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Man C, Liu T, Yan S, Xie Q, Liu H. Research status and hotspots of patient engagement: A bibliometric analysis. PATIENT EDUCATION AND COUNSELING 2024; 125:108306. [PMID: 38669762 DOI: 10.1016/j.pec.2024.108306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/20/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE This analysis aimed to examine current global trends in patient engagement research and identify critical focus areas. METHODS We searched the Web of Science Core Collection database for pertinent literature from January 1, 2000 to December 31, 2022. CiteSpace and VOSviewer were used for information analysis. RESULTS The bibliometric analysis covered 11,386 documents from 140 countries/regions, featuring contributions from 12,731 organizations and 45,489 authors. The United States and The University of Toronto were the most prolific country and institution. Leading researchers in publications and citations included Hibbard JH, Elwyn G, Legare F, and Street RL. Patient Education and Counseling led among journals. CONCLUSION Patient engagement research has experienced significant growth over the past two decades. The core of patient engagement research includes concepts, content, practical frameworks, impact assessment, and barriers. The current research focal points revolve around interventions for chronic disease patients, integrating digital health technologies to improve engagement, and incorporating patient-reported outcomes (PROs) into healthcare delivery. PRACTICE IMPLICATIONS This study unveils key trends and emphasizes global collaboration, strategic focus on chronic disease interventions, integration of digital health technologies, and the pivotal role of PROs. Embracing these insights promises to optimize healthcare practices and empower patients on a global scale.
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Affiliation(s)
- Chunxia Man
- Department of Pharmacy, Aerospace Center Hospital, Beijing 100049, China.
| | - Tiantian Liu
- Department of Pharmacy, Aerospace Center Hospital, Beijing 100049, China.
| | - Suying Yan
- Department of Pharmacy, Aerospace Center Hospital, Beijing 100049, China.
| | - Qing Xie
- Department of Pharmacy, Aerospace Center Hospital, Beijing 100049, China.
| | - Hua Liu
- Department of Pharmacy, Aerospace Center Hospital, Beijing 100049, China.
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Li T, Feng H, Bandugula V, Ding Y. Designing a Consumer-centric Care Management Program by Prioritizing Interventions Using Deep Learning Causal Inference. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2024; 2024:584-592. [PMID: 38827098 PMCID: PMC11141861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Care management is a team-based and patient-centered approach to reduce health risks and improve outcomes for managed populations. Post Discharge Management (PDM) is an important care management program at Elevance Health, which is aimed at reducing 30-day readmission risk for recently discharged patients. The current PDM program suffers from low engagement. When assigning interventions to patients, case managers choose the interventions to be conducted in each call only based on their limited personal experiences. In this work, we use deep learning causal inference to analyze the impact of interventions conducted on the first call on consumer engagement in the PDM program, which provides a reliable reference for case managers to select interventions to promote consumer engagement. With three experiments cross-validating the results, our results show that consumers will engage more in the program if the case manager conducts interventions that require more nurse-patient interactions on the first call. On the other hand, conducting less interactive and more technical interventions on the first call leads to relatively poor consumer engagement. These findings correspond to the clinical sense of experienced nurses and are consistent with previous findings in patient engagement in hospital settings.
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Affiliation(s)
- Tianhao Li
- The University of Texas at Austin, Austin, TX, USA
| | - Haoyun Feng
- Elevance Health, Inc., Indianapolis, IN, USA
| | | | - Ying Ding
- The University of Texas at Austin, Austin, TX, USA
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3
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Hou S, Wang X, Zhao Z, Ma Y, Liu J, Zhang Z, Ma J. A Scale for Measuring Electronic Patient Engagement Behaviors: Development and Validation. Patient Prefer Adherence 2024; 18:917-929. [PMID: 38685912 PMCID: PMC11057637 DOI: 10.2147/ppa.s444633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/11/2024] [Indexed: 05/02/2024] Open
Abstract
Purpose Advancements in electronic health (eHealth) technology have profoundly impacted patient engagement. This study aimed to develop and validate the Electronic Patient Engagement Behavior (EPEB) scale to measure the conceptual and underlying framework of patient engagement behaviors in an eHealth context. Patients and Methods Initial measurement items were generated based on a literature review and qualitative research. Two rounds of surveys, a pilot survey and validation survey, were conducted to evaluate the psychometric properties of the scale. Results The EPEB scale consists of 15 items in four dimensions: disease information search, physician-patient interaction, social interaction between patients, and disease self-monitoring. In the pilot survey, the exploratory factor analysis revealed a four-factor model, explaining 69.411% of variance. In the validation survey, the Cronbach's α coefficient of each sub-scale was 0.865, 0.904, 0.904, and 0.900 respectively. The Spearman-Brown split coefficient of the scale was 0.963. The results of the cross-sex measurement equivalence test indicate that all fit indices met the measurement criteria. The confirmatory factor analysis indicated second-order 4-factor model fit the data well. The EPEB has a good reliability and validity. Conclusion The EPEB scale provides a reliable tool for measuring patient engagement behaviors in the eHealth context. The utilization of this scale may yield valuable insights into strategies for enhancing patient engagement and optimizing health outcomes.
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Affiliation(s)
- Shengchao Hou
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Xiubo Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Zizhao Zhao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Yongqiang Ma
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Jing Liu
- Administrative Office, Yuebei People’s Hospital, Shaoguan, People’s Republic of China
| | - Ziyun Zhang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Jingdong Ma
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
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Palamenghi L, Usta D, Leone S, Graffigna G. Food-Related Behavioral Patterns in Patients with Inflammatory Bowel Diseases: The Role of Food Involvement and Health Engagement. Nutrients 2024; 16:1185. [PMID: 38674876 PMCID: PMC11054402 DOI: 10.3390/nu16081185] [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: 03/10/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Nutrition has been acknowledged as crucial in IBD and is relevant to patients' motives behind food choices, which are affected by health engagement (HE) and food involvement (FI). This study aimed to profile IBD patients according to their levels of health engagement and food involvement to identify patterns of different motives behind food choices, particularly regarding the use of food to regulate mood. A cross-sectional study was conducted with 890 Italian IBD patients who completed an online survey in April 2021. We measured health engagement, food involvement, motives behind food choices, emotional states, and food-related quality of life (Fr-QoL). K-means cluster analysis was performed to identify participants with similar levels of health engagement and food involvement. Four clusters were identified: "Health-conscious (high HE, low FI)", "Balanced (high HE, high FI)", "Hedonist (high FI, low HE)", and "Careless (low FI, low HE)". Clusters with high FI are inclined toward seeking pleasurable food, but when supported with high health engagement, individuals were less prone to use food to manage mood. Groups with higher health engagement demonstrated lower hospitalization rates and relapses and better Fr-QoL. Profiling IBD patients regarding FI and HE could aid clinicians in identifying individuals at greater risk of maladaptive food-related behaviors.
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Affiliation(s)
- Lorenzo Palamenghi
- EngageMinds HUB—Consumer, Food & Health Engagement Research Center, Faculty of Agriculture, Food and Environmental Sciences, Catholic University of Sacred Heart, 26100 Cremona, Italy; (L.P.); (G.G.)
| | - Dilara Usta
- EngageMinds HUB—Consumer, Food & Health Engagement Research Center, Faculty of Agriculture, Food and Environmental Sciences, Catholic University of Sacred Heart, 26100 Cremona, Italy; (L.P.); (G.G.)
| | - Salvo Leone
- National Association for Chronic Inflammatory Bowel Diseases (AMICI ETS), 20125 Milan, Italy;
| | - Guendalina Graffigna
- EngageMinds HUB—Consumer, Food & Health Engagement Research Center, Faculty of Agriculture, Food and Environmental Sciences, Catholic University of Sacred Heart, 26100 Cremona, Italy; (L.P.); (G.G.)
- Faculty of Psychology, Catholic University of Sacred Heart, 20123 Milan, Italy
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Baldwin DS, Adair M, Micheelsen A, Åstrøm DO, Reines EH. Goal setting and goal attainment in patients with major depressive disorder: a narrative review on shared decision making in clinical practice. Curr Med Res Opin 2024; 40:483-491. [PMID: 38294154 DOI: 10.1080/03007995.2024.2313108] [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] [Received: 11/01/2023] [Accepted: 01/29/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE Narrative review of the processes of goal setting and goal attainment scaling, as practical approaches to operationalizing and implementing the principles of shared decision making (SDM) in the routine care of people living with major depressive disorder (MDD). METHODS We searched electronic databases for clinical studies published in English using key terms related to MDD and goal setting or goal attainment scaling. Two clinical studies of goal setting in MDD are considered in detail to exemplify the practicalities of the goal setting approach. RESULTS While SDM is widely recommended for people living with mental health problems, there is general agreement that it has thus far been implemented variably. In other areas of medicine, the process of goal setting is an established way to engage the patient, facilitate motivation, and assist the recovery process. For people living with MDD, the concept of goal setting is in its infancy, and only few studies have evaluated its clinical utility. Two clinical studies of vortioxetine for MDD demonstrate the utility of goal attainment scaling as an appropriate outcome for assessing functional improvement in ways that matter to the patient. CONCLUSIONS Goal setting is a pragmatic approach to turning the principles of SDM into realities of clinical practice and aligns with the principles of recovery that encompasses the notions of self-determination, self-management, personal growth, empowerment, and choice. Accumulating evidence supports the use of goal attainment scaling as an appropriate personalized outcome measure for use in clinical trials.
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Affiliation(s)
- David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Mood Disorders Service, Southern Health NHS Foundation Trust, Southampton, UK
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Austin EJ, O'Brien QE, Ruiz MS, Ratzliff AD, Williams EC, Koch U. Patient and Provider Perspectives on Processes of Engagement in Outpatient Treatment for Opioid Use Disorder: A Scoping Review. Community Ment Health J 2024; 60:330-339. [PMID: 37668745 DOI: 10.1007/s10597-023-01175-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 07/22/2023] [Indexed: 09/06/2023]
Abstract
Effective treatment for opioid use disorder (OUD) is available, but patient engagement is central to achieving care outcomes. We conducted a scoping review to describe patient and provider-reported strategies that may contribute to patient engagement in outpatient OUD care delivery. We searched PubMed and Scopus for articles reporting patient and/or provider experiences with outpatient OUD care delivery. Analysis included: (1) describing specific engagement strategies, (2) mapping strategies to patient-centered care domains, and (3) identifying themes that characterize the relationship between engagement and patient-centered care. Of 3,222 articles screened, 30 articles met inclusion criteria. Analysis identified 14 actionable strategies that facilitate patient engagement and map to all patient-centered care domains. Seven themes emerged that characterize interpersonal approaches to OUD care engagement. Interpersonal interactions between patients and providers play a pivotal role in encouraging engagement throughout OUD treatment. Future research is needed to further evaluate promising engagement strategies.
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Affiliation(s)
- Elizabeth J Austin
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, 98105, USA.
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, D.C, USA.
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, D.C, USA.
| | - Quentin E O'Brien
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, D.C, USA
| | - Monica S Ruiz
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, D.C, USA
| | - Anna D Ratzliff
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, 98105, USA
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle, WA, USA
| | - Ulrich Koch
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, D.C, USA
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Kato M, Kikuchi T, Watanabe K, Sumiyoshi T, Moriguchi Y, Oudin Åström D, Christensen MC. Goal Attainment Scaling for Depression: Validation of the Japanese GAS-D Tool in Patients with Major Depressive Disorder. Neuropsychiatr Dis Treat 2024; 20:49-60. [PMID: 38239870 PMCID: PMC10796153 DOI: 10.2147/ndt.s441382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024] Open
Abstract
Purpose Goal attainment scaling (GAS) has been proposed as a person-centric, semi-quantitative measure that assimilates achievement of individually set goals into a single standardized "goal attainment score" that can be compared at the population level. We aimed to examine the reliability and validity of the Japanese version of the GAS for depression (GAS-D) tool in assessing goal attainment in people living with major depressive disorder (MDD). Patients and Methods This was a prespecified analysis of a prospective, 24-week, multicenter, observational cohort study of employed Japanese outpatients with MDD initiating treatment with vortioxetine according to the Japanese label (JRCT1031210200). Participants were assessed using the Japanese version of the GAS-D and other clinical rating scales at baseline and Weeks 8, 12 and 24. Results Goal attainment was significantly associated with symptom severity as assessed by the Montgomery-Åsberg Depression Rating Scale (MADRS) scale, confirming convergent validity. In particular, GAS-D scores were significantly related to MADRS total score at Weeks 12 and 24, indicating that improvements in overall symptom severity with vortioxetine treatment were likely to be reflected in the achievement of individualized treatment goals. With an intraclass correlation coefficient of 0.67 (95% CI 0.45-0.82), the GAS-D also showed moderate test-retest reliability between Weeks 8 and 12 while proving independent of demographic characteristics. Conclusion The results of this open-label study support the use of the GAS-D as a valid and sensitive outcome measure in the assessment of treatment response in MDD.
