
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22
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Ahlstedt Karlsson S, Henoch I, Olofsson Bagge R, Wallengren C. An intervention mapping-based support program that empowers patients with endocrine therapy management. EVALUATION AND PROGRAM PLANNING 2022; 92:102071. [PMID: 35307615 DOI: 10.1016/j.evalprogplan.2022.102071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/10/2021] [Accepted: 03/13/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND For women diagnosed with hormone-receptor-positive breast cancer, endocrine therapy (ET) is recommended. Patients experience diverse side effects, and difficulties in managing these side effects have been identified as obstacles for treatment continuation. The aim of this study was to describe the development of a support program for patients prescribed ET. METHODS Intervention mapping (IM) a comprehensive theory-based approach was used in the support program development. A participatory design was used and four advisory groups was formed including both patients and healthcare professionals. RESULTS This study employed the systematic stages of IM to develop a theory-based support program with the goal to empower patients prescribed ET to manage ETrelated symptoms and problems, and to illuminate the healthcare structure. The needs assessment identified three performance objectives: (1) Patients have knowledge of and understand their symptoms and their management strategies. (2) Patients have the knowledge and confidence to express their care needs and to ask for guidance from healthcare professionals. (3) Patients are active in and lead their healthcare process. CONCLUSION This is a systematic developed model, built upon aspects of ET both from a patient´ perspective as well as from healthcare professionals' perspectives.
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Affiliation(s)
- Susanne Ahlstedt Karlsson
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, University of Gothenburg, Gothenburg, Sweden.
| | - Ingela Henoch
- Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, University of Gothenburg, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Catarina Wallengren
- Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, University of Gothenburg, Gothenburg, Sweden
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23
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Kim SH, Choe YH, Cho YU, Park S, Lee MH. Effects of a partnership-based, needs-tailored self-management support intervention for post-treatment breast cancer survivors: A randomized controlled trial. Psychooncology 2022; 31:460-469. [PMID: 34549864 DOI: 10.1002/pon.5828] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/04/2021] [Accepted: 09/17/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To examine the effectiveness of partnErship-based, needs-tailored self-Management support Program fOr Women with breast cancER (EMPOWER), a partnership-based, needs-tailored, self-management (SM) support intervention designed to empower post-treatment breast cancer survivors (BCSs) and ultimately improve their health outcomes. METHODS This multi-center, two-armed, randomized controlled trial comprised 94 female BCSs who had completed primary cancer treatment in South Korea. Participants were randomly assigned (1:1) to the intervention group or the wait-list control group. The intervention group received a 7-week EMPOWER intervention via telephone counseling. The primary outcome was empowerment. Secondary outcomes included self-efficacy for post-treatment SM behaviors, mental adjustment, anxiety, depression, and health-related quality of life. Data were collected via a self-reported questionnaire at baseline (T0) and at 8 (T1) and 20 weeks (T2) of follow-up. Linear mixed models were used to assess group differences over time. Effective sizes were calculated using Cohen's d. RESULTS Retention rates were excellent (95.7% at T1; 94.7% at T2). Linear mixed model analyses revealed that the EMPOWER group showed significantly improved empowerment (mean difference 2.24, 95% CI = 0.18 to 4.29; p = 0.016) and general health perception (mean difference 3.68, 95% CI = 0.67 to 6.72; p = 0.037) compared with the control group. Time point analysis showed that several secondary outcomes significantly improved at T1, but the effects were not sustained. CONCLUSION EMPOWER was effective in improving empowerment and general health perception among post-treatment BCS. Further studies are needed to determine the effectiveness of the EMPOWER intervention in other cancer populations.
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Affiliation(s)
- Soo Hyun Kim
- Department of Nursing, Inha University, Incheon, South Korea
| | - Yu Hyeon Choe
- Department of Nursing, Inha University, Incheon, South Korea
| | - Young Up Cho
- Department of Surgery, Ilsan Cha Hospital, College of Medicine, Cha University, Goyang, South Korea
| | - Seho Park
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Moon Hee Lee
- Division of Hematology-Oncology, College of Medicine, Inha University, Incheon, South Korea
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Patient Participation and the Environment: A Scoping Review of Instruments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042003. [PMID: 35206191 PMCID: PMC8872044 DOI: 10.3390/ijerph19042003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/28/2022] [Accepted: 02/05/2022] [Indexed: 12/04/2022]
Abstract
Patient participation and the environment are critical factors in achieving qualitative healthcare. We conducted a systematic scoping review using Arksey and O'Malley's framework to identify instruments intended to measure patient participation. We assessed those instruments' characteristics, which areas of the healthcare continuum they target, and whether environmental factors are considered. Instruments were considered eligible if they represented the patient perspective and measured patient participation in healthcare. The search was limited to articles written in English and published in the last 10 years. We extracted concepts (i.e., patient empowerment, patient participation, and patient-centeredness) based on the framework developed by Castro et al. and outcomes of significance regarding the review questions and specific objectives. The search was conducted in PsycINFO, CINHAL/EBSCO, and PubMed in September 2019 and July 2020. Of 4802 potential titles, 67 studies reported on a total of 45 instruments that met the inclusion criteria for this review. The concept of patient participation was represented most often in these studies. Although some considered the social environment, no instrument was found to incorporate and address the physical environment. Thirteen instruments were generic and the remaining instruments were intended for specific diagnoses or healthcare contexts. Our work is the first to study instruments from this perspective, and we conclude that there is a lack of instruments that measure aspects of the social and physical environment coherently as part of patient participation.
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25
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Saarijärvi M, Wallin L, Moons P, Gyllensten H, Bratt EL. Implementation fidelity of a transition program for adolescents with congenital heart disease: the STEPSTONES project. BMC Health Serv Res 2022; 22:153. [PMID: 35123454 PMCID: PMC8817652 DOI: 10.1186/s12913-022-07549-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/25/2022] [Indexed: 11/14/2022] Open
Abstract
Background Although transition programs have been evaluated for adolescents with chronic conditions, these have rarely involved process evaluations. Indeed, outcomes of complex interventions are dependent on how the intervention is implemented in practice and evaluations of implementation process are therefore pivotal. The aim of this study was to evaluate the extent to which a transition program for adolescents with congenital heart disease was delivered as intended. Research questions were 1) to what level of fidelity was the program delivered? and 2) what potential moderating factors affected the delivery of the program and overall fidelity? Methods A mixed methods design was used, where a process evaluation was embedded in the STEPSTONES randomized controlled trial in Sweden. The implementation fidelity framework by Carrol (2007) and Hasson (2010) was used to design, collect and analyze data. Quantitative data consisted of intervention records on adherence and were analyzed with descriptive statistics. Qualitative data on moderators affecting fidelity were collected through interviews, log-books and focus group interviews with healthcare professionals implementing the intervention and participatory observations of the implementation process. Data were analyzed with deductive content analysis. Triangulation was used to integrate quantitative and qualitative data within the fidelity framework. Results Six out of eight components of the transition program were delivered to an extent that adhered to the program theory or achieved a high level of fidelity. However, components involving peer support had a low attendance by the participating sample (32.2%), and the joint transfer meeting was challenging to implement, despite achieving high adherence. Moderators affecting the implementation process were the adolescent’s and healthcare professional’s engagement in the intervention, contextual factors and a lack of standard operating procedures for all components in the program. Conclusion Barriers and facilitators for a future implementation of transition programs have been illuminated in this study. The use of an implementation fidelity framework in the process evaluation proved successful in providing a comprehensive evaluation of factors affecting the implementation process. However, implementation fidelity must be considered in relation to adaptations to the local and personal prerequisites in order to create interventions that can achieve fit. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07549-7.
