A systematic review of reliable and valid tools for the measurement of patient participation in healthcare

Towards better care: Comprehensive review of patient-reported patient engagement instruments in healthcare

OBJECTIVE

Patient engagement is widely recognized as essential for improving healthcare quality and reducing costs; however, its formal evaluation presents significant challenges. The aim of this review was to assess instruments for measuring patient engagement in healthcare from the patients' perspective and to evaluate their psychometric properties.

METHODS

A systematic review according to the PRISMA guidelines was conducted to evaluate the psychometric properties of patient-reported questionnaires assessing patient engagement. Studies published up to August 4, 2024, were included and appraised using the COSMIN checklist.

RESULTS

Forty-one studies were included in this review. The most commonly used content to describe patient engagement were 'preference', 'experiences', 'willingness', and 'informative feedback'. Few patient engagement questionnaires were designed for specific populations and lack theoretical foundation.

CONCLUSION

Further research is essential to develop valid, reliable, and feasible methodologies for assessing patient engagement within the framework of ongoing care quality improvement.

PRACTICE IMPLICATIONS

Evaluating patient engagement instruments aids in developing reliable and valid tools that better align with patient needs and preferences.

Measurement tools used to assess individual health assets among refugee populations: a scoping review

Forced migration is increasing globally, which has detrimental effects on the physical and mental health of refugees, who may face significant challenges accessing healthcare services. However, refugees also possess considerable strengths or assets that can protect against various health challenges. Identifying and strengthening the individual health assets of refugees is critical to promoting their health and mitigating these health challenges. Yet, there is a paucity of data on refugees' individual health assets, including tools to measure them. Therefore, this scoping review aimed to identify and summarise the available measurement tools to assess the individual health assets of refugees. We conducted a comprehensive literature search using six electronic databases and a Google search without restrictions on publication dates. We used Arksey and O'Malley's methodological framework approach to streamline the review processes. Forty-one eligible studies were included, from which 28 individual health asset tools were identified. Of these, 11 tools were tested for validity in refugee populations. Among the validated tools, the reliability scores for the measures of individual health asset outcomes, including resilience (Child and Youth Resilience Measure, Wagnild and Young's Resilience Scale, and Psychological Resilience Scale), acculturation (Vancouver Index of Acculturation and Bicultural Involvement Questionnaire), self-esteem (Rosenberg Self-Esteem Scale), and self-efficacy (Generalized Self-Efficacy Scale), ranged from good to excellent. The findings provide guidance for health service planners, humanitarian organisations, and researchers regarding the appropriateness and quality of tools that can be applied to assess individual health assets, which are crucial for designing culturally sensitive asset-based health promotion interventions for refugees.

Is patient participation in hypertension care based on patients' preferences? A cross-sectional study in primary healthcare

AIMS

The purpose of this study was to address the need to improve opportunities for patient participation in their health and health services. This paper reports if and how patients' preferences matched their experiences of participation in treatment for hypertension in primary healthcare and what factors were linked with having had opportunities for participation that matched one's preferences.

METHODS AND RESULTS

A total of 949 adult patients treated for hypertension completed the Patient Preferences for Patient Participation (4Ps) tool, with which they ranked their preferences for and experiences of patient participation. Descriptive and comparative analyses of 4Ps data were performed to identify patient characteristics associated with preference-based participation. Approximately half of the participants experienced patient participation to the extent that they preferred. Women were more likely to have had less patient participation than their preference compared with men. Women were also more likely to prefer being more engaged in hypertension care than men. There were also marked associations between age and educational level with the extent of participation preferred and experienced, leaving patients younger than or with lower education than the mean in this study with more insufficient opportunities for patient participation.

CONCLUSION

There is a lack of concurrence between patients' preferences for, and experiences of, patient participation, especially for women. Further efforts to facilitate person-centred engagement are required, along with research on what strategies can overcome human and organizational barriers.

REGISTRATION

ClinicalTrials.gov: NCT03554382.

Translation and psychometric validation of the Patient Participation Culture Tool for healthcare workers in Chinese nursing context

BACKGROUND

Promoting patient participation stands as a global priority in nursing care. Currently, there is a lack of a standardized tool to assess the culture of patient participation from the perspective of nurses in China.

AIMS

To translate and examine the validity and reliability of the Patient Participation Culture Tool for healthcare workers (PaCT-HCW) on general hospital wards in Chinese nursing context.

METHODS

A cross-sectional research study was conducted among 812 nurses. Brislin's recommendations were adhered to during the translation of the scale. Validity was assessed using construct validity, content validity, and face validity. Split-half reliability, test-retest reliability, and internal consistency reliability were used to evaluate dependability. The study was guided and reported following the STROBE checklist and recommendations for reporting the results of studies of instrument and scale development and testing.