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Affiliation(s)
- Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Toshiaki Kikuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Tomiki Sumiyoshi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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Fridriksdottir N, Ingadottir B, Skuladottir K, Zoëga S, Gunnarsdottir S. Supportive Digital Health Service During Cancer Chemotherapy: Single-Arm Before-and-After Feasibility Study. JMIR Form Res 2023; 7:e50550. [PMID: 38015268 PMCID: PMC10770793 DOI: 10.2196/50550] [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: 07/04/2023] [Revised: 09/22/2023] [Accepted: 11/28/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Digital supportive cancer care is recommended to improve patient outcomes. A portal was designed and embedded within the electronic medical record and public health portal of Iceland, consisting of symptom and needs monitoring, educational material, and messaging. OBJECTIVE This study aims to assess (1) portal feasibility (adoption, engagement, usability, and acceptability), (2) potential predictors of usability and acceptability, and (3) the potential impact of the portal on patient-reported outcomes. METHODS This was a single-arm, before-and-after feasibility study at a university hospital among patients with cancer who were undergoing chemotherapy. Participation included filling out the Edmonton Symptom Assessment System-Revised (ESASr) weekly and the Distress Thermometer and Problem List (DT&PL) 3 times; reading educational material and messaging; and completing study questionnaires. Clinical and portal engagement data were collected from medical records. Data from patients were collected electronically at baseline and 7 to 10 days after the third chemotherapy round. Usability was assessed using the System Usability Scale (score 0-100), and acceptability was assessed using a 35-item survey (score 1-5). Patient-reported outcome measures included ESASr and DT&PL; a single-item scale for quality of life, family support, and quality of care; and multi-item scales for health literacy (Brief Health Literacy Screener), health engagement (Patient Health Engagement Scale), self-care self-efficacy (Self-Care Self-Efficacy scale), symptom interference (MD Anderson Symptom Inventory), knowledge expectations (Hospital Patients' Knowledge Expectations), and received knowledge (Hospital Patients' Received Knowledge). Health care professionals were interviewed regarding portal feasibility. RESULTS The portal adoption rate was 72% (103/143), and the portal use rate was 76.7% (79/103) over a mean 8.6 (SD 2.7) weeks. The study completion rate was 67% (69/103). The combined completion rate of the ESASr and DT&PL was 78.4% (685/874). Patients received a mean 41 (SD 13) information leaflets; 33% (26/79) initiated messaging, 73% (58/79) received messages, and 85% (67/79) received follow-up phone calls. The mean System Usability Scale score was 72.3 (SD 14.7), indicating good usability. Usability was predicted by age (β=-.45), ESASr engagement (β=.5), symptom interference (β=.4), and received knowledge (β=.41). The mean acceptability score, 3.97 (SD 0.5), was above average and predicted by age (β=-.31), ESASr engagement (β=.37), symptom interference (β=.60), self-care self-efficacy (β=.37), and received knowledge (β=.41). ESASr scores improved for total symptom distress (P=.003; Cohen d=0.36), physical symptoms (P=.01; Cohen d=0.31), and emotional symptoms (P=.01; Cohen d=0.31). Daily symptom interference increased (P=.03; Cohen d=0.28), quality of life improved (P=.03; Cohen d=0.27) and health engagement (P=.006; Cohen d=0.35) improved, while knowledge expectations decreased (P≤.001; Cohen d=2.57). Health care professionals were positive toward the portal but called for clearer role delineation and follow-up. CONCLUSIONS This study supports the feasibility of a support portal and the results indicate the possibility of improving patient outcomes, but further developments are warranted.
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Affiliation(s)
- Nanna Fridriksdottir
- Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
| | - Brynja Ingadottir
- Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
| | - Kristin Skuladottir
- Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
| | - Sigridur Zoëga
- Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
| | - Sigridur Gunnarsdottir
- Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
- Cancer Registry, The Icelandic Cancer Society, Reykjavik, Iceland
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McMillan D, Brown D, Rieger K, Duncan G, Plouffe J, Amadi C, Jafri S. Patient and family perceptions of a discharge bedside board. PEC INNOVATION 2023; 3:100214. [PMID: 37743957 PMCID: PMC10514555 DOI: 10.1016/j.pecinn.2023.100214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 08/14/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
Objective To explore patient and family perspectives of a discharge bedside board for supporting engagement in patient care and discharge planning to inform tool revision. Methods This qualitative descriptive study included 45 semi-structured interviews with a purposeful sample of English-speaking patients (n = 44; mean age 58.5 years) and their family members (n = 5) across seven adult inpatient units at a tertiary acute care hospital in mid-western Canada. Thematic (interviews), content (board, organization procedure document), and framework-guided integrated (all data) analyses were performed. Results Four themes were generated from interview data: understanding the board, included essential information to guide care, balancing information on the board, and maintaining a sense of connection. Despite application inconsistencies, documented standard procedures aligned with recommended board (re)orientation, timely patient-friendly content, attention to privacy, and patient-provider engagement strategies. Conclusion Findings indicate the tool supported consultation and some involvement level engagement in patient care and discharge. Board information was usually valued, however, perceived procedural gaps in tool education, privacy, and the quality of tool-related communication offer opportunities to strengthen patients' and families' tool experience. Innovation Novel application of a continuum engagement framework in the exploration of multiple data sources generated significant insights to guide tool revision.
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Affiliation(s)
- D.E. McMillan
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg R3T 2N2, Canada
- Health Sciences Centre, Winnipeg R3A 1R9, Canada
| | - D.B. Brown
- Health Sciences Centre, Winnipeg R3A 1R9, Canada
| | - K.L. Rieger
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg R3T 2N2, Canada
| | - G. Duncan
- Health Sciences Centre, Winnipeg R3A 1R9, Canada
| | - J. Plouffe
- Health Sciences Centre, Winnipeg R3A 1R9, Canada
| | - C.C. Amadi
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg R3T 2N2, Canada
| | - S. Jafri
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg R3T 2N2, Canada
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Zheng Z, Bird SR, Layton J, Hyde A, Moreland A, Wong Lit Wan D, Stupans I. Patient engagement as a core element of translating clinical evidence into practice- application of the COM-B model behaviour change model. Disabil Rehabil 2023; 45:4517-4526. [PMID: 36476254 DOI: 10.1080/09638288.2022.2153935] [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: 03/01/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The results of rehabilitation trials are often not fully attained when the intervention is implemented beyond the initial trial. One of the key reasons is that a patients' ability and/or capacity to take part in their own healthcare is not considered in the trial design yet has significant impact on the outcomes during the implementation phase. BODY OF TEXT We propose a shift from a therapist-focus to patient-focus in trial design, through addressing patient engagement as a core consideration in trials. We argue that engaging patients in any rehabilitation program is a process of behavioural change. Exercise prescription is used as an example to illustrate how the Behaviour Change Wheel can be applied to analyse barriers and facilitators associated with patients' capabilities, opportunities and motivations in integrating trial interventions into their daily life. We propose a framework to assist in this shift. CONCLUSION A core part of implementing rehabilitation interventions at the primary care level requires patient engagement. Related aspects of interventions should be identified and assessed using the COM-B model at the outset of trial design to ensure that the results are realistic, meaningful and transferable, so as to enable real impact.
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Affiliation(s)
- Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Stephen R Bird
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Jennifer Layton
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Anna Hyde
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Ash Moreland
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Dawn Wong Lit Wan
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Ieva Stupans
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
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Cengiz D, Korkmaz F. Effectiveness of a nurse-led personalized patient engagement program to promote type 2 diabetes self-management: A randomized controlled trial. Nurs Health Sci 2023; 25:571-584. [PMID: 37670722 DOI: 10.1111/nhs.13048] [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: 02/11/2023] [Revised: 07/29/2023] [Accepted: 08/19/2023] [Indexed: 09/07/2023]
Abstract
PHEinAction® is a theory-based nurse-led patient engagement intervention developed among an Italian older adult population with various chronic diseases to facilitate cognitive, emotional, and behavioral processes in promoting individuals' active roles. This study aims to adapt and evaluate the effectiveness of PHEinAction® on diabetes self-management (DSM) among Turkish type 2 diabetes mellitus patients. First, the generic content of the intervention was customized for diabetes management and adapted for the Turkish population, including back-forward translation and expert panel evaluation; then, a randomized controlled trial was conducted with 51 adult diabetes patients randomly assigned to intervention or the control group receiving the usual care. The intervention consisted of two in-person sessions of 4-week intervals, a telephone consultation, and home-based written exercises, which involved personalized care activities addressing individuals' engagement levels and covering the cognitive, emotional, and behavioral aspects. The scores for treatment adherence, self-efficacy, and patient engagement had significantly improved with a large size effect in the intervention group at the fourth-week follow-up compared with the control group. Findings suggest that the nurse-led personalized patient engagement program could effectively promote DSM.
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Affiliation(s)
- Dilara Cengiz
- Department of Fundamentals of Nursing, Hacettepe University Faculty of Nursing, Ankara, Turkey
| | - Fatoş Korkmaz
- Department of Fundamentals of Nursing, Hacettepe University Faculty of Nursing, Ankara, Turkey
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Rzadkiewicz M, Chylińska J. Walking in their shoes: How primary-care experiences of adults aged 50+ reveal the benefits of e-learning intervention for general practitioners. Appl Psychol Health Well Being 2023; 15:1237-1253. [PMID: 36609871 DOI: 10.1111/aphw.12434] [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: 07/27/2022] [Accepted: 12/15/2022] [Indexed: 01/09/2023]
Abstract
Patient experiences and activation are increasingly researched. However, related data are limited in three areas: interventions for general practitioners (GPs) working with mature adults (50+), dedicated e-learning interventions for GPs, and assessments of e-learning for medical staff through patient experiences. We examined how e-learning intervention focused on improving GPs' skills in activating communication (understood as promoting engagement and active participation in healthcare) can enhance the experiences of mature patients. The intervention was designed for GPs, yet innovative assessment was based on patient experiences post-visit. Three research conditions for GPs (n = 165) were introduced: (1) e-learning or (2) pdf-article intervention and (3) control. Two independent waves of their patients participated before and after the intervention. Experience measures for patients (n = 1639) included the Patient Expectations Scale (post-visit), perceived GP's Communication Skills scale, and Patient Satisfaction with Visit scale. E-learning intervention compared with the control group had a favorable effect for 5 out of 8 dimensions of patient experience. Change in emotional support and quality of life was particularly visible. Mature patient experiences can be improved with the e-learning intervention for GPs. Measuring patient experience enriches the available knowledge and can help design future research and interventions.
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Affiliation(s)
- Marta Rzadkiewicz
- Department of Health Psychology, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Chylińska
- Department of Health Psychology, Medical University of Warsaw, Warsaw, Poland
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Yu T, Gao M, Sun G, Graffigna G, Liu S, Wang J. Cardiac rehabilitation engagement and associated factors among heart failure patients: a cross-sectional study. BMC Cardiovasc Disord 2023; 23:447. [PMID: 37697249 PMCID: PMC10496326 DOI: 10.1186/s12872-023-03470-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/23/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Chronic Heart Failure (CHF) still affects millions of people worldwide despite great advances in therapeutic approaches in the cardiovascular field. Cardiac rehabilitation (CR) is known to improve disease-related symptoms, quality of life and clinical outcomes, yet implementation is suboptimal, a frequently low engagement in rehabilitation programs has been found globally. OBJECTIVE To quantify diverse CR-engaged processes and elucidate associated factors of the various levels of CR engagement in CHF patients. METHODS Discharged patients admitted from cardiology departments between May 2022 to July 2022 were enrolled by mobile phone text messaging, CHF patients from same department between August 2022 to December 2022 were enrolled by face-to-face. Individuals who met the inclusion criteria filled the questionnaires, including the generalized anxiety disorders scale, patient health questionnaire, cardiac rehabilitation inventory, patient activation measure, Tampa scale for kinesiophobia heart, social frailty, Patient Health Engagement Scale (PHE-s®). We obtained sociodemographic characteristics and clinical data from medical records. Chi-square tests and multivariable logistic regression analyses were performed to examine the factors associated with CR engagement phases. RESULTS A total of 684 patients were included in the study. 52.49% patients were in the Adhesion phase. At the multivariate level, compared with the blackout phase process anxiety, monthly income (RMB yuan) equal to or more than 5,000 were the most important factor impacting CHF patients CR engagement. Compared with the Blackout phase, regular exercise or not, severe depression, previous cardiac-related hospitalizations 1 or 2 times, Age influenced patient CR engagement in the Arousal phase. Besides, compared with the Blackout phase, outcome anxiety and activation level were independent factors in the Eudaimonic Project phase. CONCLUSION This study characterized CR engagement, and explored demographic, medical, and psychological factors-with the most important being process anxiety, monthly income, patient activation, severe depression, and previous cardiac-related hospitalizations. The associated factors of CR engagement were not identical among different phases. Our findings suggested that factors could potentially be targeted in clinical practice to identify low CR engagement patients, and strategies implemented to strengthen or overcome these associations to address low CR engagement in CHF patients.