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26
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Acuña Mora M, Sparud-Lundin C, Moons P, Bratt EL. Definitions, instruments and correlates of patient empowerment: A descriptive review. PATIENT EDUCATION AND COUNSELING 2022; 105:346-355. [PMID: 34140196 DOI: 10.1016/j.pec.2021.06.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This review aimed to: (i) inventory the definitions and measurements of patient empowerment in healthcare literature; (ii) appraise the conceptual and methodological rigor of included studies; and (iii) identify correlates of patient empowerment in persons with chronic conditions. METHODS Four databases were searched to identify articles measuring patient empowerment in persons with chronic conditions, used a quantitative design and provided evidence on correlates of patient empowerment. Seventy-six articles were included and analyzed by descriptive statistics and summative content analysis. RESULTS The articles used a range of definitions (n = 35) and instruments (n = 38), evaluating a range of correlates in four categories: sociodemographic characteristics, clinical outcomes, patient-reported outcomes and patient-reported experiences. The most frequent associations were between patient empowerment and age (n = 21), sex (n = 15), educational level (n = 15) and quality of life (n = 18). However, they were not always significant. CONCLUSION The broad variation of definitions and instruments highlights the lack of consensus on how to interpret and measure patient empowerment. Although several covariates have been evaluated, there are few studies assess the same relationships. PRACTICE IMPLICATIONS Consensus on a definition and measurement of patient empowerment is needed to improve the quality of future research and to provide a more cohesive body of knowledge.
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Affiliation(s)
- Mariela Acuña Mora
- Institute of Health and Care Sciences, University of Gothenburg, Sweden; Academy of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
| | | | - Philip Moons
- Institute of Health and Care Sciences, University of Gothenburg, Sweden; Department of Public Health and Primary Care, KU Leuven, Belgium; Department of Paediatrics and Child Health, University of Cape Town, South Africa.
| | - Ewa-Lena Bratt
- Institute of Health and Care Sciences, University of Gothenburg, Sweden; Department of Pediatric Cardiology, The Queen Silvia Children's Hospital, Sweden.
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Ziegler E, Hill J, Lieske B, Klein J, dem OV, Kofahl C. Empowerment in cancer patients: Does peer support make a difference? A systematic review. Psychooncology 2022; 31:683-704. [PMID: 34981594 DOI: 10.1002/pon.5869] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Empowerment is critical for cancer patients to make informed choices, to manage medication, and to navigate through the oncological care system. Cancer peer support provides patients with information, emotional relief and may promote empowerment. This paper provides a systematic review of the literature examining the impact of cancer peer support interventions on psychological empowerment. METHODS PubMed, Web of Science, CINAHL, Cochrane Library, PsycINFO and PSYNDEX databases were systematically searched from inception until December 2020. We included quantitative studies, published in English or German, which examined peer-led cancer support interventions and their impact on the three components of psychological empowerment (intrapersonal, interactional and behavioural) among participating cancer patients. RESULTS Database searches and screening of relevant reference lists identified 2336 potentially relevant articles. A total of 29 studies were included in the review. Active coping, self-efficacy and knowledge were the most prominent dimensions of empowerment in these studies. The majority of studies revealed that peer support led to a small to medium, significant increase in psychological empowerment, and was associated with further patient-reported benefits. CONCLUSIONS The existing evidence suggests a weak to moderate, positive association between cancer peer support and the three components of psychological empowerment among cancer patients. Peer support groups should be seen as an important element in cancer care and clinical practice and, thus, be more systematically involved in cancer care.
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Affiliation(s)
- Elâ Ziegler
- Center for Psychosocial Medicine, Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Josephine Hill
- Center for Psychosocial Medicine, Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Berit Lieske
- Center for Psychosocial Medicine, Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Klein
- Center for Psychosocial Medicine, Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem
- Center for Psychosocial Medicine, Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher Kofahl
- Center for Psychosocial Medicine, Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kim J, Shin N. Concept Analysis of the Empowerment of Patients With Coronary Artery Disease Using a Hybrid Model. ANS Adv Nurs Sci 2022; 45:E31-E46. [PMID: 34225284 DOI: 10.1097/ans.0000000000000368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study aimed to conceptualize the empowerment of patients with coronary artery disease (CAD) using a hybrid model. In the final phase, "perceived competence and knowledge on lifestyle management," "sense of control of one's own health care," "self-acceptance to change," and "motivation for voluntary behavior" were identified as intrapersonal aspects; "information search," "active communication between patients and health care professionals," and "supportive relationships" were identified as interactional aspects; "self-management in one's life" and "coping behavior with disease" were identified as behavioral aspects. A concept accurately reflecting CAD characteristics may facilitate the implementation of risk factor management.
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Affiliation(s)
- Jiyoung Kim
- Department of Nursing, Sangmyung University, Cheonan-si, Chungcheongnam-do, South Korea (Dr Kim); and Department of Nursing, CHA University, CHA Bundang Medical Center, Seongnamsi, Gyeonggido, South Korea (Dr Shin)
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29
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Acha BV, Ferrandis ED, Ferri Sanz M, García MF. Engaging People and Co-Producing Research with Persons and Communities to Foster Person-Centred Care: A Meta-Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312334. [PMID: 34886070 PMCID: PMC8656837 DOI: 10.3390/ijerph182312334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/26/2022]
Abstract
Introduction: Engagement and co-production in healthcare research and innovation are crucial for delivering person-centred interventions in underserved communities, but the knowledge of effective strategies to target this population is still vague, limiting the provision of person-centred care. Our research aimed to identify essential knowledge to foster engagement and co-production. Materials and Methods: A meta-synthesis research design was used to compile existing qualitative research papers on health communication, engagement, and empowerment in vulnerable groups in high-income countries (HICs) from 2008 to 2018. A total of 23 papers were selected and analysed. Results: ‘Design and recruitment’ and ‘engagement and co-production’ thematic areas are presented considering the factors related to researcher–communities attunement and the strategical plans for conducting research. The insights are discussed in light of the literature. Long-term alliances, sustainable structures, and strengthened bonds are critical factors for producing real long-term change, empowering persons and communities, and paving the way to person-centred care. Conclusions: The enhancement of the recruitment, involvement, and empowerment of traditionally disengaged communities and individuals depends on the awareness and analysis of social determinants, power differentials and specific tactics, and the capacity of researchers and individuals to apply all these principles in real-world practice.