RESULTS

The Chinese version of PaCT-HCW (the PaCT-HCW-C) exhibits good face validity and content validity. A rigorous exploratory factor analyse verified a six-factor (competence, support, perceived lack of time, information sharing and dialogue, response to questions and acceptance of a new role) scale structure with a cumulative variance contribution of the factors with 44 items of 68.840%. With a Cronbach's α coefficient of 0.962, split-half reliability of 0.866, and intraclass correlation coefficients of 0.989, the instrument demonstrates great reliability. Confirmatory factor analysis results validated the consistency of the six factors with the structure of the PaCT-HCW-C scale.

CONCLUSIONS

The 44-item PaCT-HCW-C is a valid and reliable instrument with satisfactory psychometric properties. It could serve as a tool for assessing the effectiveness of international programs aimed at fostering patient participation from the perspective of nurses, while also providing insights from China's practical experiences.

Exploring differences in patient participation in simulated emergency cases in co-located and distributed rural emergency teams - an observational study with a randomized cross-over design

BACKGROUND

In northern rural Sweden, telemedicine is used to improve access to healthcare and to provide patient-centered care. In emergency care during on-call hours, video-conference systems are used to connect the physicians to the rest of the team - creating 'distributed teams'. Patient participation is a core competency for healthcare professionals. Knowledge about how distributed teamwork affects patient participation is missing. The aim was to investigate if and how teamwork affecting patient participation, as well as clinicians' perceptions regarding shared decision-making differ between co-located and distributed emergency teams.

METHODS

In an observational study with a randomized cross-over design, healthcare professionals (n = 51) participated in authentic teams (n = 17) in two scripted simulated emergency scenarios with a standardized patient: one as a co-located team and the other as a distributed team. Team performances were filmed and observed by independent raters using the PIC-ET tool to rate patient participation behavior. The participants individually filled out the Dyadic OPTION questionnaire after the respective scenarios to measure perceptions of shared decision-making. Scores in both instruments were translated to percentage of a maximum score. The observational data between the two settings were compared using linear mixed-effects regression models and the self-reported questionnaire data were compared using one-way ANOVA. Neither the participants nor the observers were blinded to the allocations.

RESULTS

A significant difference in observer rated overall patient participation behavior was found, mean 51.1 (± 11.5) % for the co-located teams vs 44.7 (± 8.6) % for the distributed teams (p = 0.02). In the PIC-ET tool category 'Sharing power', the scores decreased from 14.4 (± 12.4) % in the co-located teams to 2 (± 4.4) % in the distributed teams (p = 0.001). Co-located teams scored in mean 60.5% (± 14.4) when self-assessing shared decision-making, vs 55.8% (± 15.1) in the distributed teams (p = 0.03).

CONCLUSIONS

Team behavior enabling patient participation was found decreased in distributed teams, especially regarding sharing power with the patient. This finding was also mirrored in the self-assessments of the healthcare professionals. This study highlights the risk of an increased power asymmetry between patients and distributed emergency teams and can serve as a basis for further research, education, and quality improvement.

A Scale for Measuring Electronic Patient Engagement Behaviors: Development and Validation

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.

Preference-based patient participation in intermediate care: Translation, validation and piloting of the 4Ps in Norway

INTRODUCTION

The implementation and evaluation of patient participation to obtain high-quality transitional care for older people is an international priority. Intermediate care (IC) services are regarded as an important part of the patient's pathway from the specialist to the primary care levels, bridging the gap between the hospital and the home. Patients may experience varying capacities and conditions for patient participation. Yet, few tools for evaluating patients' preferences for patient participation within IC services are at hand. Accordingly, further knowledge is needed to understand and scaffold processes for patient participation in IC. Therefore, the aim of this project was to translate, validate and pilot test the Patient Preferences for Patient Participation (the 4Ps) with patients in IC services in Norway.

METHODS

This project comprised two phases: (1) a careful translation and cultural adaptation process, followed by a content validity trial among 15 patients and staff in Norwegian IC and (2) a cross-sectional survey of the instrument with 60 patients admitted to IC.

RESULTS

The translation between Swedish and Norwegian required no conceptual or contextual adaptations. The subsequent cross-sectional study, designed as a dialogue between the patients and staff, revealed that only 50% of the participants received a sufficient level of patient participation based on their preferences, mostly indicating that patients were receiving less-than-preferred conditions for engaging in their health and healthcare issues.

CONCLUSION

The 4Ps instrument was deemed suitable for measuring patient participation based on patient preferences in the IC context and was feasible for both healthcare professionals and patients to complete in an interview when arriving at and leaving services. This may support person-centred communication and collaboration, calling for further research on what facilitates patient participation and the implementation of person-centred services for patients in IC.

PATIENT OR PUBLIC CONTRIBUTION

First, the current paper is part of the IPIC study (i.e., the implementation of patient participation in IC). Influenced by a James Lind Alliance process, the study addresses research uncertainties identified by patients, next of kin, staff and researchers in the cocreation process. Second, cognitive interviewing was conducted with 15 representatives of the target population: seven patients receiving IC services, one home-dwelling previous IC patient (altogether four women and four men, most of them 80 years or older) and seven healthcare staff working in IC services. The interviews determined the relevance, comprehensiveness and clarity of the 4Ps. Finally, 60 patients admitted to IC took part in the cross-sectional study.