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Affiliation(s)
- Tianxi Yu
- School of Nursing, Nanjing Medical University, No.140 Han Zhong Road, Gu Lou District, Nanjing City, Jiangsu Province, China
| | - Min Gao
- Cardiology Department, The First Affiliated Hospital of Nanjing Medical University, No.300 Guang Zhou Road, Gu Lou District, Nanjing City, Jiangsu Province, China
| | - Guozhen Sun
- School of Nursing, Nanjing Medical University, No.140 Han Zhong Road, Gu Lou District, Nanjing City, Jiangsu Province, China.
| | | | - Shenxinyu Liu
- School of Nursing, Nanjing Medical University, No.140 Han Zhong Road, Gu Lou District, Nanjing City, Jiangsu Province, China
| | - Jie Wang
- School of Nursing, Nanjing Medical University, No.140 Han Zhong Road, Gu Lou District, Nanjing City, Jiangsu Province, China
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DiDomizio E, Chandra DK, Nichols L, Villanueva M, Altice FL. Challenges to Achieving HCV Micro-Elimination in People With HIV in the United States: Provider Perspectives and the Role of Implicit Bias. Health Promot Pract 2023; 24:998-1008. [PMID: 37440258 DOI: 10.1177/15248399231169928] [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] [Indexed: 07/14/2023]
Abstract
The prevalence of HIV/HCV (hepatitis C virus) co-infection is high particularly in persons who inject drugs (PWID) and is increasing because of the evolving opioid epidemic in the United States. The introduction of effective antiviral medications for HCV has raised the strategic goal of HCV micro-elimination, and efforts to understand the barriers to treatment are critical. In this study, we explored the provider perspective of factors that inhibit HCV micro-elimination efforts in people with HIV (PWH), including the role of implicit bias and related stigma in providers' health care decision making. We used the mixed-methods approach of nominal group technique (NGT) with 14 participants from 11 different clinics engaged in two virtual focus group sessions (n = 5 and n = 9). Responses from the NGTs were rank ordered during the sessions to identify providers' perspectives of major barriers and facilitators, then identified possible implicit bias after the NGTs concluded. There were 12 responses given for micro-elimination barriers with the three most prioritized being housing instability, medication nonadherence concerns, and inability to motivate patients. Of these, eight were categorized as potential implicit biases. Among the 14 responses given for facilitators of treatment, the three major solutions included distributive models of care, improved provider knowledge, and increased patient engagement. Although the solutions offered were insightful, there was consensus that the individual lives of patients were the root cause of most barriers to care. We recommend further research on behavioral design interventions that promote patients' involvement in decision making and focus on patients' eligibility criteria for HCV treatment as opposed to providers' perceived barriers to treatment.
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Affiliation(s)
| | - Divya K Chandra
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Lisa Nichols
- Yale University School of Medicine, New Haven, CT, USA
| | | | - Frederick L Altice
- Yale University School of Medicine, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
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15
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Son EH, Nahm ES. Adult Patients' Experiences of Using a Patient Portal With a Focus on Perceived Benefits and Difficulties, and Perceptions on Privacy and Security: Qualitative Descriptive Study. JMIR Hum Factors 2023; 10:e46044. [PMID: 37490316 PMCID: PMC10411420 DOI: 10.2196/46044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/07/2023] [Accepted: 06/24/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Patient portals can facilitate patient engagement in care management. Driven by national efforts over the past decade, patient portals are being implemented by hospitals and clinics nationwide. Continuous evaluation of patient portals and reflection of feedback from end users across care settings are needed to make patient portals more user-centered after the implementation. OBJECTIVE The aim of this study was to investigate the lived experience of using a patient portal in adult patients recruited from a variety of care settings, focusing on their perceived benefits and difficulties of using the patient portal, and trust and concerns about privacy and security. METHODS This qualitative descriptive study was part of a cross-sectional digital survey research to examine the comprehensive experience of using a patient portal in adult patients recruited from 20 care settings from hospitals and clinics of a large integrated health care system in the mid-Atlantic area of the United States. Those who had used a patient portal offered by the health care system in the past 12 months were eligible to participate in the survey. Data collected from 734 patients were subjected to descriptive statistics and content analysis. RESULTS The majority of the participants were female and non-Hispanic White with a mean age of 53.1 (SD 15.34) years. Content analysis of 1589 qualitative comments identified 22 themes across 4 topics: beneficial aspects (6 themes) and difficulties (7 themes) in using the patient portal; trust (5 themes) and concerns (4 themes) about privacy and security of the patient portal. Most of the participants perceived the patient portal functions as beneficial for communicating with health care teams and monitoring health status and care activities. At the same time, about a quarter of them shared difficulties they experienced while using those functions, including not getting eMessage responses timely and difficulty finding information in the portal. Protected log-in process and trust in health care providers were the most mentioned reasons for trusting privacy and security of the patient portal. The most mentioned reason for concerns about privacy and security was the risk of data breaches such as hacking attacks and identity theft. CONCLUSIONS This study provides an empirical understanding of the lived experience of using a patient portal in adult patient users across care settings with a focus on the beneficial aspects and difficulties in using the patient portal, and trust and concerns about privacy and security. Our study findings can serve as a valuable reference for health care institutions and software companies to implement more user-centered, secure, and private patient portals. Future studies may consider targeting other patient portal programs and patients with infrequent or nonuse of patient portals.
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Affiliation(s)
- Elisa H Son
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Eun-Shim Nahm
- Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, United States
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16
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Law B, Chhatwal PK, Licskai C, Scurr T, Sibbald SL. Patient engagement in interprofessional team-based chronic disease management: A qualitative description of a Canadian program. PATIENT EDUCATION AND COUNSELING 2023; 114:107836. [PMID: 37336085 DOI: 10.1016/j.pec.2023.107836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To explore how patients with chronic obstructive pulmonary disease (COPD) perceive their engagement and roles within an interdisciplinary team-based care model. METHODS A single intrinsic case study was used. Focus group participants were recruited from the Best Care COPD program across nine sites. Transcripts from patient focus groups were supplemented by healthcare provider focus group transcripts and thematically analysed. RESULTS The majority of patients viewed themselves as having an inherent or central role on the team, which was corroborated by healthcare providers. Both positive (e.g., a desire to learn) and negative drivers (e.g., fear of inadequate care without self-advocacy) of active engagement were identified, for which patient-led communication was key. Components of the interdisciplinary team-based care model, including provider coordination and action planning, enabled positively driven active engagement and increased self-management. CONCLUSION Although patients had heterogenous perspectives about engagement, most patients viewed themselves as, and were satisfied with, having a central role in their care. Active and passive engagement preferences were influenced by personal motivations and past experiences, amongst other factors. PRACTICE IMPLICATIONS This study demonstrates how interdisciplinary chronic disease management programs can support patient engagement. Clarity of provider expectations, and communication about patients' roles and preferences, are recommended.
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Affiliation(s)
- Benson Law
- Faculty of Health Sciences, University of Western Ontario, London, Canada
| | | | - Christopher Licskai
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Tiffany Scurr
- Faculty of Health Sciences, University of Western Ontario, London, Canada
| | - Shannon L Sibbald
- Faculty of Health Sciences, University of Western Ontario, London, Canada; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada; The Schulich Interfaculty Program in Public Health, University of Western Ontario, London, Canada; Department of Family Medicine, University of Western Ontario, London, Canada; Lawson Health Research Institute, London, Canada.
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17
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Soares A, Piçarra N, Giger JC, Oliveira R, Arriaga P. Ethics 4.0: Ethical Dilemmas in Healthcare Mediated by Social Robots. Int J Soc Robot 2023; 15:807-823. [PMID: 37251278 PMCID: PMC9989998 DOI: 10.1007/s12369-023-00983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/09/2023]
Abstract
This study examined people's moral judgments and trait perception toward a healthcare agent's response to a patient who refuses to take medication. A sample of 524 participants was randomly assigned to one of eight vignettes in which the type of healthcare agent (human vs. robot), the use of a health message framing (emphasizing health-losses for not taking vs. health-gains in taking the medication), and the ethical decision (respect the autonomy vs. beneficence/nonmaleficence) were manipulated to investigate their effects on moral judgments (acceptance and responsibility) and traits perception (warmth, competence, trustworthiness). The results indicated that moral acceptance was higher when the agents respected the patient's autonomy than when the agents prioritized beneficence/nonmaleficence. Moral responsibility and perceived warmth were higher for the human agent than for the robot, and the agent who respected the patient's autonomy was perceived as warmer, but less competent and trustworthy than the agent who decided for the patient's beneficence/nonmaleficence. Agents who prioritized beneficence/nonmaleficence and framed the health gains were also perceived as more trustworthy. Our findings contribute to the understanding of moral judgments in the healthcare domain mediated by both healthcare humans and artificial agents.
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Affiliation(s)
- Antonio Soares
- ISCTE-Instituto Universitário de Lisboa, CIS-IUL, Lisboa, Portugal
| | - Nuno Piçarra
- ISCTE-Instituto Universitário de Lisboa, CIS-IUL, Lisboa, Portugal
| | | | - Raquel Oliveira
- ISCTE-Instituto Universitário de Lisboa, CIS-IUL, Lisboa, Portugal
| | - Patrícia Arriaga
- ISCTE-Instituto Universitário de Lisboa, CIS-IUL, Lisboa, Portugal
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18
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Values and tensions of a health education program based on evidence-based medicine: a qualitative study. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-023-01839-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Abstract
Aim
This study explored how patients, caregivers, clinicians, designers, and funders who worked collaboratively on a health education program experienced its design. The program was based on evidence-based medicine and knowledge transmission.
Subject and methods
Through exploratory qualitative research, the authors conducted 21 semistructured interviews, collected six nonparticipatory observations, and conducted a documentary analysis. Data were analyzed using thematic analysis, producing rich descriptions about the participants’ experiences. The researchers’ interpretations were validated through peer review.
Results
Three themes were revealed by the findings: background, values, and tensions. All participants had a range of assumptions about this experience regarding which evidence-based recommendations should be prioritized and disseminated to patients/caregivers in program implementation. These assumptions were based on participants’ beliefs about how people make evidence-informed decisions, allowing them to take charge of their health. The authors found a gap between these assumptions and the purposes of the educational program.
Conclusion
Although health education programs aim to foster patients’ informed decision making and health empowerment, in our case we found some assumptions that were not in line with the objectives of the educational program. We hypothesize that some gaps in the program design, derived from different assumptions, such as (a) conflicts of particular interests, (b) knowledge gaps about health-disease processes, and (c) power asymmetries between doctors and patients/caregivers, could hinder the goals of health education (e.g., engagement) in the practice of evidence-based medicine.
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19
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Blythin AM, Elkes J, van Lindholm T, Bhogal A, Wilkinson TMA, Saville C, Kirk A. Can digital health apps provide patients with support to promote structured diabetes education and ongoing self-management? A real-world evaluation of myDiabetes usage. Digit Health 2023; 9:20552076221147109. [PMID: 36923369 PMCID: PMC10009031 DOI: 10.1177/20552076221147109] [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: 05/04/2022] [Accepted: 12/06/2022] [Indexed: 03/16/2023] Open
Abstract
Objective Structured diabetes education has evidenced benefits yet reported uptake rates for those referred to traditional in-person programmes within 12 months of diagnosis were suboptimal. Digital health interventions provide a potential solution to improve diabetes education delivery at population scale, overcoming barriers identified with traditional approaches. myDiabetes is a cloud-based interactive digital health self-management app. This evaluation analysed usage data for people with type 2 diabetes focusing on digital structured diabetes education. Methods Descriptive quantitative analyses were conducted on existing anonymised user data over 12 months (November 2019-2020) to evaluate whether digital health can provide additional support to deliver diabetes education. Data was divided into two equal 6-month periods. As this overlapped the onset of COVID-19, analyses of its effect on usage were included as a secondary outcome. All data was reported via myDiabetes. Users were prescribed myDiabetes by National Health Service healthcare primary care teams. Those who registered for app use within the study period (n = 2783) were assessed for eligibility (n = 2512) and included if activated. Results Within the study period, n = 1245/2512 (49.6%) registered users activated myDiabetes. No statistically significant differences were observed between gender (p = 0.721), or age (p = 0.072) for those who activated (59.2 years, SD 12.93) and those who did not activate myDiabetes (57.6 years, SD 13.77). Activated users (n = 1119/1245 (89.8%)) viewed 11,572 education videos. No statistically significant differences were observed in education video views across age groups (p = 0.384), gender (p = 0.400), diabetes treatment type (p = 0.839) or smoking status (p = 0.655). Comparison of usage pre-COVID-19 and post-COVID-19 showed statistically significant increases in app activity (p ≤0.001). Conclusion Digital health is rapidly evolving in its role of supporting patients to self-manage. Since COVID-19 the benefits of digital technology have become increasingly recognised. There is potential for increasing diabetes education rates by offering patients a digital option in combination with traditional service delivery which should be substantiated through future research.
