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Voigt-Barbarowicz M, Dietz G, Renken N, Schmöger R, Brütt AL. Patients' Health Literacy in Rehabilitation: Comparison between the Estimation of Patients and Health Care Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063522. [PMID: 35329219 PMCID: PMC8953381 DOI: 10.3390/ijerph19063522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 02/06/2023]
Abstract
The term health literacy (HL) comprises the handling of health information and disease-specific and generic self-management skills, especially relevant for patients with chronic conditions. Health care professionals (HCPs) should correctly identify patients’ communication needs and their HL levels. Therefore, the aims of the study were (1) to determine inpatient medical rehabilitation patients’ HL based on self-assessment, (2) to evaluate changes from admission to discharge, (3) to identify HCPs estimation of patients’ HL, and (4) to compare the estimated patient HL by patients and HCPs. A combined cross-sectional and longitudinal study was conducted in an orthopedic rehabilitation center in Germany. The multidimensional Health Literacy Questionnaire (HLQ) was filled in by patients (admission, discharge). An adapted version was administered to HCPs (n = 32) in order to assess HL of individual patients. Data from 287 patients were used for the longitudinal analysis, and comparison was based on n = 278 cases with at least two HL estimations. The results showed a significant increase in HL in five of nine scales with small effect sizes. Moreover, HCPs mostly provided higher scores than patients, and agreement was poor to fair. Differences between the HL estimation might lead to communication problems, and communication training could be useful.
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Affiliation(s)
- Mona Voigt-Barbarowicz
- Junior Research Group for Rehabilitation Sciences, Department of Health Services Research, University of Oldenburg, 26129 Oldenburg, Germany; (R.S.); (A.L.B.)
- Correspondence:
| | - Günter Dietz
- Clinic for Orthopedic and Rheumatological Rehabilitation, Rehabilitation Centre Bad Zwischenahn, 26160 Bad Zwischenahn, Germany; (G.D.); (N.R.)
| | - Nicole Renken
- Clinic for Orthopedic and Rheumatological Rehabilitation, Rehabilitation Centre Bad Zwischenahn, 26160 Bad Zwischenahn, Germany; (G.D.); (N.R.)
| | - Ruben Schmöger
- Junior Research Group for Rehabilitation Sciences, Department of Health Services Research, University of Oldenburg, 26129 Oldenburg, Germany; (R.S.); (A.L.B.)
| | - Anna Levke Brütt
- Junior Research Group for Rehabilitation Sciences, Department of Health Services Research, University of Oldenburg, 26129 Oldenburg, Germany; (R.S.); (A.L.B.)
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Giesler JM, Weis J, Caspari R, Dauelsberg T, Hoffmann W, Körber J, Bartsch HH. Patient competencies, coping self-efficacy, and coping: Do they change during oncological inpatient rehabilitation and beyond? Psychooncology 2021; 31:577-586. [PMID: 34676636 DOI: 10.1002/pon.5839] [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: 03/14/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The construct of Patient Competencies (PCs) has been suggested to allow a more comprehensive understanding of cancer patients' abilities to confront emotion- and problem-focused coping tasks arising from the diagnosis, treatment and survivorship of cancer. While providing a reliable and valid measure of PCs, research thus far has not clarified whether PCs change across time and/or through intervention. This study asks whether PCs change during oncological inpatient rehabilitation and beyond. METHODS N = 377 breast, colorectal, and prostate cancer patients from clinics for oncological rehabilitation were included to complete self-report measures of PC, coping and self-efficacy for coping with cancer at the beginning and the end of rehabilitation and 9 months afterward. In order to determine differences between tumor diagnostic groups and changes across time 3 (tumor site) x 3 (time) repeated measures analyses of variance were computed. RESULTS Tumor diagnostic groups differed only marginally in PCs, coping self-efficacy and coping. The PCs of self-regulation and managing distress and coping self-efficacy improved slightly during rehabilitation but returned to initial levels at 9 months. Differential improvement was evident in the competencies of seeking information and interest in social services. Two of five coping behaviors decreased markedly from the end of rehabilitation to follow-up. CONCLUSIONS This study suggests that oncological inpatient rehabilitation may contribute to advancing PCs, albeit to a limited extent. Aside from addressing conceptual, diagnostic and measurement issues, future research should clarify which interventions may be most effective for advancing problem- and emotion-focused PCs.