‘We are data rich but information poor’: how do patient-reported measures stimulate patient involvement in quality improvement interventions in Swedish hospital departments?

Objective

This study aimed to investigate if and how patient-reported measures from national and local monitoring stimulate patient involvement in hospital quality improvement (QI) interventions. We were also interested in the factors that influence the level and degree of patient involvement in the QI interventions.

Methods

The study used a qualitative, descriptive design. Inspired by the Framework Method, we created a working analytical framework. Four hospital departments participated in the data collection. Collaborating with a QI leader from each department, we identified the monitoring systems for the patient-reported measures that were used to initiate or evaluate QI interventions. Thereafter, the level and degree of patient involvement and the factors that influenced this involvement were analysed for all QI interventions. Data were mapped in an Excel spreadsheet to analyse connections and differences.

Results

Departments used patient-reported measures from both national and local monitoring systems to initiate or evaluate their QI interventions. Thirty-one QI interventions were identified and analysed. These interventions were mainly conducted at the direct care and organisational levels. By participating in questionnaires, patients were involved to the degree of consultation. Patients were not involved to the degree of partnership and shared leadership for the identified QI interventions.

Conclusions

Overall, hospital departments have limited knowledge regarding patient-reported measures and how they are best applied in QI interventions and how they support improvements. Applying patient-reported measures to hospital QI interventions does not enhance patient involvement beyond the degree of consultation.

Patient Participation and the Environment: A Scoping Review of Instruments

Patient participation and the environment are critical factors in achieving qualitative healthcare. We conducted a systematic scoping review using Arksey and O'Malley's framework to identify instruments intended to measure patient participation. We assessed those instruments' characteristics, which areas of the healthcare continuum they target, and whether environmental factors are considered. Instruments were considered eligible if they represented the patient perspective and measured patient participation in healthcare. The search was limited to articles written in English and published in the last 10 years. We extracted concepts (i.e., patient empowerment, patient participation, and patient-centeredness) based on the framework developed by Castro et al. and outcomes of significance regarding the review questions and specific objectives. The search was conducted in PsycINFO, CINHAL/EBSCO, and PubMed in September 2019 and July 2020. Of 4802 potential titles, 67 studies reported on a total of 45 instruments that met the inclusion criteria for this review. The concept of patient participation was represented most often in these studies. Although some considered the social environment, no instrument was found to incorporate and address the physical environment. Thirteen instruments were generic and the remaining instruments were intended for specific diagnoses or healthcare contexts. Our work is the first to study instruments from this perspective, and we conclude that there is a lack of instruments that measure aspects of the social and physical environment coherently as part of patient participation.

Mapping the Multiple Health System Responsiveness Mechanisms in One Local Health System: A Scoping Review of the Western Cape Provincial Health System of South Africa

BACKGROUND

Despite governments striving for responsive health systems and the implementation of mechanisms to foster better citizen feedback and strengthen accountability and stewardship, these mechanisms do not always function in effective, equitable, or efficient ways. There is also limited evidence that maps the diverse array of responsiveness mechanisms coherently across a particular health system, especially in low- and middle-income country (LMIC) contexts.

METHODS

This scoping review presents a cross-sectional 'map' of types of health system responsiveness mechanisms; the regulatory environment; and evidence available about these; and assesses what is known about their functionality in a particular local South African health system; the Western Cape (WC) province. Multiple forms of indexed and grey literature were synthesized to provide a contextualized understanding of current 'formal' responsiveness mechanisms mandated in national and provincial policies and guidelines (n = 379). Various forms of secondary analysis were applied across quantitative and qualitative data, including thematic and time-series analyses. An expert checking process was conducted, with three local field experts, as a final step to check the veracity of the analytics and conclusions made.

RESULTS

National, provincial and district policies make provision for health system responsiveness, including varied mechanisms intended to foster public feedback. However, while some are shown to be functioning and effective, there are major barriers faced by all, such as resource and capacity constraints, and a lack of clarity about roles and responsibilities. Most mechanisms exist in isolation, failing to feed into an overarching strategy for improved responsiveness.

CONCLUSION

The lack of synergy between mechanisms or analysis of varied forms of feedback is a missed opportunity. Decision-makers are unable to see trends or gaps in the flow of feedback, check whether all voices are heard or fully understand whether/how systemic response occurs. Urgent health system work lies in the research of macro 'whole' systems responsiveness (levels, development, trends).

Establishing a Working Definition of User Experience for eHealth Interventions of Self-reported User Experience Measures With eHealth Researchers and Adolescents: Scoping Review

BACKGROUND

Across eHealth intervention studies involving children, adolescents, and their parents, researchers have measured user experience to assist with intervention development, refinement, and evaluation. To date, no widely accepted definitions or measures of user experience exist to support a standardized approach for evaluation and comparison within or across interventions.

