Psychometric evaluation of a Swedish Self-Efficacy scale and Recovery Locus of Control scale in the context of minor illness

Better self-care through co-care? A latent profile analysis of primary care patients' experiences of e-health-supported chronic care management

Background

Efficient self-care of chronic conditions requires that an individual's resources be optimally combined with healthcare's resources, sometimes supported by e-health services (i.e., co-care). This calls for a system perspective of self-care to determine to what extent it involves demanding or unnecessary tasks and whether role clarity, needs support, and goal orientation are sufficient. This study aims to explore typical configurations of how the co-care system is experienced by individuals with chronic conditions who used an e-health service supporting self-monitoring and digital communication with primary care.

Method

We performed a latent profile analysis using questionnaire data from two waves (7 months apart) involving 180 of 308 eligible patients who pilot-tested an e-health service for co-care at a Swedish primary care center. The five subscales of the Distribution of Co-Care Activities (DoCCA) scale were used to create profiles at Time 1 (T1) and Time 2 (T2). Profiles were described based on sociodemographic variables (age, gender, education level, and health condition) and compared based on exogenous variables (self-rated health, satisfaction with healthcare, self-efficacy in self-care, and perceptions of the e-health service).

Results

We identified four typical configurations of co-care experiences at T1: strained, neutral, supportive, and optimal. Patients with optimal and supportive profiles had higher self-rated health, self-efficacy in self-care, and satisfaction with healthcare than patients with strained and neutral profiles. Slightly more than half transitioned to a similar or more positive profile at T2, for which we identified five profiles: unsupportive, strained, neutral, supportive, and optimal. Patients with optimal and supportive profiles at T2 had higher self-efficacy in self-care and satisfaction with healthcare than the other profiles. The optimal profiles also had higher self-rated health than all other profiles. Members of the optimal and supportive profiles perceived the effectiveness of the e-health service as more positive than the unsupportive and strained profile members.

Discussion

Primary care patients' co-care profiles were primarily distinguished by their experiences of needs support, goal orientation, and role clarity. Patients with more positive co-care experiences also reported higher self-rated health, self-efficacy in self-care, and satisfaction with healthcare, as well as more positive experiences of the e-health service.

The work of having a chronic condition: development and psychometric evaluation of the distribution of co-care activities (DoCCA) scale

BACKGROUND

Chronic care involves multiple activities that can be performed by individuals and healthcare staff as well as by other actors and artifacts, such as eHealth services. Thus, chronic care management can be viewed as a system where the individual interacts with people and eHealth services performing activities to maintain or improve health and functioning, called co-care. Yet, the system perspective is not reflected in concepts such as person-centered care and shared decision making. This limits the understanding of individuals' global experience of chronic care management and subsequently the ability to optimize chronic care. The aim of this study was threefold: (1) to propose a theory-based operationalization of co-care for chronic care management, (2) to develop a scale to measure co-care as a distributed system of activities, and (3) to evaluate the scale's psychometric properties. With the theory of distributed cognition as a theoretical underpinning, co-care was operationalized along three dimensions: experience of activities, needs support, and goal orientation.

METHODS

Informed by the literature on patient experiences and work psychology, a scale denoted Distribution of Co-Care Activities (DoCCA) was developed with the three conceptualized dimensions, the activities dimension consisting of three sub-factors: demands, unnecessary tasks, and role clarity. It was tested with 113 primary care patients with chronic conditions in Sweden at two time points.

RESULTS

A confirmatory factor analysis showed support for a second-order model with the three conceptualized dimensions, with activities further divided into the three sub-factors. Cronbach's alpha values indicated a good to excellent reliability of the subscales, and correlations across time points with panel data indicated satisfactory test-retest reliability. Convergent, concurrent and predictive validity of the scale were, overall, satisfactory.

CONCLUSIONS

The psychometric evaluation supports a model consisting of activities (demands, unnecessary tasks, and role clarity), needs support and goal orientation that can be reliably measured with the DoCCA scale. The scale provides a way to assess chronic care management as a system, considering the perspective of the individuals with the chronic condition and how they perceive the work that must be done, across situations, either by themselves or through healthcare, eHealth, or other means.