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Affiliation(s)
- Beatriz Vallina Acha
- Polibienestar Research Intitute-Instituto de Investigación de Políticas de Bienestar Social: Edificio Institutos de Investigación, Campus de Tarongers, University of Valencia, 46022 Valencia, Spain;
- Senior Europa S.L.–Kveloce I + D + i: C/Roger de Lauria 10–7, 46002 Valencia, Spain; (M.F.S.); (M.F.G.)
- Correspondence:
| | - Estrella Durá Ferrandis
- Polibienestar Research Intitute-Instituto de Investigación de Políticas de Bienestar Social: Edificio Institutos de Investigación, Campus de Tarongers, University of Valencia, 46022 Valencia, Spain;
| | - Mireia Ferri Sanz
- Senior Europa S.L.–Kveloce I + D + i: C/Roger de Lauria 10–7, 46002 Valencia, Spain; (M.F.S.); (M.F.G.)
| | - Maite Ferrando García
- Senior Europa S.L.–Kveloce I + D + i: C/Roger de Lauria 10–7, 46002 Valencia, Spain; (M.F.S.); (M.F.G.)
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Assessment tools measuring health-related empowerment in psychosocially vulnerable populations: a systematic review. Int J Equity Health 2021; 20:246. [PMID: 34789249 PMCID: PMC8596931 DOI: 10.1186/s12939-021-01585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many programs are undertaken to facilitate the empowerment of vulnerable populations across the world. However, an overview of appropriate empowerment measurements to evaluate such initiatives remains incomplete to date. This systematic review aims to describe and summarise psychometric properties, feasibility and clinical utility of the available tools for measuring empowerment in psychosocially vulnerable populations. METHODS A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was completed. A descriptive approach was used for data analysis. Papers were eligible if they explored the development, validation, cross-cultural translation or the utility of an empowerment measurement tool in the context of psychosocially vulnerable populations. RESULTS Twenty-six included articles described twenty-six separate studies in which 16 empowerment measurement tools were developed, validated/translated, or used. There was heterogeneity in empowerment constructs, samples targeted, and psychometric properties measured. The measurement of reliability of the included instruments was satisfactory in most cases. However, the validity, responsiveness, interpretability, feasibility and clinical utility of the identified measurement tools were often not adequately described or measured. CONCLUSION This systematic review provides a useful snapshot of the strengths as well as limitations of existing health related empowerment measurement tools used with psychosocially vulnerable populations in terms of their measurement properties, and constructs captured. It highlights significant gaps in empowerment tool measurement, development and evaluation processes. In particular, the results suggest that in addition to systematic assessments of psychometric properties, the inclusion of feasibility and clinical utility as outcome measures are important to assess relevance to clinical practice.
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Moons P, Bratt EL, De Backer J, Goossens E, Hornung T, Tutarel O, Zühlke L, Araujo JJ, Callus E, Gabriel H, Shahid N, Sliwa K, Verstappen A, Yang HL, Thomet C. Transition to adulthood and transfer to adult care of adolescents with congenital heart disease: a global consensus statement of the ESC Association of Cardiovascular Nursing and Allied Professions (ACNAP), the ESC Working Group on Adult Congenital Heart Disease (WG ACHD), the Association for European Paediatric and Congenital Cardiology (AEPC), the Pan-African Society of Cardiology (PASCAR), the Asia-Pacific Pediatric Cardiac Society (APPCS), the Inter-American Society of Cardiology (IASC), the Cardiac Society of Australia and New Zealand (CSANZ), the International Society for Adult Congenital Heart Disease (ISACHD), the World Heart Federation (WHF), the European Congenital Heart Disease Organisation (ECHDO), and the Global Alliance for Rheumatic and Congenital Hearts (Global ARCH). Eur Heart J 2021; 42:4213-4223. [PMID: 34198319 PMCID: PMC8560210 DOI: 10.1093/eurheartj/ehab388] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/06/2021] [Accepted: 06/02/2021] [Indexed: 12/12/2022] Open
Abstract
The vast majority of children with congenital heart disease (CHD) in high-income countries survive into adulthood. Further, paediatric cardiac services have expanded in middle-income countries. Both evolutions have resulted in an increasing number of CHD survivors. Expert care across the life span is necessitated. In adolescence, patients transition from being a dependent child to an independent adult. They are also advised to transfer from paediatrics to adult care. There is no universal consensus regarding how transitional care should be provided and how the transfer should be organized. This is even more challenging in countries with low resources. This consensus document describes issues and practices of transition and transfer of adolescents with CHD, accounting for different possibilities in high-, middle-, and low-income countries. Transitional care ought to be provided to all adolescents with CHD, taking into consideration the available resources. When reaching adulthood, patients ought to be transferred to adult care facilities/providers capable of managing their needs, and systems have to be in place to make sure that continuity of high-quality care is ensured after leaving paediatric cardiology.