OBJECTIVE

We conduct a scoping review with subsequent Delphi consultation to identify how user experience is defined and measured in eHealth research studies, characterize the measurement tools used, and establish working definitions for domains of user experience that could be used in future eHealth evaluations.

METHODS

We systematically searched electronic databases for published and gray literature available from January 1, 2005, to April 11, 2019. We included studies assessing an eHealth intervention that targeted any health condition and was designed for use by children, adolescents, and their parents. eHealth interventions needed to be web-, computer-, or mobile-based, mediated by the internet with some degree of interactivity. We required studies to report the measurement of user experience as first-person experiences, involving cognitive and behavioral factors reported by intervention users. We appraised the quality of user experience measures in included studies using published criteria: well-established, approaching well-established, promising, or not yet established. We conducted a descriptive analysis of how user experience was defined and measured in each study. Review findings subsequently informed the survey questions used in the Delphi consultations with eHealth researchers and adolescent users for how user experience should be defined and measured.

RESULTS

Of the 8634 articles screened for eligibility, 129 articles and 1 erratum were included in the review. A total of 30 eHealth researchers and 27 adolescents participated in the Delphi consultations. On the basis of the literature and consultations, we proposed working definitions for 6 main user experience domains: acceptability, satisfaction, credibility, usability, user-reported adherence, and perceived impact. Although most studies incorporated a study-specific measure, we identified 10 well-established measures to quantify 5 of the 6 domains of user experience (all except for self-reported adherence). Our adolescent and researcher participants ranked perceived impact as one of the most important domains of user experience and usability as one of the least important domains. Rankings between adolescents and researchers diverged for other domains.

CONCLUSIONS

Findings highlight the various ways in which user experience has been defined and measured across studies and what aspects are most valued by researchers and adolescent users. We propose incorporating the working definitions and available measures of user experience to support consistent evaluation and reporting of outcomes across studies. Future studies can refine the definitions and measurement of user experience, explore how user experience relates to other eHealth outcomes, and inform the design and use of human-centered eHealth interventions.

Patient engagement in care: A scoping review of recently validated tools assessing patients' and healthcare professionals' preferences and experience

BACKGROUND

Patient engagement in care is a priority and a key component of clinical practice. Different approaches to care have been introduced to foster patient engagement. There is a lack of a recent review on tools for assessing the main concepts and dimensions related to patient engagement in care.

OBJECTIVE

Our scoping review sought to map and summarize recently validated tools for assessing various concepts and dimensions of patient engagement in care.

SEARCH STRATEGY

A scoping review of recent peer-reviewed articles describing tools that assess preferences in and experience with patient engagement in care was conducted in four databases (Ovid Medline, Ovid EMBASE, Cochrane Database of Systematic Reviews, CINAHL-EBSCO). We adopted a broad definition based on the main concepts of patient engagement in care: patient-centredness, empowerment, shared decision-making and partnership in care.

MAIN RESULTS

Of 2161 articles found, 16, each describing a different tool, were included and analysed. Shared decision-making and patient-centredness are the two main concepts evaluated, often simultaneously in most of the tools. Only four scales measure patient-centredness, empowerment and shared decision-making at the same time, but no tool measures the core dimensions of partnership in care. Most of the tools did not include patients in their development or validation or just consulted them during the validation phase.

DISCUSSION AND CONCLUSION

There is no tool coconstructed with patients from development to validation, which can be used to assess the main concepts and dimensions of patient engagement in care at the same time.

PATIENT AND PUBLIC CONTRIBUTION

This manuscript was prepared with a patient expert who is one of the authors. Vincent Dumez, who is a patient expert and codirector of the Center of Excellence on Partnership with Patients and the Public, has contributed to the preparation of the manuscript.

The effect of patient perceived involvement on patient loyalty in primary care: The mediating role of patient satisfaction and the moderating role of the family doctor contract service

BACKGROUND

The Chinese government has taken many incentives to promote the implementation of the family doctor (FD) contract service; however, whether primary health care providers establishing a strong relationship with patients that shapes their loyalty is still unknown. Under this circumstance, drawing the public attention to patient loyalty in primary care and clarifying the underlying mechanism of loyalty is imperative to the development of primary care.

OBJECTIVE

To analyse the effect of patient perceived involvement on patient loyalty in primary care, investigate the mediating role of patient satisfaction, and explore the moderating role of the FD contract service on the relationship between patient perceived involvement and patient loyalty.

METHODS

A cross-sectional questionnaire survey of patients in primary health facilities was conducted in Jilin province of China. Participants comprised 1334 patients selected via a multi-stage sampling method.

RESULTS

Patient perceived involvement not only had a direct positive impact on patient loyalty but also had an indirect effect on patient loyalty via patient satisfaction. Furthermore, for patients who contracted with FDs, patient perceived involvement had a higher direct effect and indirect effect on patient loyalty when compared with patients who did not contract with FDs.

