Patient empowerment and engagement with a health infomediary

Refinement and Validation of the Empowerment Audiology Questionnaire: Rasch Analysis and Traditional Psychometric Evaluation

OBJECTIVES

Empowerment is the process through which individuals with hearing-related challenges acquire and use knowledge, skills and strategies, and increase self-efficacy, participation, and control of their hearing health care, hearing solutions, and everyday lives. The aim was to refine and validate the Empowerment Audiology Questionnaire (EmpAQ), a hearing-specific measure of empowerment. This was achieved through (1) refinement via Rasch analysis (study 1), and (2) traditional psychometric analysis of the final survey structure (study 2).

DESIGN

In study 1, 307 adult hearing aid owners completed the initial empowerment measure (33 items) online. To inform an intended item reduction, Rasch analysis was used to assess a range of psychometric properties for individual items. The psychometric properties included analysis of individual items (e.g., response dependency, fit to the polytomous Rasch model, threshold ordering) and the whole EmpAQ (e.g., dimensionality). Item reduction resulted in a 15-item version (EmpAQ-15) and a short-form 5-item version (EmpAQ-5), validated using modern (Rasch), and traditional (Classical Test Theory) psychometric analysis (study 2). In study 2, 178 adult hearing aid owners completed the EmpAQ-15 and EmpAQ-5, alongside 5 questionnaires to measure related constructs. These included two hearing-specific questionnaires (Social Participation Restrictions Questionnaire and Self-Assessment of Communication), two general health-related questionnaires (Patient Activation Measure and World Health Organization Disability Assessment Schedule 2.0), and a general empowerment questionnaire (Health Care Empowerment Questionnaire). Modern (Rasch) and traditional psychometric analysis techniques (internal consistency, construct validity, and criterion validity) were used to assess the psychometric properties of the EmpAQ-15 and EmpAQ-5.

RESULTS

Rasch analysis of the initial 33-item measure of empowerment identified 18 items with high response dependency, poor fit to the Rasch model, and threshold disordering, which were removed, resulting in a long-form (EmpAQ-15) hearing-specific measure of empowerment. A short-form (EmpAQ-5) version was developed for use in the clinic setting. Validation of the two EmpAQ measures using Rasch analysis showed good item fit to the Rasch model, appropriate threshold targeting, and the existence of unidimensionality. Traditional psychometric evaluation showed that both questionnaires had high internal consistency and positive correlations with the hearing-specific questionnaires. However, in contrast with our hypotheses, correlations with general health questionnaires were stronger than with hearing-specific questionnaires; all questionnaires were correlated with the EmpAQ and in the direction hypothesized. Taken together, these findings support the construct validity of the EmpAQ-15 and EmpAQ-5.

CONCLUSIONS

The EmpAQ-15 and EmpAQ-5 are the first self-report measures to be developed specifically for the measurement of empowerment. The EmpAQ-15 and EmpAQ-5 were found to meet the Rasch model criteria for interval-level measurements. Traditional psychometric evaluation supports the construct validity of both measures. The EmpAQ measures have the potential to be used in both research and clinical practice to evaluate empowerment along the hearing journey. The next stage of this research will be to further validate these measures by assessing their responsiveness, minimal clinically important difference, and clinical interpretability in a clinical population.

Empowerment Enabled by Information and Communications Technology and Intention to Sustain a Healthy Behavior: Survey of General Users

BACKGROUND

Most people with chronic conditions fail to adhere to self-management behavioral guidelines. In the last 2 decades, several mobile health apps and IT-based systems have been designed and developed to help patients change and sustain their healthy behaviors. However, these systems often lead to short-term behavior change or adherence while the goal is to engage the population toward long-term behavior change.

OBJECTIVE

This study aims to contribute to the development of long-term health behavior changes or to help people sustain their healthy behavior. For this purpose, we built and tested a theoretical model that includes enablers of empowerment and an intention to sustain a healthy behavior when patients are assisted by information and communications technology.

METHODS

Structural equation modeling was used to analyze 427 survey returns collected from a diverse population of participants and patients. Notably, the model testing was performed for physical activity as a generally desirable healthy goal.

RESULTS

Message aligned with personal goals, familiarity with technology tools, high self-efficacy, social connection, and community support played a significant role (P<.001) in empowering individuals to maintain a healthy behavior. The feeling of being empowered exhibited a strong influence, with a path coefficient of 0.681 on an intention to sustain healthy behavior.

