Patient empowerment in long-term conditions: development and preliminary testing of a new measure

Validity of a New Patient Engagement Measure: The Altarum Consumer Engagement (ACE) Measure

Objective

The objective of this study was to report on the validation of new scales [called the Altarum Consumer Engagement (ACE) Measure™] that are indicative of an individual’s engagement in health and healthcare decisions. The instrument was created to broaden the scope of how engagement is measured and understood, and to update the concept of engagement to include modern information sources, such as online health resources and ratings of providers and patient health.

Methods

Data were collected through an online survey with a US population of 2079 participants. A combination of Principal Component Analysis (PCA) and detailed Rasch analyses were conducted to identify specific subscales of engagement. Results were compared to another commonly used survey instrument, and outcomes were compared for construct validity.

Results

The PCA identified a four-factor structure composed of 21 items. The factors were named Commitment, Informed Choice, Navigation, and Ownership. Rasch analyses confirmed scale stability. Relevant outcomes were correlated in the expected direction, such as health status, lifestyle behaviors, medication adherence, and observed expected group differences.

Conclusions

This study confirmed the validity of the new ACE Measure™ and its utility in screening for and finding group differences in activities related to patient engagement and health consumerism, such as using provider comparison tools and asking about medical costs.

Towards a broader understanding of agency in biomedical ethics

With advances in medical science, the concept of agency has received increasing attention in biomedical ethics. However, most of the ethical discussion around definitions of agency has focused either on patients suffering from mental disorders or on patients receiving cutting-edge medical treatments in developed countries. Very little of the discussion around concepts of agency has focused on the situation of patients suffering from common diseases that affect populations worldwide. Therefore, the most widely-used definitions of agency may be not appropriate to analyse common diseases among large populations. The branch of social sciences known as development studies draw on their own definitions of the term agency that may provide a more applicable and accurate way of referring to common and general cases than the definitions currently used in bioethics. Moreover, the psychological Self-Determination Theory may improve the usefulness of these definitions in common situations. This article explains the characteristics and the shortcomings of current bioethical definitions of agency when they are applied to common medical conditions worldwide. A new, value-based concept of agency, informed by development studies, is proposed as more accurate and useful for biomedical ethics.

Indirect effects of contextual factors on patients' consultations with healthcare professionals about health information found online

Background

E-health users are encouraged to consult healthcare professionals about the health information they found online because it facilitates e-health users to participate in an informed decision-making process with healthcare professionals on treatment options. However, few studies have examined the path of how e-health users consult healthcare professionals about the health information. Using psychological empowerment, which claims that empowering individuals requires understanding contextual factors that interact with the individuals’ intrapsychic factors, this study tested a hypothesis: the contextual factors play an indirect role between patients’ perceived poor health and their consultations with healthcare professionals about the health information found online, holding predisposing factors constant.

Methods

The data were collected from the Health Information National Trends Survey and used a subsample of e-health users who used healthcare services during the past year. The subsample (N = 2,297) was analyzed using structural equation modeling (SEM).

Results

The SEM analysis supported the hypothesized indirect model. Meanwhile, patients with low socioeconomic statuses tended to score high in the outcome measurement of the contextual factors; however, they tended not to consult professionals.

Conclusions

It is important to acknowledge contextual factors, which encompass communication and relational aspects as well as the process and outcomes of treatments, when empowering e-health users to use e-health tools meaningfully and become empowered in caring for their own health. Particularly, those with low income and education levels were the less powered or powerless patients: they tended not to be competent in having a voice and discussing the health information that they found online with professionals.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1713-y) contains supplementary material, which is available to authorized users.

Comparison of active treatments for impaired glucose regulation: a Salford Royal Foundation Trust and Hitachi collaboration (CATFISH): study protocol for a randomized controlled trial

BACKGROUND

Diabetes is highly prevalent and contributes to significant morbidity and mortality worldwide. Behaviour change interventions that target health and lifestyle factors associated with the onset of diabetes can delay progression to diabetes, but many approaches rely on intensive one-to-one contact by specialists. Health coaching is an approach based on motivational interviewing that can potentially deliver behaviour change interventions by non-specialists at a larger scale. This trial protocol describes a randomized controlled trial (CATFISH) that tests whether a web-enhanced telephone health coaching intervention (IGR3) is more acceptable and efficient than a telephone-only health coaching intervention (IGR2) for people with prediabetes (impaired glucose regulation).