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Affiliation(s)
- A M Blythin
- Department of Research & Innovation, my mhealth Limited, Bournemouth, UK
| | - J Elkes
- School of Public Health, Imperial College Clinical Trials Unit, London, UK
| | - T van Lindholm
- Department of Research & Innovation, my mhealth Limited, Bournemouth, UK
| | - A Bhogal
- Department of Research & Innovation, my mhealth Limited, Bournemouth, UK
| | - T M A Wilkinson
- Department of Research & Innovation, my mhealth Limited, Bournemouth, UK.,Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - C Saville
- Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - A Kirk
- Department of Research & Innovation, my mhealth Limited, Bournemouth, UK
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20
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Sibbald SL, Kokorelias KM, Embuldeniya G, Wodchis WP. Engagement of patient and family advisors in health system redesign in Canada. J Health Serv Res Policy 2023; 28:25-33. [PMID: 35786052 PMCID: PMC9850384 DOI: 10.1177/13558196221109056] [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] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Globally, there has been a shift towards integrated care delivery and patient-centredness in the design of health services. Such a transformation is underway in Ontario, which is progressively using an interprofessional team-based approach known as Ontario Health Teams (OHTs) to deliver care. During their initial development, OHTs were required to integrate patient and families' preferences, experiences and opinions in the form of consultation and partnership with patient and family advisors (PFAs). This study aimed to understand how PFAs were involved in the early stages of planning for health system change and the perceived benefits of including PFAs in system reform. METHODS This study used a qualitative descriptive design. Semi-structured interviews were conducted with 126 participants at 12 OHTs, including PFA (n = 16) and non-PFA (n = 110) members (e.g. clinicians). Data were analysed thematically. RESULTS We identified four themes; mechanisms of engagement, motivations to engage, challenges to PFA engagement and PFAs' impact and added value. Overall, participants viewed PFA engagement positively and PFAs felt valued and empowered. There remain logistical challenges around PFA compensation, and the amount of time and training expected of PFAs. However, all participants believed that developing an understanding of the patient, caregiver and family experience will strengthen the engagement of PFAs in OHT planning, decisions and policies. CONCLUSIONS Diverse approaches to and stages of PFA engagement fostered meaningful and highly valued contributions to OHT development. These were considered critical to successfully achieving the mandate of patient-centred care reform.
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Affiliation(s)
- Shannon L Sibbald
- Associate Professor, School of
Health Studies, Faculty of Health Sciences, Department of Family Medicine,
Schulich School of Medicine and Dentistry, The Schulich Interfaculty Program in
Public Health, Schulich School of Medicine and Dentistry,
Western
University, London, Canada,Shannon L Sibbald, School of Health
Studies, Faculty of Health Sciences, Department of Family Medicine, Schulich
School of Medicine and Dentistry, The Schulich Interfaculty Program in Public
Health, Schulich School of Medicine and Dentistry, Western University, Room 334,
Arthur & Sonia Labatt Health Sciences Building, 1151 Richmond Street,
London, ON N6A 5B9, Canada.
| | - Kristina M Kokorelias
- Senior Academic Research
Coordinator, Department of Medicine- Geriatrics,
Sinai
Health/University Health Network,
Toronto, ON, Canada
| | - Gayathri Embuldeniya
- Researcher, Institute of Health
Policy, Management and Evaluation, University of
Toronto, Toronto, ON, Canada
| | - Walter P Wodchis
- Research Chair, Institute for
Better Health, Adjunct Scientist at ICES, Professor, Institute of Health Policy,
Management and Evaluation, University of
Toronto, Toronto, ON, Canada
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21
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Bonetti L, Barello S, Franzoso-Sartorio C, Rinaldi MC, Cattaneo A, Tolotti A, Liptrott S, Sari D. Protocol for a pilot and feasibility study evaluating a complex nurse-led patient education intervention to promote cancer patient engagement in healthy lifestyle (O-PHE programme). BMJ Open 2022; 12:e066163. [PMID: 36564120 PMCID: PMC9791443 DOI: 10.1136/bmjopen-2022-066163] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Literature suggests that patient engagement in healthy lifestyle is of crucial importance in ensuring a more effective management of side effects of cancer therapies and better quality of life for patients. While many studies describe educational interventions to promote healthy lifestyles, few are focused on promoting active patient engagement in this field. This protocol paper outlines a study to determine the feasibility of a complex nurse-led patient education intervention aimed to promote cancer patient engagement in a healthy lifestyle. METHOD AND ANALYSIS This is a randomised pilot and feasibility study. Research nurses will recruit 40 adult patients newly diagnosed with cancer. Consenting participants will be randomised to undergo the patient engagement in healthy lifestyle intervention or the control group by means of a four-block randomisation procedure. The intervention will be delivered by a clinical nurse trained in patient engagement strategies. The primary outcome will be a description of study feasibility (recruitment and retention rates, protocol adherence and stakeholder acceptability). Secondary outcomes include changes between and within groups in healthy lifestyle behaviours (ie, increase in healthy diet, smoke cessation or reduction, increase in physical activity), in quality-of-life rates after the intervention, in patient engagement levels, in the perception of the quality of care, in nutritional status; the number of recurrences or the onset of new cancer diagnosis; the number of hospitalization. ETHICS AND DISSEMINATION The study protocol has been approved by the Canton Ticino Ethical Committee (Protocol ID: 2020-02477 TI). The results will be published in peer-reviewed journals and will be presented at national and international congresses. Finally, patients' organisations, such as the Swiss Cancer League, will be involved in the dissemination process. This study will inform the decision to proceed with a randomised controlled trial to assess the effect of this intervention.
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Affiliation(s)
- Loris Bonetti
- Nursing Research Competence Centre, Department of Nursing, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Serena Barello
- EngageMinds Hub Research Center - Faculty of Psychology, Università Cattolica del Sacro Cuore, Milano, Italy
| | - Cristina Franzoso-Sartorio
- Mendrisio Outpatient Clinic, Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), Mendrisio, Switzerland
| | - Maria Claudia Rinaldi
- Mendrisio Outpatient Clinic, Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), Mendrisio, Switzerland
| | - Andrea Cattaneo
- Mendrisio Outpatient Clinic, Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), Mendrisio, Switzerland
| | - Angela Tolotti
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Sarah Liptrott
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Davide Sari
- Department of Nursing, Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
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22
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Sieck CJ, Nicks SE, Salem J, DeVos T, Thatcher E, Hefner JL. Addressing Equity and Social Needs: The New Frontier of Patient Engagement Research. Adv Health Care Manag 2022; 21:151-165. [PMID: 36437621 DOI: 10.1108/s1474-823120220000021008] [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: 06/16/2023]
Abstract
Patient engagement has been a focus of patient-centered care in recent years, encouraging health care organizations to increase efforts to facilitate a patient's ability to participate in health care. At the same time, a growing body of research has examined the impact that social determinants of health (SDOH) have on patient health outcomes. Additionally, health care equity is increasingly becoming a focus of many organizations as they work to ensure that all patients receive equitable care. These three domains - patient engagement, SDOH, and health care equity - can intersect in the implementation of social needs screenings among health care organizations. We present a case study on a two-phase social needs screening implementation project and describe how this process focuses on equity. As health care organizations seek to increase patient engagement, address SDOH, and improve health equity, we highlight the need to move away from a siloed approach and view these efforts as interrelated. By approaching efforts to address these challenges and barriers as the duty of all those involved in the patient care process, there may be larger strides made toward equitable health care.
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Walker VG. Elder's life course theory and person-centered research: A lens for conducting ethical nursing research and mental health nursing practice with older adults aging with the diagnosis of schizophrenia. J Psychiatr Ment Health Nurs 2022; 29:904-914. [PMID: 35020244 DOI: 10.1111/jpm.12819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/17/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Older adults diagnosed with schizophrenia are a vulnerable population owing to the manifestations of their illness, which can include decreased reality orientation, paranoia, hallucinations and delusions. This paper presents ethical principles of vulnerability, veracity, non-maleficence and autonomy for person-centered care in mental health nursing research and practice, focused with the lens of Elder's life course theory (LCT). AIM To present Elder's LCT as an ethical lens for person-centered care as nurses engage with older adults aging with the diagnosis of schizophrenia in clinical practice and/or research. METHOD Four ethical principles fundamental to nursing research and mental health practice are presented, with Elder's LCT as a theoretical lens for person-centered care. RESULTS A model for ethical research and mental health practice with older adults diagnosed with schizophrenia. DISCUSSION Nursing research and mental health nursing practice with an ethical LCT lens for person-centered can help nurses envision, explore and generate interventions to address the special needs of older adults aging with schizophrenia. IMPLICATIONS FOR PRACTICE The use of a LCT lens for person-centered care can encourage nurses in research and mental health practice to seek information collaboratively with older adults diagnosed with schizophrenia in a thoughtful, ethical manner, to inform the improvement of their health outcomes and health policy.
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Chan BHT, Snowdon DA, Williams CM. Describing characteristics clinicians believe predictive of patient reported outcomes after adult's ankle fracture - A modified Delphi study. Musculoskelet Sci Pract 2022; 62:102632. [PMID: 35933826 DOI: 10.1016/j.msksp.2022.102632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite explanatory studies have identified a wide range of modifiable and non-modifiable characteristics, uncertainty persists as to what characteristics are predictive of patient reported outcome following ankle fracture in adults, therefore hindering the selection of candidate variables in prognostic models without compromising the accuracy. OBJECTIVE To establish consensus-based characteristics which clinicians believe are predictive of patient reported outcomes following ankle fracture. DESIGN Three-round online modified Delphi survey. METHODS In Round 1, participants provided responses to open-ended questions, as to what characteristics within the first eight weeks following ankle fracture are predictive of short- (<6 months), medium- (6 months-2 years) and long-term (>2 years) patient reported outcome. Rounds 2 and 3 presented consensus and gathered agreement on statements. RESULTS Twenty participants answered the open-ended questions, including 13 physiotherapists and seven orthopaedic/trauma surgeons. Participants reached consensus for fracture characteristics and agreement for age, recovery of signs and symptoms, fracture management complexity, medical comorbidities, mental health status and patient journey at the short-term timepoint; agreement for age, engagement in recovery process, recovery of signs and symptoms, fracture characteristics, medical comorbidities and socioeconomic status at the medium-term timepoint; agreement for engagement in recovery process, fracture characteristics and medical comorbidities at the long-term timepoint. CONCLUSION Clinicians believed in certain modifiable and non-modifiable characteristics predictive of patient reported outcome following ankle fracture. Our findings may provide insights about characteristics which can be selected in prognostic model development and future explanatory studies, allowing targeting adults at risk of developing long-standing symptoms and disability.
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Affiliation(s)
- Billy H T Chan
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, 3199, Australia.
| | - David A Snowdon
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, 3199, Australia; Peninsula Health, Academic Unit, Frankston, Victoria, 3199, Australia; National Centre for Healthy Ageing, Melbourne, Australia.
| | - Cylie M Williams
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, 3199, Australia; Peninsula Health, Academic Unit, Frankston, Victoria, 3199, Australia.
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Graffigna G, Barello S. How does patient engagement work in a real-world setting? Recommendations, caveats, and challenges from a psychosocial perspective. PATIENT EDUCATION AND COUNSELING 2022; 105:3567-3573. [PMID: 36008187 DOI: 10.1016/j.pec.2022.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To propose a possible taxonomy for diverse stakeholders outside the healthcare communication field and to promote meaningful patient engagement in healthcare settings. Moreover, to support them in making more coherent policy, strategy, and practice decisions to enhance patient participation in their healthcare systems. DISCUSSION This paper is part of the pEACH Position Papers Series and provides a critical and experience-based reflection on patient engagement in different healthcare-related settings. We propose a framework that operationalises actionable patient engagement at the micro-meso-macro levels. Finally, the authors will highlight some "points of attention" that need to be addressed to support patient engagement implementation in healthcare organisations. CONCLUSION AND PRACTICE IMPLICATIONS Understanding and systematising the established meanings of patient engagement through a psychosocial lens is critical to addressing the following questions: "how can various health care organisations ensure that authentic patient engagement informs decision-making and strategies", "how can these organisations build authentic connections with their patients", and importantly, "how can patients gain valuable and reliable insights through patient engagement"? Answering these questions can enable key stakeholders to make informed decisions that ensure the quality and effectiveness of patient engagement initiatives in different healthcare settings.
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Affiliation(s)
- Guendalina Graffigna
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan and Cremona, Italy; Department of Psychology, Università Cattolica del Sacro Cuore, L.go Gemelli 1, 20123 Milan, Italy; Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, Via Bissolati 74, 26100 Cremona, Italy
| | - Serena Barello
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan and Cremona, Italy; Department of Psychology, Università Cattolica del Sacro Cuore, L.go Gemelli 1, 20123 Milan, Italy; Faculty of Psychology, Università Cattolica del Sacro Cuore, L.go Gemelli 1, 20123 Milan, Italy.