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Affiliation(s)
- Juergen M Giesler
- Section of Health Services Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, University of Freiburg Medical Center, Freiburg, Germany
| | - Joachim Weis
- Department of Self-Help Research, Comprehensive Cancer Center, University of Freiburg Medical Center, Freiburg, Germany
| | - Reiner Caspari
- Niederrhein Center for Oncological Rehabilitation, Bad Neuenahr-Ahrweiler, Germany
| | - Timm Dauelsberg
- Center for Oncological Rehabilitation at the Tumor Biology Center, University of Freiburg Medical Center, Freiburg, Germany
| | - Wilfried Hoffmann
- Park Therme Center for Oncological Rehabilitation, Hamm-Kliniken GmbH, Badenweiler, Germany
| | - Jürgen Körber
- Nahetal Center for Oncological Rehabilitation, Hamm-Kliniken GmbH, Bad Kreuznach, Germany
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Giesler JM, Weis J. Patient competence in the context of cancer: its dimensions and their relationships with coping, coping self-efficacy, fear of progression, and depression. Support Care Cancer 2020; 29:2133-2143. [PMID: 32875374 PMCID: PMC7892518 DOI: 10.1007/s00520-020-05699-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/19/2020] [Indexed: 12/23/2022]
Abstract
Purpose Influenced in part by research on coping, patient empowerment and self-efficacy, and by patient self-help initiatives, the construct of patient competencies (PC) has been elaborated and later integrated into Germany’s National Cancer Plan. As a self-report measure of PC, the Patient Competence Questionnaire 57 (PCQ-57) has only rarely been evaluated psychometrically. Therefore, we aimed to re-examine its dimensionality and its relationships with related constructs and potential psychosocial cancer outcomes. Methods We surveyed 424 breast, colorectal, and prostate cancer patients from clinics for oncological rehabilitation and private oncology practices who completed the PCQ-57 and self-report measures of coping, coping self-efficacy, fear of progression, and depression. Patients’ PCQ-57 responses were submitted to principal axis factor analyses. Using the original scoring keys, we computed internal consistencies (Cronbach’s α) and Pearson correlations between all measures. Results Factor analyses suggested 5 of the 8 original PCQ-57 dimensions to replicate satisfactorily, their internal consistencies ranging from 0.74 to 0.88. The competency of managing distress correlated significantly, highly, and negatively with fear of progression and depression (|r’s| ≥ 0.43) and positively with coping self-efficacy (r = 0.58). Conclusion The results support the reliability and validity of 5 of the 8 original PCQ-57 scales while suggesting refinement of the others. The replicated scales may help identify patients in need of support for dealing with the multiple tasks of adjusting to cancer. Further research should clarify the conceptual and empirical relationships between PC, health literacy, and patient activation as well as potential effects of PC on psychosocial cancer outcomes. Electronic supplementary material The online version of this article (10.1007/s00520-020-05699-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jürgen M Giesler
- Section of Health Care Research and Rehabilitation Research, University of Freiburg Medical Center, Hugstetter Str. 49, D 79106, Freiburg, Germany.
| | - Joachim Weis
- Comprehensive Cancer Center, Department of Self-Help Research, University of Freiburg Medical Center, Freiburg, Germany
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Glattacker M, Giesler JM, Klindtworth K, Nebe A. Rehabilitation use in multiple sclerosis: Do illness representations matter? Brain Behav 2018; 8:e00953. [PMID: 30106225 PMCID: PMC5991568 DOI: 10.1002/brb3.953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 01/31/2018] [Accepted: 02/20/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Multidisciplinary rehabilitation improves illness outcomes and is recommended in clinical guidelines for multiple sclerosis (MS). However, many people with MS do not make use of rehabilitation. We do not know much about the barriers to the use of rehabilitation in MS, but in other patient groups, illness representations have proven to be predictors of service utilization. Therefore, the aim of our study was to explore whether, in patients with MS, illness representations are associated with self-reports of rehabilitation use in the past and the intention to use rehabilitation in the future, beyond sociodemographic and illness-related factors. MATERIALS AND METHODS Patients were recruited in a cross-sectional nationwide online survey in Germany. Hierarchical binary logistic regression analysis was used to analyze whether illness representations are associated with the use of rehabilitation in the past and the intention to use rehabilitation in the future, over and above socio-demographic and illness-related variables. RESULTS There were 590 patients, who had MS, participating in the study. Illness representations were correlated to both outcome variables beyond sociodemographic and illness-related factors: The probabilities of having the intention to use rehabilitation and of making using of rehabilitation were higher in patients who believed that their MS was controllable by treatment and perceived that their MS would have severe consequences. CONCLUSIONS Our data suggest that addressing patients' illness representations may facilitate the intention to use and the use of multimodal rehabilitation, contributing to better illness outcomes.
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Affiliation(s)
- Manuela Glattacker
- Section of Health Care Research and Rehabilitation ResearchMedical Center—University of FreiburgFaculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Jürgen M. Giesler
- Section of Health Care Research and Rehabilitation ResearchMedical Center—University of FreiburgFaculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Katharina Klindtworth
- Section of Health Care Research and Rehabilitation ResearchMedical Center—University of FreiburgFaculty of MedicineUniversity of FreiburgFreiburgGermany
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Breuning M, Lucius-Hoene G, Burbaum C, Himmel W, Bengel J. [Patient experiences and patient centeredness : The website project DIPEx Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:453-461. [PMID: 28251275 DOI: 10.1007/s00103-017-2524-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient centeredness is a central concept in the treatment and rehabilitation of persons with chronic illness in Germany. There are various concepts of and approaches to patient centeredness, most of them developed from the perspective of health care research and the institutions. In terms of participation requirements, there has been a lack of understanding of the patient's perspective and experiences so far. In this article, the authors assume that the collection and analysis of patient experiences can improve patient participation and provide access to the experience of living and coping with an illness, including the patient's interactions with the health care system, their participation, and their preferences for participation. Potential uses for and the limits and risks of utilizing patient experiences are discussed, using the example of the website project Krankheitserfahrungen.de (DIPEx Germany). The project collects patient experiences in the form of narrative interviews. In the course of sharing their stories, the speakers become experts on their own lives and describe where and how they feel engaged in their health care and how they wish to become further engaged, thereby experiencing participation in terms of the International Classification of Functioning. The experience of rehabilitation is viewed in a comprehensive manner for those affected. It is not limited to experiences in specific institutions, but rather, the patient experience includes the context and processes, and describes how patients can find their way back to their lives after the interruption of an illness.