METHODS

CATFISH is a two-parallel group, single-centre individually randomized controlled trial. Eligible participants are patients aged ≥18 years with impaired glucose regulation (HbA1c concentration between 42 and 47 mmol/mol), have access to a telephone and home internet and have been referred to an existing telephone health coaching service at Salford Royal NHS Foundation Trust, Salford, UK. Participants who give written informed consent will be randomized remotely (via a clinical trials unit) to either the existing pathway (IGR2) or the new web-enhanced pathway (IGR3) for 9 months. The primary outcome measure is patient acceptability at 9 months, determined using the Client Satisfaction Questionnaire. Secondary outcome measures at 9 months are: cost of delivery of IGR2 and IGR3, mental health, quality of life, patient activation, self-management, weight (kg), HbA1c concentration, and body mass index. All outcome measures will be analyzed on an intention-to-treat basis. A qualitative process evaluation will explore the experiences of participants and providers with a focus on understanding usability of interventions, mechanisms of behaviour change, and impact of context on delivery and user acceptability. Qualitative data will be analyzed using Framework.

DISCUSSION

The CATFISH trial will provide a pragmatic assessment of whether a web-based information technology platform can enhance acceptability of a telephone health coaching intervention for people with prediabetes. The data will prove critical in understanding the role of web applications to improve engagement with evidence-based approaches to preventing diabetes.

TRIAL REGISTRATION

ISRCTN16534814 . Registered on 7 February 2016.

Concepts and measures of patient empowerment: a comprehensive review

Abstract OBJECTIVE Analyze the definitions and dimensions of empowerment. Identify the strengths and weaknesses of empowerment measures based on the conceptual model. METHOD This was a comprehensive literature review of publications on the MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. RESULTS Twenty-nine articles were selected. Seventeen definitions and seven dimensions of empowerment, and 10 empowerment measures were selected. Empowerment can be seen as an enabling process involving a shift in the balance of power, or as an outcome of this process. The dimensions reflect outcome indicators, such as participation in decision-making and control, and process indicators, such as knowledge acquisition and coping skills. Six of the tools analyzed by this study could be said to provide a robust measure of patient empowerment. CONCLUSION we propose a definition of empowerment that helps to deepen understanding of the term and, therefore, its operationalization.

Agreeing the content of a patient-reported outcome measure for primary care: a Delphi consensus study

BACKGROUND

As the first contact for any health-related need, primary care clinicians often address multiple patient problems, with a range of possible outcomes. There is currently no patient-reported outcome measure (PROM) which covers this range of outcomes. Therefore, many research studies into primary care services use PROMs that do not capture the full impact of these services.

OBJECTIVE

The study aim was to identify outcomes sought by primary care patients which clinicians can influence, thus providing the basis for a new primary care PROM.

METHODS

We used a Delphi process starting with an outcomes list inductively derived in a prior qualitative study. Thirty-five experts were recruited into patient, clinician and academic panels. Participants rated each outcome on whether it was (i) relevant to health, (ii) influenced by primary care and (iii) detectable by patients. In each round, outcomes which passed/failed preset levels of agreement were accepted/rejected. Remaining outcomes continued to the next round.

RESULTS

The process resulted in a set of outcomes occupying the domains of health status, health empowerment (internal and external), and health perceptions. Twenty-six of 36 outcomes were accepted for inclusion in a PROM. Primary care having insufficient influence was the main reason for exclusion.

CONCLUSIONS

To our knowledge, this is the first time PROM outcomes have been agreed through criteria which explicitly exclude outcomes less relevant to health, uninfluenced by primary care or undetected by patients. The PROM in development covers a unique set of outcomes and offers an opportunity for enhanced research into primary care.

Searching for a Role of Nursing Personnel in Developing Landscape of Ehealth: Factors Determining Attitudes toward Key Patient Empowering Applications

Introduction

Nurses may play an important role in the delivery of medical services based on the use of ehealth tools. Nevertheless, their taking an active role in an ehealth environment depends on their possessing the appropriate skills and mindset. The main objective of this paper was to assess nurses’ opinions and to analyze the predictors of their acceptance of ehealth features relevant to patient empowerment with a strong focus on chronic care.

Methods

A survey was conducted among nurses from hospital centers of south-eastern Poland based on a questionnaire designed to assess their attitudes toward the ehealth domain. The predictors of the nurses’ acceptance of ehealth usage within specific contexts were assessed with uni- and multivariate logistic regression.

Results

An analysis was performed on data from 648 questionnaires retained after a quality check. The duration of Internet use was consistently related to higher acceptance of ehealth applications and more certainty regarding the reliability of health-related information available on the Internet. Nurses from urban medical centers were more skeptical about the use of specific ehealth solutions.