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Affiliation(s)
- Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, B-3000 Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Sweden.,Department of Paediatrics and Child Health, University of Cape Town, South Africa.,ESC Association of Cardiovascular Nursing and Allied Professions (ACNAP)
| | - Ewa-Lena Bratt
- Institute of Health and Care Sciences, University of Gothenburg, Sweden.,Department of Paediatric Cardiology, Queen Silvia's Children's Hospital, Gothenburg, Sweden.,Association for European Paediatric and Congenital Cardiology (AEPC)
| | - Julie De Backer
- Department of Cardiology and Center for Medical Genetics, Ghent University Hospital, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium.,ESC Working Group on Adult Congenital Heart Disease (WG ACHD)
| | - Eva Goossens
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, B-3000 Leuven, Belgium.,ESC Association of Cardiovascular Nursing and Allied Professions (ACNAP).,Association for European Paediatric and Congenital Cardiology (AEPC).,Research Foundation Flanders (FWO), Brussels, Belgium.,Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, Division of Nursing and Midwifery, University of Antwerp, Antwerp, Belgium
| | - Tim Hornung
- Paediatric and Congenital Cardiology Service, Starship Children's Hospital, Auckland, New Zealand.,Cardiac Society of Australia and New Zealand (CSANZ)
| | - Oktay Tutarel
- ESC Working Group on Adult Congenital Heart Disease (WG ACHD).,Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Liesl Zühlke
- Department of Paediatrics and Child Health, University of Cape Town, South Africa.,Division of Paediatric Cardiology, Red Cross War Memorial Childreńs Hospital, Cape Town, South Africa.,Division of Cardiology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.,Pan-African Society of Cardiology (PASCAR)
| | - John Jairo Araujo
- Department of Pediatric and Adult Congenital Heart Disease, Somer Incare Cardiovascular Center, Medellin, Colombia.,Inter-American Society of Cardiology (IASC)
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,European Congenital Heart Disease Organisation (ECHDO)
| | - Harald Gabriel
- ESC Working Group on Adult Congenital Heart Disease (WG ACHD).,Department of Cardiology, Medical University of Vienna, Austria
| | - Nauman Shahid
- Global Alliance for Rheumatic and Congenital Hearts (Global ARCH)
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, South Africa.,CHI, Faculty of Health Sciences, University of Cape Town, South Africa.,World Heart Federation (WHF)
| | - Amy Verstappen
- Global Alliance for Rheumatic and Congenital Hearts (Global ARCH)
| | - Hsiao-Ling Yang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.,Asia-Pacific Pediatric Cardiac Society (APPCS)
| | - Corina Thomet
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, B-3000 Leuven, Belgium.,ESC Association of Cardiovascular Nursing and Allied Professions (ACNAP).,Center for Congenital Heart Disease, University Hospital Inselspital, Department of Cardiology, University of Bern, Switzerland.,International Society for Adult Congenital Heart Disease (ISACHD)
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Yumikawa D, Sato M, Kameda N. Development of an empowerment scale for inpatients in the Kaifukuki Rehabilitation Ward: validation of the validity and reliability of the scale and difference between the empowerment scale and the FIM. JAPANESE JOURNAL OF COMPREHENSIVE REHABILITATION SCIENCE 2021; 12:38-47. [PMID: 37860209 PMCID: PMC10545027 DOI: 10.11336/jjcrs.12.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 10/21/2023]
Abstract
Yumikawa D, Sato M, Kameda N. Development of an empowerment scale for inpatients in the Kaifukuki Rehabilitation Ward: validation of the validity and reliability of the scale and difference between the empowerment scale and the FIM. Jpn J Compr Rehabil Sci 2021; 12: 38-47. Objective The Kaifukuki Rehabilitation Ward (KRW) provides patients with support for improving the ability to perform activities of daily living and acquiring autonomy. The ability to solve problems independently, defined as empowerment, is crucial for life after hospital discharge. The purpose of this study was to develop a new empowerment scale for KRWs and verify its validity and reliability. Methods This new scale was created by selecting items suitable for KRWs from previous work on developing empowerment scales. The assessment of the validity and reliability of the scale and a comparison of this scale with the Functional Independence Measure (FIM) were performed based on 159 responses. Results Although three of the 18 items showed response biases, the factor structure of the scale showed moderate validity (RMSEA = 0.083, correlation coefficient between subscale and total score = 0.61 - 0.83). The concurrent validity and internal consistency were generally good, and the test-retest reliability of the total score was 0.93 in the intraclass correlation coefficients. There was no correlation between the FIM and the new scale. Conclusion The developed empowerment scale has certain validity and reliability and may provide a different outcome than the FIM.
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Affiliation(s)
- Daichi Yumikawa
- Shin-Yokohama Rehabilitation Hospital, Yokohama, Kanagawa, Japan
- Doctoral Program in Health Sciences, Graduate School of Health Sciences, Showa University, Yokohama, Kanagawa, Japan
| | - Mitsuru Sato
- Department of Physical Therapy, School of Nursing and Rehabilitation Sciences, Showa University, Yokohama, Kanagawa, Japan
| | - Nobutaka Kameda
- Shin-Yokohama Rehabilitation Hospital, Yokohama, Kanagawa, Japan
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Fayn MG, des Garets V, Rivière A. Collective empowerment of an online patient community: conceptualizing process dynamics using a multi-method qualitative approach. BMC Health Serv Res 2021; 21:958. [PMID: 34511115 PMCID: PMC8436557 DOI: 10.1186/s12913-021-06988-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/21/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Online communities for patients with chronic conditions are becoming healthcare providers. They gather to offer support and services, and to become a collective oppositional force. We found, however, that these communities and their collective power are rarely studied in the health services management literature, which focuses more on the empowering practices of healthcare professionals or patient participation. The aim of this study is thus to build a better understanding of the nature of patients' collective empowerment and the processes underlying it. We carry out two exploratory qualitative studies to examine the motivations that drive chronically ill patients to engage in an individual and then collective empowerment process. METHODS The first qualitative study involves four semi-structured interviews with experts. The second is a netnographic study carried out over a year on an online forum for people with thyroid disease. The latter has two phases: an immersion phase followed by one that traces the path of 21 forum members from their first message to their recognition as active members or even forum moderators. The data are analyzed through thematic and lexical content analyses. RESULTS We were able to identify the different stages of the collective patient empowerment process and the criteria for progression though this process. Specifically, the first study sheds light on the unmet individual and collective needs of the patients. The second emphasizes the essential role of active contributors and their impact on the growth and power of the community. CONCLUSIONS This study looks at patient communities as a self-contained system and identifies the stages of collective empowerment that match the organization's declared priorities: community, collaborative, productive, and societal. These results should help health professionals better take these online communities into account in patient care, improving their practices, and carrying out their policies. We call for future research into collective empowerment and its influence on patient behavior, the transformation of healthcare institutions, and the health services market.
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Affiliation(s)
- Marie-Georges Fayn
- VALLOREM Lab, University of Tours, 50 Avenue Jean Portalis, 37200 Tours, France
| | | | - Arnaud Rivière
- VALLOREM Lab, University of Tours, 50 Avenue Jean Portalis, 37200 Tours, France
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Stern BZ, Njelesani J, Howe TH. Transitioning from hurting to healing: self-management after distal radius fracture. Disabil Rehabil 2021; 44:6277-6286. [PMID: 34388959 DOI: 10.1080/09638288.2021.1962990] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Chronic pain and disability after musculoskeletal trauma support the need for non-biomedical perspectives to frame experiences of recovery. Self-management is a specific holistic lens with implications for improving health outcomes. This qualitative study explored how adults made meaning of self-management after distal radius fracture (DRF). METHODS Thirty-one individuals aged 45-72 with a unilateral DRF participated in a semi-structured interview 2-4 weeks after discontinuing full-time wrist immobilization. Interviews were audio-recorded and transcribed, and constructivist grounded theory techniques were used to analyze the data. RESULTS Participants made meaning of self-management as a process of "transitioning from hurting to healing," which occurred via three underlying processes. "Learning because of my injury" included gaining information for empowerment and understanding by physically living through the experience. "Working and hoping toward healing" involved taking active steps to recovery in the face of uncertainty. "Getting back to my normal self" comprised reconnecting to one's body and identity after injury. CONCLUSIONS Participants' lived experiences overlapped with those of self-managing chronic conditions, highlighting the need to consider how individuals actively engage in their recovery after DRF. Findings suggest using supportive interventions to facilitate patients' understanding, activation, and engagement in meaningful activity after DRF.Implication for rehabilitationTo maximize health outcomes after distal radius fracture, clinicians should move beyond impairment remediation to supporting multiple dimensions of recovery, including emotional distress and functional limitations.Clinicians should routinely provide early and ongoing information, such as expected symptoms and recovery time frames, to minimize loss of control related to uncertainty.Clinicians should emphasize active interventions, such as collaborative goal setting and functional tasks, that engage patients in their own healing.Clinicians should support patients' early return to meaningful activity to maintain or restore connection to the body and identity.