CONCLUSIONS

The uniqueness of this model is its recognition of needs (ie, social connection, community support, and self-efficacy) to sustain a healthy behavior. Individuals are empowered when they are assisted by family and community, specifically when they possess the knowledge, skills, and self-awareness to ascertain and achieve their goals. This nascent theory explains what might lead to more sustainable behavior change and is meant to help designers build better apps that enable people to conduct self-care routines and sustain their behavior.

The role of empowering leadership and psychological empowerment on nurses’ work engagement and affective commitment

Purpose

This study aims to investigate to role of empowering leadership and psychological empowerment on nurses' work engagement and affective commitment.

Design/methodology/approach

Self-administered questionnaire data from 231 nurses working in a university hospital in Saudi Arabia were analysed using a cross-sectional research design using structural equation modelling (SEM) to assess the relationship between empowering leadership (EL), affective commitment (AC) and work engagement (WE) while testing for the mediating role of psychological empowerment (PE).

Findings

SEM analysis demonstrated that EL significantly relates to AC. AC similarly significantly relates to WE. Further, the results showed that PE substantially mediates the relationship between EL and WE. There is no significant direct relationship found between EL and WE.

Practical implications

The study findings are essential for nursing managers. They illustrate that nurses become more committed to their organisation and, in return, more engaged with their work when they receive EL. Therefore, nursing managers could train their leaders to practice EL as increased WE has been found to result in other positive work attitudes such as reduced turnover intention.

Originality/value

This study corroborates the relationships between EL, AC and WE, as well as the mediating role of PE. However, this research is unique as the long-established relationship between EL and WE was not supported. It shows that the propositions of leader-member exchange theory may not hold for unique non-Western contexts, in this case, Saudi Arabia.

Interaction Empowerment in Mobile Health: Concepts, Challenges, and Perspectives

In its most trending interpretation, empowerment in health care is implemented as a patient-centered approach. In the same sense, many mobile health (mHealth) apps are being developed with a primary focus on the individual user. The integration of mHealth apps into the health care system has the potential to counteract existing challenges, including incomplete or nonstandardized medical data and lack of communication, especially in the intersectional context (eg, patients, medical forces). However, concerns about data security and privacy, regional differences in regulations, lack of accessibility, and nontransparent apps hinder the successful integration of mHealth into the health care system. One approach to address this is to rethink the interpretation of empowerment. On that basis, we here examine existing approaches of individual empowerment and subsequently analyze a different view of empowerment in digital health, namely interaction empowerment. Such a change of perspective could positively influence intersectoral communication and facilitate secure data and knowledge sharing. We discuss this novel viewpoint on empowerment, focusing on more efficient integration and development of mHealth approaches. A renewed interpretation of empowerment could thus buffer current limitations of individual empowerment while also advancing digitization of the health system.

Understanding the process of patient empowerment and their well-being in the context of outpatient services

Purpose

This study has conceptualized and empirically investigated how the psychological empowerment process is generated from a patient's cognitive knowledge and participation at different recovery places that results in a state of empowerment and predicts positive outcomes.

Design/methodology/approach

Data were collected from 150 physiotherapy outpatients who have been attending a series of physiotherapy courses at clinic and concurrently progressing with home physio exercise plan. Data were analyzed using structural equation modeling (SEM) with SmartPLS software.

Findings

The results reveal that psychological empowerment best formed when patient centric knowledge is combined with place-based behavioral experiences that are gathered via healthcare encounters and experience patient gained outside of the clinic. Patients' involvement at different environmental settings contributes to patients' empowerment which further assists their well-being.

Practical implications

Understanding the process of empowerment in different environmental contexts can help healthcare organizations to better design patient empowerment strategies and support patients through the empowerment journey to demonstrate their capability to achieve more effective health recovery outcomes.

Originality/value

Patient empowerment is a concept of growing importance in the healthcare industry, yet the journey about how patients are being empowered within their sphere has not been well studied in the past. To the authors' knowledge, this study is the first study that discusses the utilization of patient empowerment must be aimed at both the process and the outcomes. This study provides empirical insights to understand the factors that formulate patient empowerment and predicts positive patient outcomes such as feelings of well-being.

The General Self-Efficacy of Older Adults Receiving Care: A Systematic Review and Meta-Analysis

Background and Objectives

General self-efficacy (GSE) encourages health-promoting behaviors in older adults. It is unsurprising then that older adults receiving health care services are reported to have a greater risk of low GSE than older adults who are not. Despite this, there is currently limited evidence investigating whether the effect differs based on the environment in which care is received. This review aims to determine whether the GSE of older adults is affected by the receipt of health care services and whether GSE varies based on the setting in which care is received.