CONCLUSIONS

Our findings suggest that health managers should encourage patients to participate in medical visits to improve patient satisfaction. Additionally, customised and tailored health services that meet individuals' specific needs and preferences should be designed and implemented to attract more patients to contract the FD contract service.

Assessing and promoting partnership between patients and health-care professionals: Co-construction of the CADICEE tool for patients and their relatives

CONTEXT

Partnership between patients and health-care professionals (HCPs) is a concept that needs a valid, practical measure to facilitate its use by patients and HCPs.

OBJECTIVE

To co-construct a tool for measuring the degree of partnership between patients and HCPs.

DESIGN

The CADICEE tool was developed in four steps: (1) generate key dimensions of patient partnership in clinical care; (2) co-construct the tool; (3) assess face and content validity from patients' and HCPs' viewpoints; and (4) assess the usability of the tool and explore its measurement performance.

RESULTS

The CADICEE tool comprises 24 items under 7 dimensions: 1) relationship of Confidence or trust between the patient and the HCPs; 2) patient Autonomy; 3) patient participation in Decisions related to care; 4) shared Information on patient health status or care; 5) patient personal Context; 6) Empathy; and 7) recognition of Expertise. Assessment of the tool's usability and measurement performance showed, in a convenience sample of 246 patients and relatives, high face validity, acceptability and relevance for both patients and HCPs, as well as good construct validity.

CONCLUSIONS

The CADICEE tool is developed in co-construction with patients to evaluate the degree of partnership in care desired by patients in their relationship with HCPs. The tool can be used in various clinical contexts and in different health-care settings.

PATIENT OR PUBLIC CONTRIBUTION

Patients were involved in determining the importance of constructing this questionnaire. They co-constructed it, pre-tested it and were part of the entire questionnaire development process. Three patients participated in the writing of the article.

A Systematic Review of Measurement Tools for the Proactive Assessment of Patient Safety in General Practice

BACKGROUND

Primary care physicians have reported a difficulty in understanding how best to measure and improve patient safety in their practices.

OBJECTIVES

The aims of the study were to identify measures of patient safety suitable for use in primary care and to provide guidance on proactively monitoring and measuring safety.

METHODS

Searches were conducted using Medline, Embase, CINAHL and PsycInfo in February 2016. Studies that used a measure assessing levels of or attitudes toward patient safety in primary care were considered for inclusion. Only studies describing tools focused on the proactive assessment of safety were reviewed. Two independent reviewers extracted data from articles and applied the Quality Assessment Tool for Studies with Diverse Designs.

RESULTS

More than 2800 studies were screened, of which 56 were included. Most studies had used healthcare staff survey or interviews to assess patient safety (n = 34), followed by patient chart audit (n = 14) or use of a practice assessment checklist (n = 7). Survey or interview of patients, active monitoring systems, and simulated patients were used with less frequency.

CONCLUSIONS

A lack of appropriate measurement tools has been suggested to limit the ability to monitor patient safety in primary care and to improve patient care. There is no evident "best" method of measuring patient safety in primary care. However, many of the measures are readily available, quick to administer, do not require external involvement, and are inexpensive. This synthesis of the literature suggests that it is possible for primary care physicians to take a proactive approach to measuring and improving safety.

The validity and reliability of self-reported satisfaction with healthcare as a measure of quality: a systematic literature review

PURPOSE

The aim of this paper is to systematize the evidence on the validity and reliability of subjective measurements of satisfaction with healthcare.

DATA SOURCES

In this qualitative systematic literature review, we searched for relevant publications in PubMed and JSTOR databases.

STUDY SELECTION

The key inclusion criteria included (i) original research articles in peer-reviewed journals, (ii) year of publication from 2008 onward and (iii) English language publications.

DATA EXTRACTION

We applied directed qualitative content analysis to the publications included in the review.

RESULTS OF DATA SYNTHESIS

Overall, 1167 publications are found and screened. Of these, 39 publications that focus on the psychometric properties of the measurement of patient satisfaction are included. The majority of the studies validate the already existing instruments adapted to different contexts; the rest describe psychometric properties of self-developed tools. Psychometric properties are assessed by means of reliability and validity assessment. Reliability assessment is performed via Cronbach alpha and test-retest reliability. Overall, 94.9% of studies find that the satisfaction measures are reliable. Validation is performed by a variety of different methods, among which the most applicable are face validity and factor analysis. Overall, 71.8% of studies find that the satisfaction measures are valid.

CONCLUSION

Because of the complexity of the studies, we cannot make strong recommendations on the application of self-reported satisfaction measures. We recommend the following key strategies: (i) developing of a unified standard toward satisfaction measurement and (ii) identifying a combination of tools to routinely measure satisfaction. We also suggest to further research the issue of subjectivity reduction.

Hospital practices for the implementation of patient partnership in a multi-national European region

BACKGROUND

The extent to which patients are involved in their care can be influenced by hospital policies and interventions. Nevertheless, the implementation of patient participation and involvement (PPI) at the organisational (meso) level has rarely been assessed systematically. The aim of this study was to assess the occurrence of PPI practises in hospitals in Belgium, France, Germany and Luxembourg and to analyze if, and to what extent, the hospital vision and the presence of a patient committee influence the implementation of PPI practises.