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Affiliation(s)
- Brocha Z Stern
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA.,Kessler Rehabilitation Center, Howell, NJ, USA
| | - Janet Njelesani
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA
| | - Tsu-Hsin Howe
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA
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Ania-González N, Olano-Lizarraga M, Vázquez-Calatayud M. Interventions to empower cardiorenal patients: A systematic review. J Adv Nurs 2021; 78:363-376. [PMID: 34363636 DOI: 10.1111/jan.15007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/02/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
AIMS To identify the most effective interventions to empower cardiorenal patients. DESIGN A systematic review of the literature has been carried out. DATA SOURCES The PubMed, CINAHL, PsycINFO and Cochrane databases were reviewed, and journals in the field were manually searched between January and February 2020. REVIEW METHODS Five randomized clinical trials and quasi-experimental studies that met the selection and CONSORT & TREND methodological quality criteria were selected. RESULTS The evidence supports that there are no existing interventions aimed at empowering cardiorenal patients. However, the interventions to empower people with chronic kidney disease and heart failure suggest that their integration should address seven domains: patient education, sense of self-management, constructive coping, peer sharing, enablement, self-efficacy and quality of life. CONCLUSION A gap has been revealed in the literature regarding the empowerment of cardiorenal patients. This review provides relevant information to help design, implement and evaluate interventions to empower these patients by describing the strategies used to empower people experiencing both chronic conditions and the tools used for their assessment. IMPACT There is a need for further research to design, implement and evaluate a multidimensional intervention that favours the empowerment of cardiorenal patients by using valid and reliable instruments that measure the domains that constitute it in an integrated manner. Interventions aimed at empowering the cardiorenal patient should include seven domains: patient education, sense of self-management, constructive coping, peer sharing, enablement, self-efficacy and quality of life.
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Affiliation(s)
| | - Maddi Olano-Lizarraga
- School of Nursing, Universidad de Navarra, Pamplona, Spain.,Innovation for a Person-Centred Care Research Group (ICCP-UNAV), Universidad de Navarra, Pamplona, Spain.,IdisNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Mónica Vázquez-Calatayud
- Clínica Universidad de Navarra, Pamplona, Spain.,School of Nursing, Universidad de Navarra, Pamplona, Spain.,Innovation for a Person-Centred Care Research Group (ICCP-UNAV), Universidad de Navarra, Pamplona, Spain.,IdisNA, Navarra Institute for Health Research, Pamplona, Spain
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Schicktanz S, Schweda M. Aging 4.0? Rethinking the ethical framing of technology-assisted eldercare. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2021; 43:93. [PMID: 34342739 PMCID: PMC8332600 DOI: 10.1007/s40656-021-00447-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/04/2021] [Indexed: 05/31/2023]
Abstract
Technological approaches are increasingly discussed as a solution for the provision of support in activities of daily living as well as in medical and nursing care for older people. The development and implementation of such assistive technologies for eldercare raise manifold ethical, legal, and social questions. The discussion of these questions is influenced by theoretical perspectives and approaches from medical and nursing ethics, especially the principlist framework of autonomy, non-maleficence, beneficence, and justice. Tying in with previous criticism, the present contribution is taking these principles as a starting point and as a frame of reference to be critically re-examined. It thus aims to outline how existing ethical frameworks need to be extended or reconsidered to capture the ethical issues posed by technological developments regarding care for older people. In a first step, we provide a brief overview of assistive technologies in eldercare according to their purposes and functions. In the next step, we discuss how the questions and problems raised by new technologies in eldercare call for an expansion, re-interpretation, and revision of the principlist framework. We underline that the inclusion of ethical perspectives from engineering and computer science as well as a closer consideration of socio-political dimensions and fundamental anthropological and praxeological questions are needed.
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Affiliation(s)
- Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldt Allee 36, 37073, Göttingen, Germany.
| | - Mark Schweda
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstr. 114-118, 26111, Oldenburg, Germany
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Van Bulck L, Luyckx K, Goossens E, Moons P. Identity formation in adults with congenital heart disease: What have we learned so far? INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Morton C, Habib S, Morris J. What women want: the effect of health agency advertising on patient-doctor communication. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2021. [DOI: 10.1108/ijphm-07-2020-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study is to investigate the relationship between women’s sexual health agency and their intent to initiate communications with their doctors. The research questions examined the effect sexual health agency has on patient-doctor communication, women’s emotional responses to health advertisements encouraging patient communication with their doctors, attitude toward the message and behavioral intentions after exposure to the advertising message.
Design/methodology/approach
An experimental design was implemented via an online questionnaire instrument to test the differences between younger-aged women (25 to 45 years) and mature-aged women (46 to 70 years). It was observed that 188 women who reported their status as single and sexually active in the past 12 months were exposed to a health advertisement that encouraged patient-doctor communication. Analyses were conducted to compare between-group measures on sexual health agency, emotional response and attitude toward the ad and behavioral intention.
Findings
No statistical difference existed between younger and older women. In general, women expect their doctor to lead conversations about sexual health but are positively reinforced by health messages that encourage their assertiveness as patients.
Research limitations/implications
The small sample size also may have limited the study’s potential to evaluate differences between age segments. Future research should explore this further.
Practical implications
The study provides evidence that sexual health advertising can reinforce women’s intent to initiate conversations with doctors regardless of age.
Social implications
Health communications can bolster women’s sexual health agency and improve patient-initiated conversations with doctors.
Originality/value
The study is the first to explore advertising messaging’s potential for applying health agency as a communication strategy for encouraging sexual health communications between women and their doctors.