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Anderson E, Dvorin K, Etingen B, Barker AM, Rai Z, Herbst AN, Mozer R, Kingston RP, Bokhour BG. 'It Makes You Sit Back and Think Where You Wanna Go': Veteran experiences in virtual whole health peer-led groups. Health Expect 2022; 25:2548-2556. [PMID: 35957491 PMCID: PMC9615064 DOI: 10.1111/hex.13581] [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: 04/29/2022] [Revised: 07/28/2022] [Accepted: 07/31/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The Veterans Health Administration (VHA) is building a Whole Health system of care that aspires to empower and equip each Veteran to pursue a personally meaningful vision of health and well-being. As part of this effort, VHA has developed Taking Charge of My Life and Health (TCMLH), a peer-led, group-based programme that seeks to support Veterans in setting and pursuing health and well-being goals. Prior research showed TCMLH groups to positively impact Veteran outcomes; yet, little is known about Veterans' own experiences and perspectives. METHODS We completed semi-structured telephone interviews with 15 Veterans across 8 sites who had participated in TCMLH groups offered by the VHA in the virtual format between Summer 2020 and Fall 2021. Inductive thematic analysis was applied to interview transcripts to generate themes. FINDINGS We identified five themes regarding Veterans' experiences with TCMLH: (1) navigating the virtual format; (2) internalizing the value of health engagement; (3) making healthy lifestyle changes; (4) forging social connections; and (5) taking on a more active role in healthcare. CONCLUSION Veterans perceived virtual TCMLH groups as meaningful and beneficial, yet also highlighted several challenges. Their perspectives speak to the need to supplement time-limited programmes like TCMLH with ongoing, community-based support. Virtual group-based well-being programmes are a promising innovation. Other healthcare systems may draw on VHA's experience while tailoring format and content to the needs of their patient populations. PATIENT OR PUBLIC CONTRIBUTION Veterans were involved as evaluation participants. A Veteran consultant, who is a coauthor on this paper, was engaged through the conceptualization of the evaluation, development of data collection materials (interview guide) and writing.
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Affiliation(s)
- Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
| | - Kelly Dvorin
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare (CINCCH)Edward Hines Jr. VA HospitalHinesIllinoisUSA
| | - Anna M. Barker
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Zenith Rai
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Abigail N. Herbst
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Reagan Mozer
- Department of Mathematical SciencesBentley UniversityWalthamMassachusettsUSA
| | - Rodger P. Kingston
- Veteran Engagement in Research Group, Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Barbara G. Bokhour
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
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Tolotti A, Barello S, Vignaduzzo C, Liptrott SJ, Valcarenghi D, Nania T, Sari D, Bonetti L. Patient Engagement in Oncology Practice: A Qualitative Study on Patients' and Nurses' Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11644. [PMID: 36141919 PMCID: PMC9517681 DOI: 10.3390/ijerph191811644] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
Patient engagement has gained increasing attention in cancer care as it is widely acknowledged as an essential element of high-quality care. There are limited data on how oncology nurses might apply techniques that encourage patient engagement. Therefore, this study aims to understand which nursing strategies can favour patient engagement in oncological care from patients' and nurses' perspectives. We conducted a qualitative study involving oncology patients and oncology nurses. Patients were interviewed, while nurses were involved in focus groups (FGs). Both interviews and FGs were analysed by the means of thematic analysis. We interviewed six patients and conducted two FGs, involving 17 nurses. Five themes were identified from patients' interviews: effective information, having the opportunity to choose, being considered a person, trusted relationship with nurses, and receiving support and advice. Additionally, five themes were identified from the FGs: the nurse-patient relationship, personalisation of care, information style, engagement strategies, and the team. The participants highlighted the importance of comprehensive information in order for patients to feel more involved. Great importance was given to the nurse-patient relationship, which must be based on trust and mutual respect. Both nurses and patients emphasised the importance of person-centred care. A more systematic implementation of suggestions from the participants in this study is desirable for the future.
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Affiliation(s)
- Angela Tolotti
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland
| | - Serena Barello
- EngageMinds HUB—Consumer, Food & Health Engagement Research Center, Department of Psychology, Università Cattolica del Sacro Cuore, Milano and Cremona, L.Go Gemelli 1, 20123 Milan, Italy
| | - Camilla Vignaduzzo
- EngageMinds HUB—Consumer, Food & Health Engagement Research Center, Department of Psychology, Università Cattolica del Sacro Cuore, Milano and Cremona, L.Go Gemelli 1, 20123 Milan, Italy
| | - Sarah Jayne Liptrott
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland
- Nursing Development and Research Unit, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale (EOC), Via Ospedale 12, 6500 Bellinzona, Switzerland
| | - Dario Valcarenghi
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland
| | - Tiziana Nania
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 2, San Donato Milanese, 20097 Milan, Italy
| | - Davide Sari
- Department of Nursing, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland
| | - Loris Bonetti
- Nursing Research Competence Centre, Department of Nursing, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland or
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Via Violino, 11, 6928 Manno, Switzerland
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Turk E, Wontor V, Vera-Muñoz C, Comnes L, Rodrigues N, Ferrari G, Moen A. Human-centered integrated care pathways for co-creating a digital, user-centric health information solution. JOURNAL OF INTEGRATED CARE 2022. [DOI: 10.1108/jica-01-2022-0007] [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
PurposeA broader challenge of co-creating digital solutions with patients addresses the question how to apply an open-access digital platform with trusted digital health information as a measure to transform the way patients access and understand health information. It further addresses use this for adherence to treatment, risk minimization and quality of life throughout the integrated patient journey. The aim of this paper is to demonstrate the early steps in towards progress to co-creating the digital solution.Design/methodology/approachTo coordinate the co-creation process, the authors established a multiphased plan to deep-dive into user needs and behaviors across patient journeys, to identify nuances and highlight important patterns in stakeholder and end-user segment at various stages in the patient's journey.FindingsA set of tools was designed to serve as a human-centered compass throughout the lifecycle of the project. Those tools include shared objects; personas, user journeys, a set of performance indicators with related requirements – all those tools being consistently refined in ongoing co-creation workshops with members of the cross-functional stakeholder groups.Originality/valueIn this study, a multidisciplinary, public-private partnership looked at integrated digital tool to improve access, understanding and adherence to treatment for diverse groups of patients across all stages of their health journeys in a number of countries including European Union (EU) and United States of America (USA). As a result of this work, the authors attempt to increase the possibility that the improved availability and understanding of health information from trusted sources translates to higher levels of adherence to treatment, safer use of medication (pharmacovigilance), better health outcomes and quality of life integrated in the patient's journey.
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Anderson G, Rega ML, Casasanta D, Graffigna G, Damiani G, Barello S. The association between patient activation and healthcare resources utilization: a systematic review and meta-analysis. Public Health 2022; 210:134-141. [PMID: 35970015 DOI: 10.1016/j.puhe.2022.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/11/2022] [Accepted: 06/19/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To measure the association between patient activation and hospitalization or emergency department (ED) visits among adults with chronic diseases. STUDY DESIGN Systematic review and meta-analysis. METHODS A systematic review of English articles was performed using the following databases: PubMed, Cochrane Library, Web of Science, PsycINFO, and Embase. Articles were searched from 2005 until July 2021. Observational studies that measured the association between patient activation, measured by the Patient Activation Measure (PAM), and hospitalization or ED visits among adults with chronic or multichronic diseases were included. Pairs of reviewers independently screened the studies and extracted data for qualitative and quantitative synthesis. The methodological quality was assessed using the Quality in Prognostic Studies (QUIPS) tool. RESULTS A total of nine observational studies (153,121 participants) were included in the qualitative synthesis, whereas six were pooled in the quantitative synthesis (151,359 participants). High levels of patient activation were significantly associated with a reduced risk for both hospitalizations (RR [95% CI] = 0.69 [0.61; 0.77], I2 = 78%) and ED visits (RR [95% CI] = 0.76 [0.70; 0.84], I2 = 72%). CONCLUSIONS Our findings suggest the existence of an inverse association between patient activation and healthcare resources utilization. Further observational studies are needed to fully comprehend the magnitude of this association.
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Affiliation(s)
- G Anderson
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome, 00133, Italy
| | - M L Rega
- School of Nursing, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, Rome, 00168, Italy
| | - D Casasanta
- Children Hospital Bambino Gesù, Piazza di Sant'Onofrio, 4, 00165, Roma, Italy
| | - G Graffigna
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milan, 20123, Italy; EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Milan, 20123, Italy; Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, via Milano 24, Cremona, 26100, Italy
| | - G Damiani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, Rome, 00168, Italy; Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, Rome, 00168, Italy
| | - S Barello
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milan, 20123, Italy; EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Milan, 20123, Italy.
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Do Patient Engagement IT Functionalities Influence Patient Safety Outcomes? A Study of US Hospitals. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:505-512. [PMID: 35867503 DOI: 10.1097/phh.0000000000001562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patient engagement using health information technology (IT) functionalities can be a powerful tool in managing their own care for better health outcomes. Therefore, this study explores whether patient engagement IT functionalities and electronic health record (EHR) can affect patient safety outcomes. DESIGN Using longitudinal study design for general acute care hospitals within the United States, we examine the interaction effects of EHR and patient engagement IT functionalities on patient safety outcomes (adverse incident rate) using a generalized estimating equation. SETTING Our national sample consisted of 9759 hospital-year observations from 2014 to 2018. Overall, we found a significant association between adverse incident rate and patient engagement level and EHR adoption level. RESULTS On average, as the combined effects of patient engagement level and EHR adoption level increases, the adverse incident rate decreases by approximately 0.49 (P < .01). Incorporating patient engagement functionalities is becoming an essential tool to improve health outcomes and will play an instrumental role in meeting meaningful use standards. CONCLUSIONS Our study provides insights into the potential synergy between a hospital's existing EHR maturity and patient engagement health IT functionalities in affecting organizational performance. Organizational culture and capabilities pertinent to adopting patient engagement health IT functionalities infrastructure should be established first to provide the impetus for this synergy.
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Bonetti L, Tolotti A, Anderson G, Nania T, Vignaduzzo C, Sari D, Barello S. Nursing interventions to promote patient engagement in cancer care: A systematic review. Int J Nurs Stud 2022; 133:104289. [PMID: 35751947 DOI: 10.1016/j.ijnurstu.2022.104289] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patient engagement is becoming increasingly relevant in cancer care. Nurses have been recognized as crucial in promoting active engagement of people with carcer. Despite the growing interest on this topic and the relevance of patient engagement interventions to improve patient' conditions, to the best of our knowledge there is no synthesis of the literature on the characteristics and impact of nurse-led patient engagement intervention for adults with cancer. OBJECTIVE This review aims to systematically summarize nurse-led patient engagement interventions for adult patients diagnosed with cancer and to describe the state of the art on the impact of these interventions on patients' outcomes. DESIGN Systematic review. SETTING(S) Hospital and outpatient care. PARTICIPANTS Adults with cancer. METHODS We searched PubMed, CINAHL, Embase, Scopus, Web of Science and Cochrane library from 2005 to 2021. We included randomized clinical trials, quasi-experimental studies and single-arm, pre-test/post-test studies written in English, Spanish, French and Italian. All the included articles reported nurse-led patient engagement interventions designed to improve patient engagement in the management of their own disease and to assess outcomes related to patient engagement. We appraised the methodological quality of the included articles with the Joanna Briggs Institute appraisal tools. RESULTS Twenty-four articles met the inclusion criteria. Four distinct types of nurse-led engagement interventions, showing different degrees of complexity, were classified: (i) generic health information delivery, (ii) patient-specific information delivery, (iii) personalized decision support and (iv) motivational support. These interventions were effective in supporting behavioral changes and reducing symptoms burden of adults with cancer. In addition, many of the retrieved studies showed significant increase in patients' knowledge, informed decisions making, perceived quality of nurse-patient interaction and quality of life after the engagement intervention. CONCLUSIONS This systematic review summarized a wide variety of nurse-led patient engagement interventions with different degrees of complexity. In addition, a significant positive effect of these interventions was found on outcomes such as patient activation, self-efficacy, health literacy and quality of life. Among those identified, nurse-led motivational interventions appear to be the most effective ones for improving engagement outcomes in adults with cancer. REGISTRATION NUMBER PROSPERO Nr: CRD42020146189.
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Affiliation(s)
- Loris Bonetti
- Nursing Research Competence Centre, Department of Nursing, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland; University of Applied Sciences and Arts of Southern Switzerland, Department of Business Economics, Health and Social Care, Via Violino, 11, Manno 6928, Switzerland.
| | - Angela Tolotti
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, Bellinzona, Switzerland.
| | - Gloria Anderson
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Tiziana Nania
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
| | - Camilla Vignaduzzo
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Department of Phychology, Università Cattolica del Sacro Cuore, Milano and Cremona, L.Go Gemelli 1, 20123 Milan, Italy.
| | - Davide Sari
- Department of Nursing, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, Bellinzona, Switzerland.
| | - Serena Barello
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Department of Phychology, Università Cattolica del Sacro Cuore, Milano and Cremona, L.Go Gemelli 1, 20123 Milan, Italy.
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Rzadkiewicz M, Jaworski M, Włodarczyk D. The Brave Patient after 80-Satisfaction with Visit and Individual Determinants of Proactive Patient Attitude among the Oldest General Practice Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106214. [PMID: 35627751 PMCID: PMC9140419 DOI: 10.3390/ijerph19106214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 12/04/2022]
Abstract
Background. A patient’s adherence to a course of treatment depends on the individual’s activation, the quality of patient–clinician relations, attitudes, self-efficacy, or positive emotions. Patient proactive attitude (PAA) is seldom researched among the oldest healthcare users. This study was designed to identify predictors of PAA toward health and treatment among community-dwelling general practice patients aged 80+, and was based on a PRACTA (PRomoting ACTive Aging) project. Methods. Patients (n = 658), aged 80+ visiting a general practitioner (GP) filled in the PRACTA attitude toward treatment and health scale and the PRACTA self-efficacy scale questionnaires. Sociodemographic factors, self-reported health status, and satisfaction with the visit were analyzed as independent factors. Results. Attitudes toward treatment and health scores were predicted by marital status, living alone or not alone, hospitalization the prior year, level of impairment, and satisfaction with visit. However, some differences were observed depending on the device’s subscale. Self-efficacy score was determined by marital status, living alone or not alone, prior hospitalization, and satisfaction with visit. We did not find an effect of age or gender on PAA. Patient satisfaction with visit was the strongest predictor of all PAA dimensions. Conclusion. Higher visit satisfaction helps to retain a PAA among seniors 80+. Screening questions about living situation, marital and functional status, emotional state, and recent history of hospitalization might help GPs additionally anticipate PAA level and adjust their actions accordingly.