METHODS

A cross-sectional study was carried out using an online questionnaire in hospitals in the border regions of the four countries. The data were analyzed for differences between regions and the maturity of PPI development.

RESULTS

Full responses were obtained from 64 hospitals. A wide range of practices were observed, the degree of maturity was mixed. A majority of hospitals promoted patient partnership in the hospital's philosophy of care statement. However, the implementation of specific interventions for PPI was not found uniformly and differences could be observed between the countries.

CONCLUSIONS

Hospitals in the region seem to be motivated to include patients more fully, however, implementation of PPI interventions seems incomplete and only partially integrated into the general functioning of the hospitals. The implementation of the concept seems to be more mature in the francophone part of the region perhaps due, in part, to a more favourable political context.

Let's ask the patient - composition and validation of a questionnaire for patients' feedback to medical students

BACKGROUND

Adequate communication and maintaining a patient-centered approach throughout patient encounters are important skills for medical students to develop. Feedback is often provided by clinical teachers. Patients are seldom asked to provide feedback to students that systematically addresses knowledge and skills regarding communication and patient-centeredness during an encounter. One way for patients to provide feedback to students is through a questionnaire; there is, however, a lack of such validated feedback questionnaires. This study aimed to compose and validate a feedback questionnaire for patients' feedback to medical students regarding students' ability to communicate and apply patient-centeredness in clinical practice.

METHOD

This study comprises (a) composition of the questionnaire and (b) validation of the questionnaire. The composition included (1) literature review, (2) selection and composition of items and construction of an item pool, (3) test of items' content, and (4) test of the applicability of the questionnaire. The items originated from the Calgary-Cambridge Guide (Kurtz S, Silverman J, Benson J and Draper J, Acad Med 78:802-809, 2003), the 'Swedish National Patient Survey' (National Patient Survey, Primary Health Care, 2020), patient evaluation form by Braend et al. (Tidsskr Nor Laegeforen 126:2122-5, 2006), and additional developed items. The items were further developed after feedback from 65 patients, 22 students, eight clinical supervisors, and six clinical teachers. The validation process included 246 patients who provided feedback to 80 students. Qualitative content analysis and psychometric methods were used and exploratory factor analysis assessed internal validity. Cronbach's alpha was used to test the reliability of the items.

RESULTS

The process resulted in the 19-item 'Patient Feedback in Clinical Practice' (PFCP) questionnaire. Construct validity revealed two dimensions: consultational approach and transfer of information. Internal consistency was high. Thematic analysis resulted in three themes: ability to capture the personal agenda of the consultation, alignment with the consultation, and constructs and characteristics. Students reported that the PFCP questionnaire provided useful feedback that could facilitate their learning in clinical practice.

CONCLUSIONS

The results of this study indicate that the questionnaire is a valid, reliable, and internally consistent instrument for patients' feedback to medical students. The participants found the questionnaire to be useful for the provision of feedback in clinical practice. However, further studies are required regarding the PFCP questionnaire applicability as a feedback tool in workplace learning.

Patient, clinician and independent observer perspectives of shared decision making in adult orthodontics

OBJECTIVES

To investigate and compare the extent of shared decision making (SDM) in orthodontics from the perspective of patients, clinicians and independent observers.

DESIGN

A cross-sectional, observational study.

SETTING

NHS teaching hospital.

PARTICIPANTS

A total of 31 adult patients and their treating clinicians were included in the study.

METHODS

The extent of SDM in new patient orthodontic consultations was measured using three versions of a validated instrument: the self-administered patient dyadic-OPTION scale; the self-administered clinician dyadic-OPTION scale; and an independent observer-rated OPTION¹² scale. Patients and clinicians completed the 12-item dyadic-OPTION questionnaire independently at the end of the consultation to rate their perceived levels of SDM. The consultations were also audio-recorded and two calibrated raters independently rated the extent of SDM in these consultations using the OPTION¹² scale.

RESULTS

There was excellent inter-rater reliability between the two independent raters using the OPTION¹² scale (intraclass correlation coefficient (ICC) = 0.909). The mean patient, clinician and independent observer OPTION scores for SDM were 90.4% (SD 9.1%, range 70.8% to 100%), 76.2% (SD 8.95%, range 62.5% to 95.8%) and 42.6% (SD 17.4%, range 13.5% to 68.8%), respectively. There was no significant correlation between the OPTION scores for the three groups (ICC = -0.323).

CONCLUSIONS

The results showed that generally high levels of SDM were perceived by patients and clinicians but lower levels of SDM were scored by the independent observers. However, it could be argued that the patient's perception of SDM is the most important measure as it is their care that is affected by their involvement.