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Fairweather NH, Jones FW, Harris SA, Deiros Collado M, Shayle A. Thriving alongside cystic fibrosis: Developing a grounded theory of empowerment in children and young people with cystic fibrosis during key life transitions. Child Care Health Dev 2021; 47:484-493. [PMID: 33638555 DOI: 10.1111/cch.12860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/21/2020] [Accepted: 02/21/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although the importance of patient empowerment is increasingly recognized, little is known about empowerment in children and young people (CYP) with long-term conditions. Empowerment may be particularly important in CYP with cystic fibrosis (CF) due to high treatment burden and limited opportunities for peer support. METHODS A Grounded Theory method was employed to develop a preliminary theory of empowerment in CYP with CF. Seven CYP with CF, five parents and four professionals were interviewed. RESULTS AND CONCLUSIONS The emerging model suggests that 'thriving alongside CF' may be supported by interactions between 'having a team' and 'taking charge and having a voice', leading to 'being able to just be a child', that 'concealing self' may get in the way of 'thriving alongside CF' and that these processes occur within wider medical and developmental contexts. Study limitations, clinical and research implications are discussed.
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Affiliation(s)
- Naomi H Fairweather
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Kent, UK.,Sussex Partnership NHS Foundation Trust, Sussex, UK
| | - Fergal W Jones
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Kent, UK.,Sussex Partnership NHS Foundation Trust, Sussex, UK
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Bedford LE, Yeung MHY, Au CH, Tse ETY, Yim WY, Yu EYT, Wong CKH, Lam CLK. The validity, reliability, sensitivity and responsiveness of a modified Patient Enablement Instrument (PEI-2) as a tool for serial measurements of health enablement. Fam Pract 2021; 38:339-345. [PMID: 32968812 PMCID: PMC8414911 DOI: 10.1093/fampra/cmaa102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Patient enablement is a core tenet of patient-centred and holistic primary care. The Patient Enablement Instrument (PEI) is a transitional measure limited in its ability to measure changes over time. A modified version, PEI-2, has been developed to measure enablement at a given time-point without comparison to a recalled baseline. OBJECTIVE To assess the validity, reliability, sensitivity and responsiveness of PEI-2. METHODS PEI-2 was modified from the Chinese PEI to assess enablement over 4 weeks in a prospective cohort study nested within a community support programme [Trekkers Family Enhancement Scheme (TFES)] in Hong Kong. Construct validity was assessed by factor analysis and convergent validity by Spearman's correlations with health-related quality of life and depressive symptoms. Internal reliability was assessed using Cronbach's alpha. Test-retest reliability was assessed by intraclass correlation (ICC), responsiveness by 12-24-month change in PEI-2 score and sensitivity by differences in change of PEI-2 score between TFES participants and a control group. RESULTS PEI-2 demonstrated construct validity with all items loading on one factor (factor loadings >0.7). Convergent validity was confirmed by significant correlations with 12-item Short Form Questionnaire, version 2 (r = 0.1089-0.1919) and Patient Health Questionnaire-9 (r = -0.2030). Internal reliability was high (Cronbach's alpha = 0.9095) and test-retest reliability moderate (ICC = 0.520, P = 0.506). Significant improvements in PEI-2 scores among the TFES group suggested good responsiveness (P < 0.001). The difference in change of PEI-2 scores between TFES and control was significant (P = 0.008), indicating good sensitivity. CONCLUSIONS This study supports the validity, reliability, sensitivity and responsiveness of PEI-2 in measuring changes in enablement, making it a promising tool for evaluating enablement in cohort and intervention studies.
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Affiliation(s)
- Laura Elizabeth Bedford
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Maegan Hon Yan Yeung
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Chi Ho Au
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Emily Tsui Yee Tse
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Wing Yee Yim
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China.,Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
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Saarijärvi M, Wallin L, Moons P, Gyllensten H, Bratt EL. Mechanisms of impact and experiences of a person-centred transition programme for adolescents with CHD: the Stepstones project. BMC Health Serv Res 2021; 21:573. [PMID: 34112174 PMCID: PMC8194131 DOI: 10.1186/s12913-021-06567-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/21/2021] [Indexed: 01/10/2023] Open
Abstract
Background During the past decade there has been some evaluation of transition programmes for adolescents with chronic conditions. However, this has rarely involved process evaluations focusing on mechanisms leading to outcomes, thus hampering implementation of these complex interventions. Our aim was to (I) describe adolescents’ and parents’ experiences of participating in a person-centred transition programme aiming to empower them in transition to adulthood and (II) explore the mechanisms of impact. Methods A qualitative process evaluation was performed, embedded in a randomized controlled trial evaluating the effectiveness of a transition programme for adolescents with congenital heart disease in Sweden. A purposive sample of 14 adolescents and 12 parents randomized to the intervention group were interviewed after participation in the programme. Data were analysed deductively and inductively in NVivo v12. Results Experiences of participation in the transition programme were generally positive. Meeting a transition coordinator trained in person-centred care and adolescent health and embarking on an educational process based on the adolescents’ prerequisites in combination with peer support were considered key change mechanisms. However, support to parents were not sufficient for some participants, resulting in ambivalence about changing roles and the unmet needs of parents who required additional support. Conclusions Participants experienced increased empowerment in several dimensions of this construct, thus demonstrating that the transition programme was largely implemented as intended and the evidence-based behaviour-change techniques used proved effective in reaching the outcome. These findings can inform future implementation of transition programmes and illuminate challenges associated with delivering a complex intervention for adolescents with chronic conditions. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06567-1.
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Affiliation(s)
- Markus Saarijärvi
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden. .,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Lars Wallin
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Philip Moons
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ewa-Lena Bratt
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Pediatric Cardiology, The Queen Silvia Children's Hospital, Gothenburg, Sweden
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Pereira PDF, Santos JCD, Cortez DN, Reis IA, Torres HDC. Evaluation of group education strategies and telephone intervention for type 2 diabetes. Rev Esc Enferm USP 2021; 55:e03746. [PMID: 34105688 DOI: 10.1590/s1980-220x2020002603746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 12/10/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate group education strategies and telephone intervention regarding the variables empowerment, self-care practices, and glycemic control of people with diabetes. METHOD Clinical trial with eight randomized clusters, conducted between 2015 and 2016, with 208 users with type 2 diabetes mellitus allocated for group education, telephone intervention, or control group. Sociodemographic data, glycated hemoglobin, empowerment, and self-care practices were collected. RESULTS The user mean age was of 63.5 years (SD = 8.9 years), with the participation of 124 women, which amounts to 59.6% of these users. The strategies led to a statistically significant reduction in the levels of glycated hemoglobin (p < 0.001). The telephone intervention was also observed to present statistically significant results regarding self-care practices (p < 0.001) and empowerment in diabetes (p < 0.001) when compared to group education. CONCLUSION The telephone intervention presented statistically significant results for empowerment and practices of self-care when compared to group education. Brazilian Registry of Clinical Trials (Registro Brasileiro de Ensaios Clínicos): RBR-7gb4wm.