Conclusion

Previous experience in using information technologies is the main factor influencing the acceptance of specific ehealth solutions relevant for care provided to patients suffering from chronic conditions.

It's not just a knee, but a whole life: A qualitative descriptive study on patients' experiences of living with knee osteoarthritis and their expectations for knee arthroplasty

AIM

Knee arthroplasties are an increasingly common treatment for osteoarthritis (OA) and the main indication is pain. Previous research states, however, that 15-20% of the operated patients are dissatisfied and 20-30% have persistent pain after surgery. This study is aimed at describing patients' experiences of living with knee OA when scheduled for surgery and further their expectations for future life after surgery.

METHODS

We interviewed 12 patients with knee OA scheduled for arthroplasty, using semi-structured qualitative interviews. The interviews were recorded and transcribed verbatim and analyzed using qualitative thematic analysis.

FINDINGS

Three categories were formulated with an overriding theme: "It's not just a knee, but a whole life." The three categories were "Change from their earlier lives," "Coping with knee problems," and "Ultimate decision to undergo surgery." The main finding was that knee OA affects the whole body and self, ultimately affecting the patients' lives on many levels. Further findings were that knee OA was considered to be the central focus in the participants' lives, which limited their level of activity, their ability to function as desired, their quality of life, and their mental well-being. Although surgery was considered to be the only solution, the expectations regarding the outcome differed.

CONCLUSIONS

The participants were forced to change how they previously had lived their lives resulting in a feeling of loss. Thus, the experienced loss and expectations for future life must be put into the context of the individual's own personality and be taken into account when treating individuals with knee OA. The experience of living with knee OA largely varies between individuals. This mandates that patients' assessment should be considered on individual basis with regard to each patient.

Empowerment of Cancer Survivors Through Information Technology: An Integrative Review

BACKGROUND

Patient empowerment may be an effective approach to strengthen the role of cancer survivors and to reduce the burden on health care. However, it is not well conceptualized, notably in oncology. Furthermore, it is unclear to what extent information technology (IT) services can contribute to empowerment of cancer survivors.

OBJECTIVE

We aim to define the conceptual components of patient empowerment of chronic disease patients, especially cancer survivors, and to explore the contribution of existing and new IT services to promote empowerment.

METHODS

Electronic databases were searched to identify theoretical and empirical articles regarding empowerment. We extracted and synthesized conceptual components of patient empowerment (ie, attributes, antecedents, and consequences) according to the integrated review methodology. We identified recent IT services for cancer survivors by examining systematic reviews and a proposed inventory of new services, and we related their features and effects to the identified components of empowerment.

RESULTS

Based on 26 articles, we identified five main attributes of patient empowerment: (1) being autonomous and respected, (2) having knowledge, (3) having psychosocial and behavioral skills, (4) perceiving support from community, family, and friends, and (5) perceiving oneself to be useful. The latter two were specific for the cancer setting. Systematic reviews of IT services and our additional inventory helped us identify five main categories: (1) educational services, including electronic survivorship care plan services, (2) patient-to-patient services, (3) electronic patient-reported outcome (ePRO) services, (4) multicomponent services, and (5) portal services. Potential impact on empowerment included knowledge enhancement and, to a lesser extent, enhancing autonomy and skills. Newly developed services offer promising and exciting opportunities to empower cancer survivors, for instance, by providing tailored advice for supportive or follow-up care based on patients' input.

CONCLUSIONS

We identified five main components of empowerment and showed that IT services may especially contribute to empowerment by providing knowledge. The components of empowerment could be used to develop IT services for cancer survivors. It is important to take into account patients' needs, follow up on these needs, and create a service that is attractive and easy to use.

Patient and practitioners' views on the most important outcomes arising from primary care consultations: a qualitative study

BACKGROUND

Primary care clinicians often address multiple patient problems, with a range of possible outcomes. There is currently no patient-reported outcome measure (PROM) which covers this range of outcomes. Consequently, many researchers use PROMs that do not capture the full impact of primary care services. In order to identify what outcomes a PROM for primary care would need to include, we conducted interviews with patients and practitioners. This paper reports these patient and practitioners' views on the outcomes arising from primary care consultations.

METHODS

Semi-structured interviews were held with 30 patients and eight clinicians across five sites in Bristol. Interviews were audio-recorded, transcribed and analysed thematically. We used a broad definition of health outcome as 'the impacts of healthcare on health, or a patient's ability to impact health' to identify outcomes through this process.