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Affiliation(s)
- Martina Breuning
- Abteilung für Rehabilitationspsychologie und Psychotherapie, Institut für Psychologie, Universität Freiburg, 79085, Freiburg, Deutschland.
| | - Gabriele Lucius-Hoene
- Abteilung für Rehabilitationspsychologie und Psychotherapie, Institut für Psychologie, Universität Freiburg, 79085, Freiburg, Deutschland
| | - Christina Burbaum
- Abteilung für Rehabilitationspsychologie und Psychotherapie, Institut für Psychologie, Universität Freiburg, 79085, Freiburg, Deutschland
| | - Wolfgang Himmel
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Jürgen Bengel
- Abteilung für Rehabilitationspsychologie und Psychotherapie, Institut für Psychologie, Universität Freiburg, 79085, Freiburg, Deutschland
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Bäuerle K, Feicke J, Scherer W, Spörhase U, Bitzer EM. Evaluation of a standardized patient education program for inpatient asthma rehabilitation: Impact on patient-reported health outcomes up to one year. PATIENT EDUCATION AND COUNSELING 2017; 100:957-965. [PMID: 27993435 DOI: 10.1016/j.pec.2016.11.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/21/2016] [Accepted: 11/27/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To modify and evaluate a patient education program for adult asthma patients in consideration of quality criteria for teaching. METHODS This was a prospective single-center controlled trial in an inpatient rehabilitation center. The control group (n=215) received the usual lecture-based education program, and the intervention group (n=209) the modified patient education program. Data were assessed at admission, discharge, 6 and 12 months post discharge. The primary outcome was asthma control, the secondary outcomes were asthma knowledge, quality of life, and program acceptance. Analysis of change was performed by ANCOVA for each follow-up, adjusting for baseline values. RESULTS Statistically significant increases in all health outcomes and in asthma control were maintained in both groups at 12 months: CG: +1.9 (95%-CI 1.3-2.6) IG: +1.6 (95%-CI 0.8-2.3). We observed no significant differences between the programs for asthma control and quality of life. Regarding practical asthma knowledge, after 12 months, a group*time interaction emerged with a small effect size (P=0.06, η2=0.01). CONCLUSION The modified program was not superior to traditional patient education concerning asthma control. It permanently increased self-management knowledge. PRACTICAL IMPLICATIONS Structured and behavioral patient education fosters patient's disease management ability. Possible ways of improving asthma control need to be explored.
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Affiliation(s)
- Kathrin Bäuerle
- Department of Everyday Culture, Exercise and Health, University of Education, Freiburg, Germany.
| | - Janine Feicke
- Department of Biology and its Didactics, University of Education, Freiburg, Germany
| | | | - Ulrike Spörhase
- Department of Biology and its Didactics, University of Education, Freiburg, Germany
| | - Eva-Maria Bitzer
- Department of Everyday Culture, Exercise and Health, University of Education, Freiburg, Germany
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Gesundheitskompetenz in der medizinischen Rehabilitation und die Bedeutung für die Patientenschulung. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 58:983-8. [DOI: 10.1007/s00103-015-2205-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Literatur zu Schwartz F.W. et al.: Public Health – Gesundheit und Gesundheitswesen. Public Health 2012. [DOI: 10.1016/b978-3-437-22261-0.16001-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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[Changes in medical rehabilitation of the German Statutory Pension Insurance Scheme]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54:404-10. [PMID: 21465395 DOI: 10.1007/s00103-011-1240-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Medical rehabilitation in Germany has changed continuously since its inception following the Bismarck Legislation. This article describes its development up until the millennium and discusses quantitative and qualitative changes that followed. Central quantitative changes are demonstrated using the examples of rehabilitation utilization, spectrum of diseases, setting, and postacute rehabilitation. Important qualitative changes in medical rehabilitation pertain to the significance of research for the advancement of rehabilitation, the emphasis on work-related problems in rehabilitative concepts, patient orientation as a new paradigm, integration of rehabilitation into the health system, and prevention. The article ends with an outlook on future developments, such as the anticipated increase in rehabilitation need due to demographic changes and extended working life. Changes in the work environment lead to complex requirements for the development of rehabilitation. In view of increasingly scarce resources, continuous adaptation of rehabilitation concepts is mandatory to maintain health and earning capacity of the population.
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