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Affiliation(s)
- Priscila de Faria Pereira
- Secretaria de Estado de Saúde de Minas Gerais, Subsecretaria de Políticas e Ações de Saúde, Superintendência de Atenção Primária à Saúde, Belo Horizonte, MG, Brasil
| | | | | | - Ilka Afonso Reis
- Universidade Federal de Minas Gerais, Instituto de Ciências Exatas, Departamento de Estatística, Belo Horizonte, MG, Brasil
| | - Heloisa de Carvalho Torres
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Departamento de Enfermagem Aplicada, Belo Horizonte, MG, Brasil
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Knowledge about osteoarthritis: Development of the Hip and Knee Osteoarthritis Knowledge Scales and protocol for testing their measurement properties. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100160. [DOI: 10.1016/j.ocarto.2021.100160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/12/2021] [Indexed: 11/20/2022] Open
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Gotowiec S, Larsson J, Incerti P, Young T, Smeds K, Wolters F, Herrlin P, Ferguson M. Understanding patient empowerment along the hearing health journey. Int J Audiol 2021; 61:148-158. [PMID: 34032531 DOI: 10.1080/14992027.2021.1915509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Related to the hearing health journey, this study aimed to: (i) explore how empowerment manifests itself from individuals' first awareness of hearing loss through to hearing aid fitting and then to becoming an active hearing aid user, (ii) identify points when the different dimensions of empowerment are most relevant, and (iii) conceptualise empowerment. DESIGN A semi-structured interview study was conducted, followed by a template analysis of the data. STUDY SAMPLE Adult hearing aid users from Sweden (n = 8) and Australia (n = 10) who had worn hearing aids for between 6 and 36 months. RESULTS The themes that emerged from the transcripts were knowledge, skills and strategies, participation, self-efficacy, and control. CONCLUSIONS This study conceptualises empowerment along the hearing health journey as the process through which individuals with hearing-related challenges acquire and use knowledge, skills, and strategies, and increase self-efficacy, participation, and the feeling of control of their hearing health care, hearing solutions, and everyday lives. There are not specific points along the hearing health journey where any dimension is uniquely relevant, instead, each dimension is a dynamic component at all stages.
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Affiliation(s)
| | | | | | - Taegan Young
- National Acoustic Laboratories, Sydney, Australia
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Enablers of Patient Knowledge Empowerment for Self-Management of Chronic Disease: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052247. [PMID: 33668329 PMCID: PMC7956493 DOI: 10.3390/ijerph18052247] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 11/16/2022]
Abstract
The non-development of the concept of patient knowledge empowerment for disease self-management and the non-development of the theory of patient knowledge empowerment in patients with chronic diseases, cause methodological inconsistency of patient empowerment theory and does not provide a methodological basis to present patient knowledge empowerment preconditions. Therefore, the aim of the present integrative review was to synthesize and critically analyze the patient knowledge enablers distinguished in the public health management theory, the knowledge sharing enablers presented in the knowledge management theory and to integrate them by providing a comprehensive framework of patient knowledge enablers. To implement the purpose of the study, in answering the study question of what patient knowledge empowerments are and across which levels of patient knowledge empowerment they operate, an integrative review approach was applied as proposed by Cronin and George. A screening process resulted in a final sample of 78 papers published in open access, peer-review journals in the fields of public health management and knowledge management theories. Based on the results of the study, the Enablers of Patient Knowledge Empowerment for Self-Management of Chronic Disease Framework was created. It revealed that it is important to look at patient knowledge empowerment as a pathway across the empowerment levels through which both knowledge enablers identified in public health management theory and knowledge sharing enablers singled out in knowledge management theory operate. The integration of these two perspectives across patient empowerment levels uncovers a holistic framework for patient knowledge empowerment.
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Morris RL, Gallacher K, Hann M, Rolfe C, Small N, Giles SJ, Sanders C, Campbell SM. Protocol for a non-randomised feasibility study evaluating a codesigned patient safety guide in primary care. BMJ Open 2021; 11:e039752. [PMID: 33472773 PMCID: PMC7818830 DOI: 10.1136/bmjopen-2020-039752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 12/17/2020] [Accepted: 12/26/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Patients and carers should be active partners in patient safety with healthcare professionals and be empowered to use personalised approaches to identify safety concerns and work together to prevent them. This protocol paper details a study to examine the feasibility of a multicomponent intervention to involve patients and/or carers in patient safety in primary care in the UK. METHODS AND ANALYSIS This is a two-phase, non-randomised feasibility mixed methods pragmatic study of a patient safety guide for primary care (PSG-PC). 8 general practices will recruit 120 patient and/or carer participants. All patient and/or carer participants will receive the PSG-PC. It will examine the feasibility and acceptability of the PSG-PC in primary care settings in patients aged 18 years or older who attend appointments at general practice with health professionals four or more times per year as either patients or carers. It will identify secondary outcomes for improving patient safety, health status and patient empowerment, and reducing health service utilisation over 6 months between baseline and 6-month follow-ups. The findings will inform whether a main effectiveness trial is feasible and, if so, how it should be designed, and how many patients and practices will be needed. The study will be undertaken between January 2020 and September 2021. ETHICS AND DISSEMINATION Ethical approval was obtained from the National Health Service London-West London and Gene Therapy Advisory Committee Research Ethics Committee (reference: 19/LO/1289). Research findings will be disseminated with participating general practices and shared in a range of different ways to engage different audiences, including presenting at international and national conferences, publishing in open-access, peer-reviewed journals and facilitating dissemination workshops within local communities with patients, carers and healthcare professionals. TRIAL REGISTRATION NUMBER ISRCTN90222092.
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Affiliation(s)
- Rebecca L Morris
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | | | - Mark Hann
- Centre for Biostatistics and Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Carly Rolfe
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | | | - Sally J Giles
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Caroline Sanders
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Stephen M Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
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Mogueo A, Oga‐Omenka C, Hatem M, Kuate Defo B. Effectiveness of interventions based on patient empowerment in the control of type 2 diabetes in sub-Saharan Africa: A review of randomized controlled trials. Endocrinol Diabetes Metab 2021; 4:e00174. [PMID: 33532614 PMCID: PMC7831206 DOI: 10.1002/edm2.174] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 12/20/2022] Open
Abstract
Background It is estimated that 1.6 million deaths worldwide were directly caused by diabetes in 2016, and the burden of diabetes has been increasing rapidly in low- and middle-income countries. This study reviews existing interventions based on patient empowerment and their effectiveness in controlling diabetes in sub-Saharan Africa. Method PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, PsycINFO and Global Health were searched through August 2018, for randomized controlled trials of educational interventions on adherence to the medication plan and lifestyle changes among adults aged 18 years and over with type 2 diabetes. Random-effects meta-analysis was used. Results Eleven publications from nine studies involving 2743 participants met the inclusion criteria. The duration of interventions with group education and individual education ranged from 3 to 12 months. For six studies comprising 1549 participants with meta-analysable data on glycaemic control (HbA1c), there were statistically significant differences between intervention and control groups: mean difference was -0.57 [95% confidence interval (CI) -0.75, -0.40] (P < .00001, I2 = 27%). Seven studies with meta-analysable data on blood pressure showed statistically significant differences between groups in favour of interventions. Subgroup analyses on glycaemic control showed that long-term interventions were more effective than short-term interventions and lifestyle interventions were more effective than diabetes self-management education. Conclusion This review supports the findings that interventions based on patient empowerment may improve glycaemia (HbA1c) and blood pressure in patients with diabetes. The long-term and lifestyle interventions appear to be the most effective interventions for glycaemic control.