Research Design and Methods

In accordance with PRISMA guidelines (PROSPERO registration number CRD42018092191), a systematic search was undertaken across 7 databases. Standardized mean differences (SMD) and mean General Self-Efficacy Scale scores, with 95% confidence intervals (CI), were pooled for meta-analysis.

Results

A total of 40 studies were identified, they consisted of 33 population cohorts that were included in the meta-analysis. Older adults receiving health care services were found to be at greater risk of having lower GSE than those who do not (SMD = −0.62; 95% CI: −0.96 to −0.27, p < .0001). Following identification of sources of heterogeneity, older adults receiving acute inpatient care were more likely to have lower GSE than those receiving care in other health care settings.

Discussion and Implications

Older adults receiving inpatient care have a greater risk of lower GSE, and consequently, poorer health-promoting behaviors. Further research is recommended that focuses on the GSE of older adults and health outcomes following discharge from inpatient care.

Does emotional intelligence and empowering leadership affect psychological empowerment and work engagement?

Purpose

The objective of this study is to investigate the role of emotional intelligence and empowering leadership in enhancing psychological empowerment and work engagement in private hospitals.

Design/methodology/approach

A total of 500 questionnaires were distributed to staff nurses at five private hospitals in Riyadh, Saudi Arabia, 100 questionnaires to each hospital, with an achieved response rate of 34.8%.

Findings

The results show statistically significant positive relationships between emotional intelligence, empowering leadership, psychological empowerment and work engagement. The relationship between emotional intelligence and work engagement and psychological empowerment and work engagement were not significant.

Research limitations/implications

The study found that employees who have a high level of emotional intelligence and the positive stimulus of empowering leadership demonstrate enhanced psychological empowerment and work engagement.

Practical implications

A better understanding of the role of EI and EL in enhancing psychological empowerment and work engagement could help hospitals reduce turnover among nurses and improve their relationships with patients, as well as maintaining competitive advantage.

Originality/value

The study provides evidence to support the effect of EI on empowering leadership, psychological empowerment and work engagement in private hospitals.

Understanding the satisfaction and continuance intention of knowledge contribution by health professionals in online health communities

Participation of health-care professionals in online health communities is essential for these communities to achieve their goals of improving health outcomes. However, little research has been conducted to understand what motivates health-care providers to participate in such communities. This study utilizes the expectancy/value theory to identify the factors that might affect health professionals' intentions to continue contributing health knowledge in online health communities (OHCs). Specific motivators driving health professionals' continuance intentions in OHCs include intrinsic motivators (helping motivator, self-efficacy, and moral obligation), and extrinsic motivators (reputation). This study also investigates how health professionals' satisfaction in the OHC mediates the relationship between the study motivators and the continuance intentions. The study also suggests that health professional characteristics have a moderating effect on continuance intentions. The study employed a sample of 234 health professionals who contribute to a well-regarded OHC in Jordan to test the theoretical model developed for this study. The findings suggest that helping motivator, self-efficacy motivator, and reputation motivator affect OHC members' satisfaction. The helping motivator, reputation motivator, moral obligation motivator, and satisfaction affect OHC members' contribution continuance intentions. Finally, the study finds that age, work experience, experience in the OHC, and the daily time spent in the OHC, moderate the relationship between the helping motivator and continuance intentions.

Knowledge sharing in a health infomediary: role of self-concept, emotional empowerment, and self-esteem

Health infomediary systems are emerging as important knowledge sharing platforms that help patients manage their own health outside of traditional health care delivery models. Patients participate in health infomediaries to learn from other patients' experiences and knowledge. Knowledge sharing is an important aspect of the success of a health infomediary. Factors related to self-concept have been widely studied in the domains of psychiatry and psychology, in settings such as mental health and behavioural well-being, but remain unexplored in the digital health context. In particular, it is not known how self-concept influences knowledge sharing behaviours in health infomediaries. This study posits that self-efficacy, social identity, and self-stigma drive knowledge sharing in an infomediary through emotional empowerment and appearance-contingent self-esteem. We use the health belief model as a foundation to propose a two-stage model and testable hypotheses. We used secondary archival data of 222 patients participating in a health infomediary specialising in reconstructive surgery. Analyses using structural equation modelling and econometric methods support the hypotheses. Findings broadly suggest that there are distinct paths through emotional empowerment and appearance-contingent self-esteem that can motivate users to contribute knowledge in health infomediaries. We explain the managerial insights and contributions of our study.