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Affiliation(s)
- Marta Rzadkiewicz
- Department of Health Psychology, Medical University of Warsaw, 01-575 Warsaw, Poland;
- Correspondence: ; Tel.: +48-22-116-9211
| | - Mariusz Jaworski
- Department of Education and Research in Health Sciences, Medical University of Warsaw, 01-575 Warsaw, Poland;
| | - Dorota Włodarczyk
- Department of Health Psychology, Medical University of Warsaw, 01-575 Warsaw, Poland;
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Frías CE, Casafont C, Cabrera E, Zabalegui A. Validation of the Spanish Version of the Double Knowledge Expectations and Received Knowledge Significant Other Scale for Informal Caregivers of People with Dementia (KESO-DEM/RKSO-DEM). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5314. [PMID: 35564708 PMCID: PMC9104362 DOI: 10.3390/ijerph19095314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/06/2022] [Accepted: 04/22/2022] [Indexed: 12/07/2022]
Abstract
Dementia is associated with cognitive decline. Becoming an informal caregiver raises questions, requiring information and support from health professionals to guide home care. A multicenter, longitudinal study was carried out to validate the Spanish version of the double scale of expected and received knowledge for informal caregivers of people with dementia (KESO-DEM/RKSO-DEM), the analysis of the dimensional structure of the instrument, its validity and reliability, and temporary stability was carried out. An analysis of criterion and construct validity, internal consistency, and test−retest stability was performed. The evaluation of the interrelation between dimensions was statistically significant. Regarding internal consistency, the scale values were good both for the scale totals and for each dimension of knowledge, with Cronbach’s alpha coefficients of 0.97. For criterion validity, all items showed temporal stability for both questionnaires (p < 0.05). The availability of a valid, reliable tool for the measurement of expected and received knowledge in caregivers of people with dementia allows an approach based on the real needs of the family and the patient. It is important to design care protocols for people with dementia that are adapted to their needs and expectations and to their non-curative treatment, to improve the emotional well-being of patients and informal caregivers.
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Affiliation(s)
- Cindy E. Frías
- Hospital Clinic of Barcelona, 08836 Barcelona, Spain; (C.E.F.); (C.C.)
| | - Claudia Casafont
- Hospital Clinic of Barcelona, 08836 Barcelona, Spain; (C.E.F.); (C.C.)
| | - Esther Cabrera
- School of Health Sciences, TecnoCampus, Pompeu Fabra University, 08302 Mataro, Spain;
- Department of Care Management and Social Work, Sechenov University, 119435 Moscow, Russia
| | - Adelaida Zabalegui
- Department of Nursing, Hospital Clinic of Barcelona, 08836 Barcelona, Spain
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Cengiz D, Agrali H, Korkmaz F, Akyar I. Mediation role of patient engagement on the association between health literacy and self-care behaviours in individuals with type 2 diabetes. Int J Nurs Pract 2022; 28:e13051. [PMID: 35318773 DOI: 10.1111/ijn.13051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/26/2022] [Accepted: 02/27/2022] [Indexed: 11/30/2022]
Abstract
AIM This study examined the relationship between health literacy and self-care behaviours among individuals with type 2 diabetes and whether the association is mediated by patient engagement. METHODS This cross-sectional study was conducted between November 2019 and September 2020. The sample consisted of 218 participants with type 2 diabetes, older than 18 years old, applying to two endocrine outpatient clinics in Turkey. Multiple regression analyses were performed to identify the relationship between health literacy and self-care behaviours. The Sobel test method was used to examine the mediation role of patient engagement. RESULTS Sample characteristics included mean age of 53.7 years, 57.3% were female and the mean A1C was 7.8%. The regression equation analyses demonstrated that health literacy (β = 0.219, P < 0.05) and patient engagement (β = 2.844, P < 0.05) significantly predicted diabetes self-care behaviours. Patient engagement served a mediational role in the association of health literacy and self-care behaviours (z value = 2.049, P < 0.02). CONCLUSION Given the relationship between health literacy and diabetes self-care behaviours, the patient engagement concept presented a practical insight into the applicability of health-related information. Clinicians are recommended to consider patients' health literacy and engagement levels while planning customized interventions to facilitate diabetes management.
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Affiliation(s)
- Dilara Cengiz
- Faculty of Nursing, Department of Fundamentals of Nursing, Hacettepe University, Ankara, Turkey
| | - Hatice Agrali
- Faculty of Health Sciences, Department of Internal Medicine Nursing, Suleyman Demirel University, Isparta, Turkey
| | - Fatos Korkmaz
- Faculty of Nursing, Department of Fundamentals of Nursing, Hacettepe University, Ankara, Turkey
| | - Imatullah Akyar
- Faculty of Nursing, Department of Fundamentals of Nursing, Hacettepe University, Ankara, Turkey
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Massaroni V, Delle Donne V, Ciccarelli N, Lombardi F, Lamonica S, Borghetti A, Ciccullo A, Di Giambenedetto S. HIV-Related Internalized Stigma and Patient Health Engagement Model in an Italian Cohort of People Living With HIV. Psychol Rep 2022; 126:1181-1200. [PMID: 35015591 DOI: 10.1177/00332941211057142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The care engagement of people living with HIV (PLWH) measured with the patient health engagement (PHE) model and its association with HIV-related internalized stigma are not well established. Indeed, currently there are no data yet about the engagement of PLWH measured with the PHE model. This study aimed to evaluate the effects of HIV-related internalized stigma on care engagement and mental health and to fill the lack of data on PHE model applied to PLWH. We found that the internalized stigma score was significantly higher for PLWH (n=82) in worse care engagement phase and both higher internalized stigma scores and worse engagement were associated to major depression symptoms.In conclusion, our findings describe for the first time the engagement in care of PLWH measured with PHE and highlight the importance of PLWH support to find strategies to cope stigma-related stress and optimize their care engagement.
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Affiliation(s)
- Valentina Massaroni
- Infectious Diseases Institute, Department of Safety and Bioethics, 60234Catholic University of Sacred Heart, Rome, Italy
| | - Valentina Delle Donne
- Infectious Diseases Institute, Department of Safety and Bioethics, 60234Catholic University of Sacred Heart, Rome, Italy
| | | | - Francesca Lombardi
- UOC Infectious Diseases, 18654Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Lamonica
- UOC Infectious Diseases, 18654Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alberto Borghetti
- UOC Infectious Diseases, 18654Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Simona Di Giambenedetto
- Infectious Diseases Institute, Department of Safety and Bioethics, 60234Catholic University of Sacred Heart, Rome, Italy.,UOC Infectious Diseases, 18654Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Graffigna G, Palamenghi L, Barello S, Savarese M, Castellini G, Lozza E, Bonanomi A. Measuring citizens' engagement during emergencies: Psychometric validation of the Public Health Engagement Scale for Emergency Settings (PHEs-E). PLoS One 2021; 16:e0261733. [PMID: 34936693 PMCID: PMC8694417 DOI: 10.1371/journal.pone.0261733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/07/2021] [Indexed: 12/31/2022] Open
Abstract
The Covid-19 pandemic has highlighted the importance of citizens' behaviors in the containment of the virus. Individuals might change their intention to adhere to public health prescriptions depending on various personal characteristics, including their own emotional status, which has been recognized to be a crucial psychological factor in orienting people's adherence to public health recommendation during emergency settings. In particular, it is crucial to support citizens' alliance with authorities and feeling of trust: public engagement is a concept that refers to the general involvement of citizens into public affairs which is generally considered an effective approach to enhance citizens' understanding of their crucial role in public affairs. However, so far there is no agreement on the metrics and indexes that should be used to measures public engagement during a health crisis. The aim of this paper is to validate a psychometric scale (PHEs-E), which intends to measure the readiness of individuals to adhere to the prescribed behavioral change to contain the emergency. Data were collected throughout the pandemic in Italy: in particular, five independent samples were recruited starting from March 2020 to March 2021. Results showed that the proposed measure has good psychometric characteristics. A general linear model was computed to assess the differences of public engagement across the different data points and among citizens with different sociodemographic characteristics. Correlations with other psychological constructs (i.e. Anxiety, Depression and Self-Efficacy) were also tested, showing that more engaged citizens have a lower level of anxiety and depression, and a higher self-efficacy. This study's findings indicate that individuals' characteristics may differentiate citizens' motivation to engage in public health behavioral recommendation to prevent the COVID-19 contagion. However the scale could be useful to perform a psychological monitoring of psychological readiness to engage in public health strategies to face critical events and settings.
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Affiliation(s)
- Guendalina Graffigna
- Engageminds HUB – Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Faculty of Agricultural, Nutrition and Environmental Sciences, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Lorenzo Palamenghi
- Engageminds HUB – Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Faculty of Agricultural, Nutrition and Environmental Sciences, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Serena Barello
- Engageminds HUB – Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Mariarosaria Savarese
- Engageminds HUB – Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
- Faculty of Agricultural, Nutrition and Environmental Sciences, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Greta Castellini
- Engageminds HUB – Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
- Faculty of Agricultural, Nutrition and Environmental Sciences, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Edoardo Lozza
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Andrea Bonanomi
- Department of Statistical Science, Università Cattolica del Sacro Cuore, Milan, Italy
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Schusselé Filliettaz S, Moiroux S, Marchand G, Gilles I, Peytremann-Bridevaux I. Realist evaluation of a pilot intervention implementing interprofessional and interinstitutional processes for transitional care. Home Health Care Serv Q 2021; 40:302-323. [PMID: 34689706 DOI: 10.1080/01621424.2021.1989356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In 2016, in Switzerland, we implemented transitional interprofessional and interinstitutional shared decision-making processes (IIPs) between a short-stay inpatient care unit (SSU) and primary care professionals. Between 2018 and 2019, we evaluated this intervention using a realist design to answer the following questions: for whom, with whom, in which context and how have IIPs been implemented? Our initial theory was tested via interviews with patients, primary care professionals and staff from the SSU. Results showed that a patient's stay at the SSU, with actors committed to facilitating IIPs, reinforced the perceived appropriateness and implementation of those IIPs. However, this appropriateness varied according to different contextual elements, such as the complexity of needs, preexisting collaborative practices and the purpose of the inpatient stay. Since IIPs occurred in a context of fragmented practices, proactive and sustained efforts are required of the actors implementing them and the organizations supporting them.
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Affiliation(s)
- Séverine Schusselé Filliettaz
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.,Association for the Promotion of Integrated Patient Care Networks (PRISM), Geneva, Switzerland
| | | | | | - Ingrid Gilles
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Hamilton CB, Dehnadi M, Snow ME, Clark N, Lui M, McLean J, Mamdani H, Kooijman AL, Bubber V, Hoefer T, Li LC. Themes for evaluating the quality of initiatives to engage patients and family caregivers in decision-making in healthcare systems: a scoping review. BMJ Open 2021; 11:e050208. [PMID: 34635521 PMCID: PMC8506891 DOI: 10.1136/bmjopen-2021-050208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To identify the key themes for evaluating the quality of initiatives to engage patients and family caregivers in decision-making across the organisation and system domains of healthcare systems. METHODS We conducted a scoping review. Seven databases of journal articles were searched from their inception to June 2019. Eligible articles were literature reviews published in English and provided useful information for determining aspects of engaging patients and family caregivers in decision-making to evaluate. We extracted text under three predetermined categories: structure, process and outcomes that were adapted from the Donabedian conceptual framework. These excerpts were then independently open-coded among four researchers. The subsequent themes and their corresponding excerpts were summarised to provide a rich description of each theme. RESULTS Of 7747 unique articles identified, 366 were potentially relevant, from which we selected the 42 literature reviews. 18 unique themes were identified across the three predetermined categories. There were six structure themes: engagement plan, level of engagement, time and timing of engagement, format and composition, commitment to support and environment. There were four process themes: objectives, engagement approach, communication and engagement activities. There were eight outcome themes: decision-making process, stakeholder relationship, capacity development, stakeholder experience, shape policy/service/programme, health status, healthcare quality, and cost-effectiveness. CONCLUSIONS The 18 themes and their descriptions provide a foundation for identifying constructs and selecting measures to evaluate the quality of initiatives for engaging patients and family caregivers in healthcare system decision-making within the organisation and system domains. The themes can be used to investigate the mechanisms through which relevant initiatives are effective and investigate their effectiveness.