Evaluating health service outcomes of public involvement in health service design in high-income countries: a systematic review

BACKGROUND

Internationally, it is expected that health services will involve the public in health service design. Evaluation of public involvement has typically focused on the process and experiences for participants. Less is known about outcomes for health services. The aim of this systematic review was to a) identify and synthesise what is known about health service outcomes of public involvement and b) document how outcomes were evaluated.

METHODS

Searches were undertaken in MEDLINE, EMBASE, The Cochrane Library, PsycINFO, Web of Science, and CINAHL for studies that reported health service outcomes from public involvement in health service design. The review was limited to high-income countries and studies in English. Study quality was assessed using the Mixed Methods Appraisal Tool and critical appraisal guidelines for assessing the quality and impact of user involvement in health research. Content analysis was used to determine the outcomes of public involvement in health service design and how outcomes were evaluated.

RESULTS

A total of 93 articles were included. The majority were published in the last 5 years, were qualitative, and were located in the United Kingdom. A range of health service outcomes (discrete products, improvements to health services and system/policy level changes) were reported at various levels (service level, across services, and across organisations). However, evaluations of outcomes were reported in less than half of studies. In studies where outcomes were evaluated, a range of methods were used; most frequent were mixed methods. The quality of study design and reporting was inconsistent.

CONCLUSION

When reporting public involvement in health service design authors outline a range of outcomes for health services, but it is challenging to determine the extent of outcomes due to inadequate descriptions of study design and poor reporting. There is an urgent need for evaluations, including longitudinal study designs and cost-benefit analyses, to fully understand outcomes from public involvement in health service design.

Development and Psychometric Evaluation of the Patient Engagement in Health Care Questionnaire

BACKGROUND

Patient engagement in health care can contribute to improving care quality and safety. A valid measurement is essential for promoting it.

PURPOSE

The purpose was to develop the Patient Engagement in Health Care Questionnaire and test its psychometric properties.

METHODS

An item pool was generated based on a literature review and qualitative research, and was reviewed by 2 expert panels. Two rounds of survey, with 364 and 433 patients, respectively, were conducted to evaluate psychometric properties of the questionnaire.

RESULTS

The questionnaire consists of 33 items. Exploratory factor analysis revealed a 6-factor model, explaining 67.16% of the variance, which included communication and information exchange, engaging in treatment and care, engaging in decision-making, giving feedback about care quality, monitoring care safety, and choosing health care providers. Confirmatory factor analysis indicated that the 6-factor model fit the data well. The scale-level content validity index, Cronbach α, and test-retest reliability were 0.935, 0.928, 0.882, respectively.

CONCLUSIONS

The Patient Engagement in Health Care Questionnaire is a reliable and valid tool to assess patient engagement.

Reliability and Validity of the Turkish Version of the Oxford Participation and Activities Questionnaire in Older People

Background

Activities and participation play important roles in the maintenance of healthy aging. The maintenance of these factors optimizes social life to increase the quality of life with aging. However, there is a lack of questionnaires in Turkish to evaluate activity and participation among older people. This study translated and cross-culturally adapted the Oxford Participation and Activities Questionnaire (Ox-PAQ) into Turkish and investigated its psychometric properties in the older adult population.

Methods

The Turkish version of the Ox-PAQ was produced after a translation and back-translation process. The Ox-PAQ was administered to 230 and 60 individuals for construct validity and reliability analyses, respectively. To assess the test-retest reliability of the Turkish Ox-PAQ, the questionnaire was reapplied 7 days after the first interview. Cronbach’s alpha (α) was used to evaluate the internal consistency. The Ox-PAQ was compared to the Short Form-12 and the Katz Index of Independence in Activities of Daily Living Scale to determine its validity.

Results

The Turkish Ox-PAQ showed excellent internal consistency (α=0.98) and test-retest reliability (intraclass correlation coefficient=0.98, 0.96, and 0.97 for the subscales of routine activity level, social engagement, and emotional well-being, respectively). In the validity analysis, factor analysis demonstrated a probable structure of the three factors that together explained 66.35% of the total variance. The Turkish Ox-PAQ was correlated with the other comparison measures used in this study.

Conclusion

The Turkish Ox-PAQ is a reliable and valid questionnaire to evaluate the participation and activity levels of older people (Clinical Trial Number: NCT04368754).

Families' control preference for participation in patient care in adult intensive care

OBJECTIVE

Understand families' preferences and observed participation in patient care in an adult ICU.

RESEARCH METHODOLOGY

The mixed-methods design used survey and naturalistic observation to collect data from a convenience sample of 30 family members of critically ill patients.

SETTING

Two public hospital intensive care units in Australia.

MAIN OUTCOME MEASURES

1) Families' preferences for participation in decision-making and physical patient care activities in the adult intensive care unit, measured using a modified Control Preference Scale; 2) the type and frequency of family participation in patient care activities in the intensive care unit.

RESULTS

Almost half (47%) reported a preference to share in decision-making about care for their relative with healthcare professionals; 17% reported a preference for active participation in decision-making. Alternatively, most families preferred a passive (60%) role in the physical care of their relative ; 33% preferred shared participation with staff and very few (3%) preferred active participation with little involvement of staff. Of the 193 activities observed, family participation in physical care was the least frequent (24%).