RESULTS

10 outcome groups were identified. These occupied 3 domains: Health Empowerment: These are the internal and external resources which enable patients to improve their health. This involves 1) patients' understanding of their illnesses, 2) ability to self-care and stay healthy, 3) agreeing and adhering to a patient-clinician shared plan, 4) confidence in seeking healthcare and 5) access to support. Health Status: This involves 6) reduction of symptoms and 7) reducing the impact of symptoms on patients' lives. Health Perceptions: This involves 8) patients' satisfaction with their health, 9) health concerns, and 10) confidence in their future health. The structure, organisation and nature of primary care means it can affect all 3 domains.

CONCLUSIONS

No existing PROM captures all these outcomes. For example, many health empowerment PROMs do not consider patient preference on empowerment. Many health status tools are not responsive to changes resulting from primary care. Health perceptions PROMs have generally been designed for measuring personality traits rather than outcomes. This study provides a platform for designing a new PROM containing outcomes that matter to patients and can be influenced by primary care. Such a PROM would greatly enhance the value of primary care research.

Empowering patients through eHealth: a case report of a pan-European project

Background

This paper crystallises the experience developed by the pan-European PALANTE Consortium in dealing with the generation of relevant evidence from heterogeneous eHealth services for patient empowerment in nine European Regions. The European Commission (EC) recently funded a number of pan-European eHealth projects aimed at empowering European patients/citizens thus transforming the traditional patient/citizen role in the management of their health (e.g., PALANTE, SUSTAIN, CARRE, HeartCycle, Empower). However, the heterogeneity of the healthcare systems, of the implemented services and of the target patients, the use of ad-hoc definitions of the salient concepts and the development of small-size experiences have prevented the dissemination of “global” results and the development of cumulative knowledge. The main challenge has been the generation of large-scale evidence from heterogeneous small-size experiences.

Discussion

Three lessons have been collectively learnt during the development of the PALANTE project, which involves 9 sites that have implemented different eHealth services for empowering different typologies of patients. These lessons have been refined progressively through project meetings, reviews with the EC Project Officer and Reviewers. The paper illustrates the ten steps followed to develop the three lessons.

The first lesson learnt is about how EC-funded projects should develop cumulative knowledge by avoiding self-crafted measures of outcome and by adopting literature-grounded definitions and scales. The second lesson learnt is about how EC-funded projects should identify ambitious, cross-pilot policy and research questions that allow pooling of data from across heterogeneous experiences even if a multi-centre study design was not agreed before. The third lesson learnt is about how EC-funded projects should open their collections of data and make them freely-accessible to the scientific community shortly after the conclusion of the project in order to guarantee the replicability of results and conclusions.

Summary

The three lessons might provide original elements for fuelling the ongoing debate about the capability of the EC to develop evidence-based policies by pooling evidence from heterogeneous, local experiences.

Conceptualising patient empowerment: a mixed methods study

BACKGROUND

In recent years, interventions and health policy programmes have been established to promote patient empowerment, with a particular focus on patients affected by long-term conditions. However, a clear definition of patient empowerment is lacking, making it difficult to assess effectiveness of interventions designed to promote it. The aim in this study was to develop a conceptual map of patient empowerment, including components of patient empowerment and relationships with other constructs such as health literacy, self-management and shared decision-making.

METHODS

A mixed methods study was conducted comprising (i) a scoping literature review to identify and map the components underpinning published definitions of patient empowerment (ii) qualitative interviews with key stakeholders (patients, patient representatives, health managers and health service researchers) to further develop the conceptual map. Data were analysed using qualitative methods. A combination of thematic and framework analysis was used to integrate and map themes underpinning published definitions of patient empowerment with the views of key UK stakeholders.

RESULTS

The scoping literature review identified 67 articles that included a definition of patient empowerment. A range of diverse definitions of patient empowerment was extracted. Thematic analysis identified key underpinning themes, and these themes were used to develop an initial coding framework for analysis of interview data. 19 semi-structured interviews were conducted with key stakeholders. Transcripts were analysed using the initial coding framework, and findings were used to further develop the conceptual map. The resulting conceptual map describes that patient empowerment can be conceived as a state ranging across a spectrum from low to high levels of patient empowerment, with the level of patient empowerment potentially measurable using a set of indicators. Five key components of the conceptual map were identified: underpinning ethos, moderators, interventions, indicators and outcomes. Relationships with other constructs such as health literacy, self-management and shared decision-making are illustrated in the conceptual map.