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Affiliation(s)
- Clayon B Hamilton
- Evaluation and Research Services, Fraser Health Authority, Surrey, British Columbia, Canada
- Primary Care Division, Ministry of Health, Victoria, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maryam Dehnadi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - M Elizabeth Snow
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada
| | - Nancy Clark
- Faculty of Human and Social Development, University of Victoria, Victoria, British Columbia, Canada
| | - Michelle Lui
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Janet McLean
- Family Caregivers of British Columbia, Victoria, British Columbia, Canada
| | - Hussein Mamdani
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Allison L Kooijman
- Patient Voices Network, BC Patient Safety and Quality Council, Vancouver, British Columbia, Canada
- School of Interdisciplinary Studies, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vikram Bubber
- Patient Voices Network, BC Patient Safety and Quality Council, Vancouver, British Columbia, Canada
| | - Tammy Hoefer
- BC Patient Safety and Quality Council, Vancouver, British Columbia, Canada
| | - Linda C Li
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Graffigna G. Patient engagement as a crucial asset of preclinical biomedical research. EBioMedicine 2021; 71:103528. [PMID: 34419926 PMCID: PMC8385174 DOI: 10.1016/j.ebiom.2021.103528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- G Graffigna
- Director of EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Cremona, Italy.
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40
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Savarese M, Castellini G, Leone S, Previtali E, Armuzzi A, Graffigna G. Psychological reaction to Covid-19 of Italian patients with IBD. BMC Psychol 2021; 9:115. [PMID: 34362456 PMCID: PMC8343359 DOI: 10.1186/s40359-021-00622-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/31/2021] [Indexed: 12/29/2022] Open
Abstract
Background Patients with inflammatory bowel disease (IBD) may be particularly vulnerable to the effects of the novel coronavirus (Covid-19) on disease management and psychological status. This study explored psychological reactions to the Covid-19 emergency and IBD disease management in a sample of Italian patients. Methods An online questionnaire was designed to assess general concerns, psychological reaction, disease management, socio-demographics, and clinical information with validated scales and ad hoc items. A non-probabilistic purposive sample was selected, comprised patients with IBD who belonged to the Italian Association for patients with IBD (AMICI Onlus) completed the questionnaire in April 2020. Data obtained were analyzed using descriptive statistics, student’s T-test for independent groups, and one-way ANOVA (Analysis of Variance). Results One thousand fourteen eligible questionnaires were analyzed. Italian patients with IBD appeared to be very worried about the Covid-19 emergency (60.7%) and concerned about the risks of infection (59%). Half of the sample reported medium to high-perceived stress, and 74% had low-medium coping self-efficacy levels. One third was in a state of psychological arousal. Twenty-nine percent of patients had canceled hospital appointments for fear of contracting the virus. The majority of responders believed that belonging to the Italian Association for Patients with IBD - AMICI Onlus - is useful. Conclusions The results revealed that this sample of Italian patients with IBD lived with medium level of stress and with inadequate coping self-efficacy regarding disease management. Accordingly, Covid-19 may affect self-management behaviors. Therefore, national and regional associations for patients with IBD, should largely support these patients in this emergency. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00622-6.
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Affiliation(s)
- Mariarosaria Savarese
- EngageMinds HUB - Consumer, Food and Health Engagement Research Center, Faculty of Agricultural, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, Via Milano, 24, 26100, Cremona, Italy
| | - Greta Castellini
- EngageMinds HUB - Consumer, Food and Health Engagement Research Center, Faculty of Agricultural, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, Via Milano, 24, 26100, Cremona, Italy.
| | | | | | - Alessandro Armuzzi
- Associazione AMICI Onlus, Milan, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Guendalina Graffigna
- EngageMinds HUB - Consumer, Food and Health Engagement Research Center, Faculty of Agricultural, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, Via Milano, 24, 26100, Cremona, Italy
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41
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Vick JB, Wolff JL. A Scoping Review of Person and Family Engagement in the context of Multiple Chronic Conditions. Health Serv Res 2021; 56 Suppl 1:990-1005. [PMID: 34363217 DOI: 10.1111/1475-6773.13857] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review definitions, concepts, and evidence regarding person and family engagement for persons with multiple chronic conditions (MCC) in order to identify opportunities to advance the field. DATA SOURCE Ovid MEDLINE STUDY DESIGN: We performed a two-step process: (1) a critical review of conceptual models of engagement to identify key concepts most pertinent to engagement among persons with MCC as a "launch pad" to our scoping review, and (2) a scoping review of reviews of engagement for persons living with MCC. DATA COLLECTION/EXTRACTION METHODS First, we critically reviewed six models of engagement. Second, our scoping review identified 1297 citations, with 67 articles meeting criteria for inclusion. Of these, we focused on reviews, of which there were nine titles/abstracts retained for full text consideration. Six full-text reviews were included in the final analysis. The purpose, review type, population, number/type of included studies, theoretical framework, and findings of each study were extracted and analyzed thematically. PRINCIPAL FINDINGS Conceptual models of engagement differ with respect to areas of emphasis (e.g., systems or clinical encounters) as well as attention to vulnerable populations; involvement of family; consideration of cost-benefit tradeoffs; and attention to outcomes that matter most. Our scoping review of reviews identified just one article explicitly focused on engagement interventions for those with MCC. Other reviews examined elements of self-management and involvement in decision-making, conceptually related to engagement without explicit use of the word. We find that existing evidence has predominantly described individual-level strategies rather than targeting organizations, systems, or policies. Barriers to engagement are not well described, nor are potential downsides to engagement. Family engagement is rarely considered. CONCLUSIONS Promising areas of future work include attention to barriers to engagement including trust, goal-based care, the design of structural changes to care delivery, tradeoffs between benefits and costs, and family engagement. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Judith B Vick
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer L Wolff
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Martinsson C, Uhlin F, Wenemark M, Eldh AC. Preference-based patient participation for most, if not all: A cross-sectional study of patient participation amongst persons with end-stage kidney disease. Health Expect 2021; 24:1833-1841. [PMID: 34337836 PMCID: PMC8483194 DOI: 10.1111/hex.13323] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/22/2021] [Accepted: 07/15/2021] [Indexed: 01/25/2023] Open
Abstract
Background Patient participation is considered central for good healthcare. Yet, the concept is not fully understood when it comes to patients' experiences of participation in conjunction with their preferences, particularly in long‐term healthcare. The aim of this study was to investigate the extent and variation of preference‐based patient participation in patients with end‐stage kidney disease (ESKD). Methods A cross‐sectional study was conducted with 346 patients in renal care. The main variables were patients' preferences for and experiences of patient participation, determined using the Patient Preferences for Patient Participation tool, the 4Ps. Analyses identified the degree of match between preferences and experiences, that is, the preference‐based patient participation measure. Results Overall, 57%–84% of the patients reached a sufficient level of preference‐based patient participation on the items, while 2%–12% reached an insufficient level. A mismatch indicated either less or more participation than preferred; for example, 40% had less experience than preferred for taking part in planning, and 40% had more than preferred for managing treatment. Conclusion This study shows that, although many patients reach a sufficient level of preference‐based patient participation, this is not the case for all patients and/or attributes. Further opportunities for a mutual understanding of patients' preferences are needed for healthcare professionals to support person‐centred patient participation. Patient or Public Contribution The 4Ps is manufactured in collaboration with people with experience of the patient role, and persons living with ESKD were engaged in identifying their preferences and experiences of participation in renal care.
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Affiliation(s)
- Caroline Martinsson
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Fredrik Uhlin
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Department of Nephrology, Region Östergötland, Linköping, Sweden.,Department of Health Technologies, Tallinn University of Technology (TalTech), Tallinn, Estonia
| | - Marika Wenemark
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Unit of Public Health and Statistics, Region Östergötland, Linköping, Sweden
| | - Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Adherence to Therapy, Physical and Mental Quality of Life in Patients with Multiple Sclerosis. J Pers Med 2021; 11:jpm11070672. [PMID: 34357139 PMCID: PMC8303119 DOI: 10.3390/jpm11070672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
Ensuring multiple sclerosis (MS) patients' adherence to therapy is often challenging, but it is crucial to their survival and health-related quality of life (HRQoL). The aim of the present study was to outline connections between adherence, physical and mental HRQoL, levels of psychological readiness to engage in a treatment, levels of social support, anthropometric, socio-demographic and clinical factors in patients suffering from MS. This cross-sectional study involved a sample of 237 Italian MS patients. A survey was conducted with a structured self-administered online questionnaire using validated measures of quality of life, adherence to therapy and anthropometric, socio-demographic, psychological and clinical variables. A path analysis was used to test the overall structure of the associations between the variables. The pathway indicates a positive association between mental health index and a stronger degree of engagement and being or having been in a long-term relationship. Physical health index was positively associated with age, having an occupation, and having a specific form of MS. Having had relapses in the previous year raised the odds of better adherence to therapy, while an increase in Body Mass Index (BMI) reduced them. Our findings could help in the management of MS patients, promoting behavioral interventions that take the psychological and socio-demographic peculiarities of each patient into account with a view to improving their adherence to therapy.
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Ripamonti CI, Massa G, Insolvibile D, Guglielmo M, Miccinesi G, Regalia C, Saita E, Pagnini F. Fears, beliefs, and quality of life of patients with cancer vs the general population during the coronavirus disease 2019 (COVID-19) pandemic in Lombardy. TUMORI JOURNAL 2021; 108:431-438. [PMID: 34176373 DOI: 10.1177/03008916211022848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIM To understand how patients with cancer reacted to the coronavirus disease 2019 (COVID-19) pandemic and whether their quality of life (QoL) was affected. METHODS In June 2020, 111 patients with cancer treated in the supportive care unit of a Comprehensive Cancer Center in Milan and 201 healthy controls from the general population were enrolled and assessed both quantitatively and qualitatively for fears and COVID-19-related beliefs as well as for QoL. RESULTS Fear of COVID-19 was significantly lower among patients (41% vs 57.6%; p = 0.007), as was fear of cancer (61.5% vs 85.6%; p < 0.001) and other diseases. The perceived risk of getting COVID-19 was lower among patients (25.2% vs 52.7%; p < 0.001), as was the belief of having been exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (18.1% vs 40.8%; p < 0.001). The physical component of QoL was better among the population (54.5 vs 43.8; p < 0.001); the reverse was true for patients' psychological well-being (44.6 vs 39.6; p < 0.001). The qualitative data supported such results, showing a reduced psychological effect on the patients with cancer compared to the controls. Various reasons explain this result, including the awareness of being treated for cancer and nevertheless protected against getting infected in a cancer center of public health reorganized to continue treating patients by protecting them and personnel from the risk of infection. CONCLUSIONS The experience of a cancer diagnosis, together with proper hospital reorganization, may act as protective factors from fears and psychological consequences of the COVID-19 outbreak.
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Affiliation(s)
- Carla Ida Ripamonti
- Oncology-Supportive Care Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Medical Oncology & Haematology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Giacomo Massa
- Department of Medical Oncology & Haematology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Daniela Insolvibile
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Mauro Guglielmo
- Oncology-Supportive Care Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Medical Oncology & Haematology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy
| | - Guido Miccinesi
- Clinical Epidemiology, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Camillo Regalia
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Emanuela Saita
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Harvard University, Cambridge, MA, USA
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Murray S, Augustyniak M, Murase JE, Fischer-Betz R, Nelson-Piercy C, Peniuta M, Vlaev I. Barriers to shared decision-making with women of reproductive age affected by a chronic inflammatory disease: a mixed-methods needs assessment of dermatologists and rheumatologists. BMJ Open 2021; 11:e043960. [PMID: 34135086 PMCID: PMC8212186 DOI: 10.1136/bmjopen-2020-043960] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The main study objective was to identify challenges and barriers experienced by dermatologists and rheumatologists when engaging women of reproductive age in shared decision-making (SDM) related to treatment and management of chronic inflammatory disease (CID) before, during and after pregnancy. DESIGN A mixed-methods study was conducted, employing (1) semistructured interviews, (2) an online survey and (3) triangulation of findings. PARTICIPANTS 524 dermatologists and rheumatologists entered the study; 495 completed it; 388 met inclusion criteria for analysis. Participants were included if actively practising in Germany (GER), the UK or the USA; had a minimum 5% caseload of female patients of reproductive age with either axial spondyloarthritis, psoriasis, psoriatic arthritis or rheumatoid arthritis; and had experience prescribing biologics. RESULTS 48 interviews and 340 surveys were analysed. Interviews underscored dermatologists and rheumatologists' suboptimal integration of SDM in clinical practice. In the survey, 90% (n=305) did not know about SDM models. A perceived lack of competency counselling patients on pregnancy and family planning was also identified during interviews. Among the survey sample, 44% (n=150) of specialists agreed they preferred leaving pregnancy-related discussions to obstetricians and/or gynaecologists and 57% (n=189) reported having suboptimal skills discussing contraceptive methods with patients. Another finding that emerged from interviews was the perception that all biologics are strictly contraindicated during pregnancy. Suboptimal knowledge was noted among 57% (n=95) of dermatologists and 48% (n=83) of rheumatologists surveyed in that regard, with a statistically significant difference by country among dermatologists (GER: 42% vs UK: 71% vs USA: 57%, p=0.015). CONCLUSIONS This study identified low levels of knowledge, skill and confidence, as well as attitudinal issues, that explain why SDM is not fully integrated in dermatology and rheumatology clinical practice. Blended-learning interventions are recommended to assist CID specialists in developing effective communication and patient engagement competencies.