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Affiliation(s)
- Amélie Mogueo
- School of Public Health of the University of MontrealMontrealQCCanada
- Public Health Research Institute of the University of MontrealMontrealQCCanada
| | - Charity Oga‐Omenka
- School of Public Health of the University of MontrealMontrealQCCanada
- Public Health Research Institute of the University of MontrealMontrealQCCanada
| | - Marie Hatem
- School of Public Health of the University of MontrealMontrealQCCanada
- Sainte‐Justine University Hospital CentreMontrealQCCanada
| | - Barthelemy Kuate Defo
- School of Public Health of the University of MontrealMontrealQCCanada
- Public Health Research Institute of the University of MontrealMontrealQCCanada
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Bennett L, Bergin M, Wells JSG. Exploring user empowerment and service improvement within an Irish epilepsy service using Checkland's 'Soft Systems' approach. J Nurs Manag 2020; 29:844-854. [PMID: 33283352 DOI: 10.1111/jonm.13227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 11/28/2022]
Abstract
AIM To illustrate the value of Checkland's 'Soft Systems' approach to explore and analyse the interaction of human and organisational factors that affect service delivery and patient experience in one specialist epilepsy service. BACKGROUND Checkland's approach is underutilized in relation to health service improvement. One epilepsy service in Ireland is used as an example to illustrate the value of his approach to improve service delivery, particularly when what needs to change is not clear. METHOD Checkland's 'Soft Systems' seven-stage approach was used collaboratively to explore patients' and clinicians' experience of service delivery and how to improve it. RESULTS The research identified the practice of empowerment affected the quality of the service experience. Checkland's concept of a human activity system was particularly pertinent in identifying this issue and providing a 'map' for change. CONCLUSION Wider inferences for the use of Checkland's approach by nurse managers are discussed, as is the value of using Checkland's approach to improve services. IMPLICATIONS FOR NURSING MANAGEMENT Checkland's 'Soft Systems' is an underutilized approach in health care that could be used by managers to initiate and embed change within a health care service.
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Affiliation(s)
- Louise Bennett
- Department of Nursing and Health Care, School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland
| | - Michael Bergin
- Department of Applied Arts, School of Humanities, Waterford Institute of Technology, Waterford, Ireland
| | - John S G Wells
- School of Health Science, Waterford Institute of Technology, Waterford, Ireland
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Zare F, Ghafari M, Ramezankhani A, Kamran BL, Kavoosi A. Identifying dimensions of empowerment in patients with inflammatory bowel disease: a qualitative study. HEALTH EDUCATION RESEARCH 2020; 35:637-647. [PMID: 32995862 DOI: 10.1093/her/cyaa023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/29/2020] [Accepted: 06/28/2020] [Indexed: 06/11/2023]
Abstract
The role of patients' empowerment in enhancing the quality of life of chronic patients is undeniable and its importance in health policy making and health care is increasing day by day. However, no guidelines have been defined to empower people with inflammatory bowel disease (IBD). The purpose of this study was to identify the dimensions of IBD patients' empowerment. Semi-structured interviews were conducted with 26 participants who were purposefully selected from 2 IBD clinics in Tehran and Shiraz cities to gain diversity in the clinical and demographic characteristics. The data were analyzed based on the Granheim and Landman's content analysis method. According to the result of this study, the empowerment of IBD patients is composed of five dimensions including self-care, psychological coping with disease, social interaction skills, disease-specific health literacy and self-evaluation. The participants' most emphasis was on self-care and psychological coping dimensions. These findings can be used as a basis for educational interventions toward IBD patients' empowerment. More researches are needed to explore factors affecting the empowerment processes of IBD patients.
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Affiliation(s)
- Fatemeh Zare
- Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohtasham Ghafari
- Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Ramezankhani
- Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bagheri Lankarani Kamran
- Department of Internal Medicine, Gastroenterohepatology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Kavoosi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Devi R, Kanitkar K, Narendhar R, Sehmi K, Subramaniam K. A Narrative Review of the Patient Journey Through the Lens of Non-communicable Diseases in Low- and Middle-Income Countries. Adv Ther 2020; 37:4808-4830. [PMID: 33052560 PMCID: PMC7553852 DOI: 10.1007/s12325-020-01519-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/28/2020] [Indexed: 01/08/2023]
Abstract
Low- and middle-income countries (LMICs) are challenged with a disproportionately high burden of noncommunicable diseases (NCDs) and limited healthcare resources at their disposal to tackle the NCD epidemic. Understanding the patient journey for NCDs from the patients' perspective can help healthcare systems in these settings evolve their NCD care models to address the unmet needs of patients, enhance patient participation in their management, and progress towards better outcomes and quality of life. This paper aims to provide a theoretical framework outlining common touchpoints along the patient journey for NCDs in LMICs. It further aims to review influencing factors and recommend strategies to improve patient experience, satisfaction, and disease outcomes at each touchpoint. The co-occurrence of major NCDs makes it possible to structure the patient journey for NCDs into five broad touchpoints: awareness, screening, diagnosis, treatment, and adherence, with integration of palliative care along the care continuum pathway. The patients' perspective must be considered at each touchpoint in order to inform interventions as they experience first-hand the impact of NCDs on their quality of life and physical function and participate substantially in their disease management. Collaboratively designed health communication programs, shared decision-making, use of appropriate risk assessment tools, therapeutic alliances between the patient and provider for treatment planning, self-management tools, and improved access to palliative care are some strategies to help improve the patient journeys in LMICs. Long-term management of NCDs entails substantial self-management by patients, which can be augmented by pharmacists and nurse-led interventions. The digital healthcare revolution has heralded an increase in patient engagement, support of home monitoring of patients, optimized accurate diagnosis, personalized care plans, and facilitated timely intervention. There is an opportunity to integrate digital technology into each touchpoint of the patient journey, while ensuring minimal interruption to patients' care in the face of global health emergencies.
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