CONCLUSION

A novel conceptual map of patient empowerment grounded in published definitions of patient empowerment and qualitative interviews with UK stakeholders is described, that may be useful to healthcare providers and researchers designing, implementing and evaluating interventions to promote patient empowerment.

The Mini-OAKHQOL for knee and hip osteoarthritis quality of life was obtained following recent shortening guidelines

OBJECTIVES

To develop a short form of the knee and hip osteoarthritis quality of life questionnaire, the Mini-OAKHQOL, preserving the conceptual model and, as far as possible, the content and the psychometric properties of the original instrument.

STUDY DESIGN AND SETTING

A two-step shortening procedure was used: (1) a consensus Delphi method, with a panel of patients and another of professionals independently asked to select items and (2) a nominal group, where patients, professionals, and methodologists reached consensus on the final selection of items, using information from the panels and from modern measurement and classical test theory analyses. The psychometric properties of the Mini-OAKHQOL were assessed in an independent population-based sample of 581 subjects with knee or hip osteoarthritis.

RESULTS

The two-step shortening procedure resulted in a 20-item questionnaire. Confirmatory factor analysis showed preservation of the original five-dimensional structure. Rasch analyses showed the unidimensionality and invariance by sex, age, and joint of the main dimensions. Convergent validity, reproducibility, and internal consistency were similar to or better than those of the original OAKHQOL.

CONCLUSIONS

The 20-item Mini-OAKHQOL has good psychometric properties and can be used for the measurement of quality of life in subjects with osteoarthritis of the lower limbs.

Assessment of patient empowerment--a systematic review of measures

BACKGROUND

Patient empowerment has gained considerable importance but uncertainty remains about the best way to define and measure it. The validity of empirical findings depends on the quality of measures used. This systematic review aims to provide an overview of studies assessing psychometric properties of questionnaires purporting to capture patient empowerment, evaluate the methodological quality of these studies and assess the psychometric properties of measures identified.

METHODS

Electronic searches in five databases were combined with reference tracking of included articles. Peer-reviewed articles reporting psychometric testing of empowerment measures for adult patients in French, German, English, Portuguese and Spanish were included. Study characteristics, constructs operationalised and psychometric properties were extracted. The quality of study design, methods and reporting was assessed using the COSMIN checklist. The quality of psychometric properties was assessed using Terwee's 2007 criteria.

FINDINGS

30 studies on 19 measures were included. Six measures are generic, while 13 were developed for a specific condition (N=4) or specialty (N=9). Most studies tested measures in English (N=17) or Swedish (N=6). Sample sizes of included studies varied from N=35 to N=8261. A range of patient empowerment constructs was operationalised in included measures. These were classified into four domains: patient states, experiences and capacities; patient actions and behaviours; patient self-determination within the healthcare relationship and patient skills development. Quality assessment revealed several flaws in methodological study quality with COSMIN scores mainly fair or poor. The overall quality of psychometric properties of included measures was intermediate to positive. Certain psychometric properties were not tested for most measures.

DISCUSSION

Findings provide a basis from which to develop consensus on a core set of patient empowerment constructs and for further work to develop a (set of) appropriately validated measure(s) to capture this. The methodological quality of psychometric studies could be improved by adhering to published quality criteria.

Best practices on pregnancy on dialysis: the Italian Study Group on Kidney and Pregnancy

BACKGROUND

Pregnancy during dialysis is increasingly being reported and represents a debated point in Nephrology. The small number of cases available in the literature makes evidence-based counselling difficult, also given the cultural sensitivity of this issue. Hence, the need for position statements to highlight the state of the art and propose the unresolved issues for general discussion.

METHODS

A systematic analysis of the literature (MESH, Emtree and free terms on pregnancy and dialysis) was conducted and expert opinions examined (Study Group on Kidney and Pregnancy; experts involved in the management of pregnancy in dialysis in Italy 2000-2013). Questions regarded: timing of dialysis start in pregnancy; mode of treatment, i.e. peritoneal dialysis (PD) versus haemodialysis (HD); treatment schedules (for both modes); obstetric surveillance; main support therapies (anaemia, calcium-phosphate parathormone; acidosis); counselling tips.