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Affiliation(s)
- Suzanne Murray
- Department of Research, AXDEV Group Inc, Brossard, Quebec, Canada
| | | | - Jenny E Murase
- Department of Dermatology, University of California, San Francisco, San Francisco, California, USA
- Dermatology, Palo Alto Medical Foundation, Mountain View, California, USA
| | - Rebecca Fischer-Betz
- Policlinic of Rheumatology and Hiller Research Unit for Rheumatology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Morgan Peniuta
- Department of Research, AXDEV Group Inc, Brossard, Quebec, Canada
| | - Ivo Vlaev
- Warwick Business School, University of Warwick, Warwick, UK
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46
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Stichler JF, Pelletier LR. Psychometric Testing of a Patient Empowerment, Engagement, and Activation Survey. J Nurs Care Qual 2021; 35:E49-E57. [PMID: 31821184 DOI: 10.1097/ncq.0000000000000452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patient or person-centered care has become a widely used philosophical framework and yet has varying definitions and characteristics. Person-centered care has recently been conceptualized as patient empowerment, engagement, and activation with studies citing positive outcomes. PURPOSE This study reports the psychometric properties of the Patient Empowerment, Engagement, and Activation Survey. METHODS An instrument development and testing approach was used. RESULTS A 21-item survey was developed demonstrating respectable Cronbach α coefficients for the total scale (α = 0.88) and for each subscale: Empowerment (α = 0.71), Engagement (α = 0.81), and Activation (α = 0.76). A regression analysis with 1 item, "I am ready to be discharged" as the dependent variable and all other items as independent variables explained 65% of the variance in readiness for discharge (P < .001). DISCUSSION The Patient Empowerment, Engagement, and Activation Survey can be used to evaluate patients' perspectives of care quality (empowerment and engagement) and readiness for discharge (activation).
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Affiliation(s)
- Jaynelle F Stichler
- Research & Professional Development, Sharp Center of Nursing Excellence, San Diego, California (Dr Stichler); San Diego State University, San Diego, California (Dr Stichler); and Sharp Mesa Vista Hospital, San Diego, California (Mr Pelletier)
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Graffigna G, Palamenghi L, Savarese M, Castellini G, Barello S. Effects of the COVID-19 Emergency and National Lockdown on Italian Citizens' Economic Concerns, Government Trust, and Health Engagement: Evidence From a Two-Wave Panel Study. Milbank Q 2021; 99:369-392. [PMID: 33822424 PMCID: PMC8241271 DOI: 10.1111/1468-0009.12506] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Policy Points Preventive measures such as the national lockdown in Italy have been effective in slowing the spread of COVID-19. However, they also had psychological and economic impacts on people's lives, which should not be neglected as they may reduce citizens' trust and compliance with future health mandates. Engaging citizens in their own health management and in the collaboration with health care professionals and authorities via the adoption of a collaborative approach to health policy development is fundamental to fostering such measures' effectiveness. Psychosocial analysis of citizens' concerns and emotional reactions to preventive policies is important in order to plan personalized health communication campaigns. CONTEXT Because of the COVID-19 pandemic, between February 23 and March 8, 2020, some areas of Italy were declared "red zones," with citizens asked to stay home and avoid unnecessary interpersonal contacts. Such measures were then extended, between March 10 and May 4, 2020, to the whole country. However, compliance with such behaviors had an important impact on citizens' personal, psychological, and economic well-being. This could result in reduced trust in authorities and lowered compliance. Keeping citizens engaged in their own health and in preventive behaviors is thus a key strategy for the success of such measures. This paper presents the results from a study conducted in Italy to monitor levels of people's health engagement, sentiment, trust in authorities, and perception of risk at two different time points. METHODS Two independent samples (n = 968 and n = 1,004), weighted to be representative of the adult Italian population, were recruited in two waves corresponding to crucial moments of the Italian COVID-19 epidemic: between February 28 and March 4 (beginning of "phase 1," after the first regional lockdowns), and between May 12 and May 18 (beginning of "phase 2," after the national lockdown was partially dismissed). Respondents were asked to complete an online survey with a series of both validated measures and ad hoc items. A series of t-tests, general linear models, and contingency tables were carried out to assess if and how our measures changed over time in different social groups. FINDINGS Although sense of self and social responsibility increased between the two waves, and trust toward authorities remained substantially the same, trust in science, consumer sentiment, and health engagement decreased. Our results showed that while both the level of general concern for the emergency and the perceived risk of infection increased between the two waves, in the second wave our participants reported being more concerned for the economic consequences of the pandemic than the health risk. CONCLUSIONS The potentially disruptive psychological impact of lockdown may hamper citizens' compliance with, and hence the effectiveness of, behavioral preventive measures. This suggests that preventive measures should be accompanied by collaborative educational plans aimed at promoting people's health engagement by making citizens feel they are partners in the health preventive endeavor and involved in the development of health policies.
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Affiliation(s)
- Guendalina Graffigna
- EngageMinds HUB, Consumer, Food, and Health Engagement Research Center, Università Cattolica del Sacro Cuore.,Department of Psychology, Università Cattolica del Sacro Cuore.,Faculty of Agricultural, Nutrition, and Environmental Sciences, Università Cattolica del Sacro Cuore
| | - Lorenzo Palamenghi
- EngageMinds HUB, Consumer, Food, and Health Engagement Research Center, Università Cattolica del Sacro Cuore.,Department of Psychology, Università Cattolica del Sacro Cuore.,Faculty of Agricultural, Nutrition, and Environmental Sciences, Università Cattolica del Sacro Cuore
| | - Mariarosaria Savarese
- EngageMinds HUB, Consumer, Food, and Health Engagement Research Center, Università Cattolica del Sacro Cuore.,Faculty of Agricultural, Nutrition, and Environmental Sciences, Università Cattolica del Sacro Cuore
| | - Greta Castellini
- EngageMinds HUB, Consumer, Food, and Health Engagement Research Center, Università Cattolica del Sacro Cuore.,Faculty of Agricultural, Nutrition, and Environmental Sciences, Università Cattolica del Sacro Cuore
| | - Serena Barello
- EngageMinds HUB, Consumer, Food, and Health Engagement Research Center, Università Cattolica del Sacro Cuore.,Department of Psychology, Università Cattolica del Sacro Cuore
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Barello S, Guida E, Leone S, Previtali E, Graffigna G. Does patient engagement affect IBD patients' health-related quality of life? Findings from a cross-sectional study among people with inflammatory bowel diseases. Health Qual Life Outcomes 2021; 19:77. [PMID: 33678181 PMCID: PMC7938585 DOI: 10.1186/s12955-021-01724-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/01/2021] [Indexed: 01/19/2023] Open
Abstract
Background Patients diagnosed with inflammatory bowel disease (IBD) are required to deal with the unpredictability of this clinical condition, which is associated with poorer health-related quality of life (HRQoL) compared to other clinical conditions. Patient engagement is currently demonstrated to relate with chronic patients’ HRQoL, but few studies have been conducted among this population. Methods A cross-sectional study was conducted among 1176 IBD patients. Data were collected on participants’ HRQoL (SIBD-Q) and patient engagement (PHE-s®). Regression analysis was used to examine the effects of patient engagement on HRQoL. Results About the half of the sample (47%) reported a low patient engagement level. 30% of the sample reported a low level of HRQoL. Psycho-emotional functioning resulted to be the aspect of HRQoL most impacted in the 37% of the sample. The regression model showed that PHE-s® is significantly related to the SIBD-Q total score (B = .585; p < .001; R squared = .343) and to the subscales’ scores—systemic symptoms (B = .572; p < .001; R squared = .327), bowel symptoms (B = .482; p < .001; R squared = .232), social (B = .485; p < .001; R squared = .234) and psycho-emotional (B = .607; p < .001; R squared = .369) functioning. Conclusions Patients who are engaged in their IBD care pathway are more likely to report higher level of HRQoL, thus offering clues to potential therapeutic approaches to ameliorating IBD patients’ wellbeing. As this is a modifiable factor, screening for patient health engagement levels, coupled with appropriate interventions, could improve care, and ultimately improve HRQoL outcomes among IBD patients.
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Affiliation(s)
- Serena Barello
- EngageMinds Hub, Consumer, Food and Health Engagement Research Center, Faculty of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.
| | - Elena Guida
- EngageMinds Hub, Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | | | - Guendalina Graffigna
- EngageMinds Hub, Consumer, Food & Health Engagement Research Center, Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, Piacenza, Italy
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Kabukye JK, Ilozumba O, Broerse JEW, de Keizer N, Cornet R. Implementation of an Interactive Voice Response System for Cancer Awareness in Uganda: Mixed Methods Study. JMIR Mhealth Uhealth 2021; 9:e22061. [PMID: 33496672 PMCID: PMC7872833 DOI: 10.2196/22061] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/11/2020] [Accepted: 11/15/2020] [Indexed: 12/23/2022] Open
Abstract
Background Cancer awareness is crucial for cancer care and prevention. However, cancer awareness in Uganda is low, and access to cancer information is limited. Objective This study aims to (1) understand the cancer awareness situation in Uganda (perceptions, beliefs, information needs, and challenges to accessing cancer information) and opinions about interactive voice response (IVR) systems; (2) develop cancer awareness messages and implement them in an IVR system; and (3) evaluate user acceptance and use of the IVR system. Methods A participatory design approach was adopted. To understand cancer awareness needs and challenges, 3 interviews and 7 focus group discussions (FGDs) were conducted with cancer health care providers, patients with cancer, caregivers and survivors, administrators, and lay citizens (n=73). On the basis of the resulting qualitative data, audio messages addressing cancer information needs were developed and implemented in an IVR system. The system and messages were tested with users (n=12) during 2 co-design workshops before final rollout. Finally, the system was evaluated over 6 months after going live, using call records and user feedback from telephone interviews with callers (n=40). Results The cancer information needs included general topics such as what cancer is, what causes it, cancer screening and diagnosis, cancer treatment, and practical information on what to expect during cancer care. There were also myths and misconceptions that need to be addressed, such as that cancer is due to witchcraft and has no treatment. Information on COVID-19 was also sought after following the outbreak. We developed 20 audio cancer messages (approximately 2 minutes each) in English and Luganda, along with 14 IVR navigation instructions. These were implemented in an IVR system with 24/7 availability from all over Uganda via a toll-free multi-channel telephone number. The total number of calls made to the IVR system 6 months after going live was 3820. Of these, 2437 (63.8%) lasted at least 30 seconds and were made from 1230 unique telephone numbers. There were 191 voice messages and 760 calls to live agents, most of which (681/951, 71.6%) were in Luganda. Call volumes peaked following advertisement of the system and lockdowns due to COVID-19. Participants were generally familiar with IVR technology, and caller feedback was largely positive. Cited benefits included convenience, toll-free access, and detailed information. Recommendations for improvement of the system included adding live agents and marketing of the system to target users. Conclusions IVR technology provides an acceptable and accessible method for providing cancer information to patients and the general public in Uganda. However, a need remains for health system reforms to provide additional cancer information sources and improve cancer care services in general.
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Affiliation(s)
- Johnblack K Kabukye
- Uganda Cancer Institute, Kampala, Uganda.,Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam UMC - Location AMC, Amsterdam, Netherlands
| | - Onaedo Ilozumba
- Athena Institute, Faculty of Science, Vrije Universiteit, Amsterdam, Netherlands
| | | | - Nicolette de Keizer
- Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam UMC - Location AMC, Amsterdam, Netherlands
| | - Ronald Cornet
- Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam UMC - Location AMC, Amsterdam, Netherlands
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Watach AJ, Hwang D, Sawyer AM. Personalized and Patient-Centered Strategies to Improve Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea. Patient Prefer Adherence 2021; 15:1557-1570. [PMID: 34285474 PMCID: PMC8286071 DOI: 10.2147/ppa.s264927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/23/2021] [Indexed: 12/12/2022] Open
Abstract
Obstructive sleep apnea (OSA), a common sleep disorder characterized by repeated pauses in breathing during sleep, is effectively treated with positive airway pressure (PAP) therapy. The magnitude of improvements in daily functioning and reduced negative health risks are dependent on maintaining PAP adherence, which is a significant challenge. Evidence-based interventions to improve PAP use are not easily translated to clinical practice because they are labor-intensive and require specialty expertise. Further, to date, individualized care, inclusive of personalized medicine and patient- and person-centered care have been marginally incorporated in the field's understanding of OSA and PAP adherence. This integrative review describes current PAP adherence assessment processes, interventions to improve adherence, and outlines future opportunities to advance the field, particularly as it relates to individualizing care and the use of implementation science to apply evidence to practice.
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Affiliation(s)
- Alexa J Watach
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Correspondence: Alexa J Watach University of Pennsylvania, School of Nursing, Claire Fagin Hall, Rm 349, 418 Curie Blvd, Philadelphia, PA, 19104, USATel +1-717-599-9908 Email
| | - Dennis Hwang
- Kaiser Permanente Southern California, Sleep Medicine and Department of Research and Evaluation, Fontana, CA, USA
| | - Amy M Sawyer
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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