MAIN RESULTS

Timing of dialysis start is not clear, considering also the different support therapies; successful pregnancy is possible in both PD and HD; high efficiency and strict integration with residual kidney function are pivotal in both treatments, the blood urea nitrogen test being perhaps a useful marker in this context. To date, long-hour HD has provided the best results. Strict, personalized obstetric surveillance is warranted; therapies should be aimed at avoiding vitamin B12, folate and iron deficits, and at correcting anaemia; vitamin D and calcium administration is safe and recommended. Women on dialysis should be advised that pregnancy is possible, albeit rare, with both types of dialysis treatment, and that a success rate of over 75% may be achieved. High dialysis efficiency and frequent controls are needed to optimize outcomes.

Psychometric evaluation of the Diabetes Self-Management Instrument Short Form (DSMI-20)

PURPOSE

Accurately assessing the self-management of patients with diabetes requires a valid and reliable assessment instrument. The purpose of this study was to revise and simplify the original assessment instrument (DSMI-35), and to evaluate the psychometric properties of the new short form (DSMI-20) in order to enhance its practicality in clinical settings.

METHODS

The short form instrument (DSMI-20) was created by revising our previous longer instrument (DSMI-35) through having in-depth small group discussions and validation by experts. The draft (DSMI-20) was pilot tested, and its items were analyzed. We verified the draft (DSMI-20) by conducting an exploratory factor analysis (EFA) and correlating the (DSMI-20) with the diabetes empowerment scale (DES). We tested its reliability including internal consistency and established its test-retest reliability using Cronbach's alpha and Pearson correlation coefficients.

RESULTS

EFA identified four factors with loadings ranging from -0.727 to -0.535 and 0.547 to 0.907: communication with HCPs, self-integration, self-monitoring of blood glucose, and problem solving. These factors accounted for 57.110% of the total variance. The Cronbach's alpha coefficient of the DSMI-20 total scale was 0.925 and of subscales ranged from 0.838 to 0.892. The test-retest correlation for the DSMI-20 total scale was acceptable (r=0.790, p<0.001). Correlation with the DES was r=0.552 (p<0.001).

CONCLUSION

The DSMI-20 is a rapid, viable assessment tool for identifying self-management problems among patients with diabetes.

Elders Health Empowerment Scale: Spanish adaptation and psychometric analysis

INTRODUCTION

Empowerment refers to patient skills that allow them to become primary decision-makers in control of daily self-management of health problems. As important the concept as it is, particularly for elders with chronic diseases, few available instruments have been validated for use with Spanish speaking people.

OBJECTIVE

Translate and adapt the Health Empowerment Scale (HES) for a Spanish-speaking older adults sample and perform its psychometric validation.

METHODS

The HES was adapted based on the Diabetes Empowerment Scale-Short Form. Where "diabetes" was mentioned in the original tool, it was replaced with "health" terms to cover all kinds of conditions that could affect health empowerment. Statistical and Psychometric Analyses were conducted on 648 urban-dwelling seniors.

RESULTS

The HES had an acceptable internal consistency with a Cronbach's α of 0.89. The convergent validity was supported by significant Pearson's Coefficient correlations between the HES total and item scores and the General Self Efficacy Scale (r= 0.77), Swedish Rheumatic Disease Empowerment Scale (r= 0.69) and Making Decisions Empowerment Scale (r= 0.70). Construct validity was evaluated using item analysis, half-split test and corrected item to total correlation coefficients; with good internal consistency (α> 0.8). The content validity was supported by Scale and Item Content Validity Index of 0.98 and 1.0, respectively.

CONCLUSIONS

HES had acceptable face validity and reliability coefficients; which added to its ease administration and users' unbiased comprehension, could set it as a suitable tool in evaluating elder's outpatient empowerment-based medical education programs.

Risk factor awareness in a coronary population and the association with health-related quality of life outcomes

OBJECTIVES

The purpose of this study was to investigate the risk factor level awareness in coronary patients and to assess its associations with health-related quality of life (HRQoL)/psychological distress.

METHODS

Data on 8,743 coronary patients from 22 European countries, interviewed and examined at least 6 months after their acute event was available.

RESULTS

81.7% of patients indicated to be aware of their own blood pressure level, whereas only 46.6% of patients indicated to be aware of their cholesterol level. Furthermore, 43.7% of patients were aware of their blood glucose level, whereas in diabetes patients blood glucose level awareness reached 81.8%. Risk factor level awareness was significantly associated with HRQoL/psychological distress, with patients being unaware of their risk factor levels having worse outcomes. The relationship between awareness and HRQoL/psychological distress seemed to be partly mediated by the attempt of patients to adopt a healthier behaviour.

CONCLUSIONS

Health care workers should be encouraged to inform their patients about the importance of their coronary risk factors, the actual level and their personal target.