CONCLUSION

Differences emerged in family preferences for participation in physical care compared to their involvement in decision-making about care for their relative. The findings indicate a need for tailored interventions to support family participation aligned with their preferences.

Assessment of shared decision-making in community mental health care: Validation of the CollaboRATE

Background/Objective

CollaboRATE is a 3-item self-report measure of the patient experience of shared decision-making (SDM) process. The objective of this study is to assess the psychometric properties of CollaboRATE in community mental health care.

Method

A cross-sectional study was conducted at a Community Mental Health Center of the Canary Islands Health Service. Two hundred and fifty consecutive psychiatric outpatients were invited to participate. Of those, 191 accepted (76.40% of response rate) and completed the CollaboRATE, the Control Preferences Scale (CPS), and a form with sociodemographic and clinical variables.

Results

Exploratory factor analysis ratified the unidimensionality of the measure. High internal consistency was found (α Cronbach = .95, Guttman's λ = .93, and ω = .95). Strong positive correlations (p < .0001) were found between the CollaboRATE and the CPS. Only 39.80% of respondents gave the best possible score on CollaboRATE.

Conclusions

This study provides evidence for the reliability and validity of the Spanish version of the CollaboRATE as a measure of SDM. The measure is quick to complete and feasible for use in outpatient mental health care. At present, a significative number of psychiatric outpatients are not involved in SDM. The use of this measure in psychiatric routine care can be a key tool in assessing and implementing SDM.

Assessing and reporting patient participation by means of patient preferences and experiences

BACKGROUND

Although patient participation is strongly associated with high quality of healthcare, valid means to measure and report a comprehensive notion of patient participation are scarce. The Patient Preferences for Patient Participation (4Ps) is a new healthcare practice and research tool, comprising patients' preferences as well as experiences. The 4Ps employs 12 items for the patient to conceptualise patient participation. The aim of this paper is to describe how the two perspectives of patient participation, namely preferences and experiences, can be combined to visualise and report preference-based patient participation.

METHODS

With four response alternatives in each section, the 4Ps offers sixteen possible combinations of degree of match per item. Theoretical and clinical principles fostered a tentative order of six ranks and three levels of preference-based patient participation. To test the standard, statistical analyses for ordinal data were performed, using data from a randomised controlled trial evaluating an intervention aiming to improve patient participation. Further, structures for visualising the preference-based patient participation of individuals and groups were suggested.

RESULTS

Data from the 4Ps demonstrated the individuals' preference-based patient participation, indicating either a match or a mismatch for each item. Mismatches represented either the experience of participation surpassing the patient's preferences, or the patient's preferences for patient participation not being established. At group level, the suggested approach for visualising and reporting the 4Ps demonstrated that the intervention group had a significantly higher proportion of sufficient preference-based patient participation for certain items than the control group. These results had not been identified earlier, when using the preferences and experiences of patient participation as separate measures.

CONCLUSIONS

Ways to easily acquaint stakeholders with patients' preferences for patient participation are needed, in order for healthcare staff to better use resources to match the basic requirements of individuals and groups. While the 4Ps can guide professionals to patient participation as framed in legislations, concept analyses and by patients, a visualisation of the results is needed to capture preference-based patient participation. The proposed route to representing degree of match in preferences and experiences may also be relevant to other dimensions of quality of healthcare.

Patient participation in gastrointestinal endoscopy - From patients' perspectives

Background

Patient participation is associated with satisfaction and improved health‐related outcomes. In gastrointestinal endoscopy, patient participation is an underexplored area.

Objective

To gain understanding on patients' experiences, attitudes and preferences concerning patient participation in the endoscopy pathway.

Methods

Semi‐structured interviews with endoscopy patients (n = 17, female n = 8, male n = 9, ages 19‐80 years) were performed. Interview transcripts were analysed using qualitative content analysis. Participants were recruited by purposive sampling from an endoscopy unit in a Swedish university hospital. Inclusion:≥ 18 years, fluency in Swedish and recent experience of endoscopy at the unit.

Results

Five generic categories emerged, two within the area of the patient's role, which was described as active or passive/included or excluded. Another three generic categories related to factors, critical to active participation, including organizational aspects, impressions of staff and individual circumstances were identified. In this context, patient participation described in the interviews was on a low to basic level, although sometimes reaching a higher level when staff ‘invited’ patients in decision making.

Discussion

This study contributes to the understanding of patient participation in endoscopy. Patients are in an inferior position and need support from the staff for an active role in their care. Although there were variations on the perceived importance of different factors, a heavy responsibility lies on the endoscopy staff to acknowledge the patients' individual needs and to facilitate patient participation.

Conclusions

Endoscopy staff has a key role in supporting patient participation. In endoscopy settings, patient participation is vulnerable to multiple factors.

Systematic review of psychometric properties of instruments measuring patient preferences for engagement in health care

AIM

To identify, critically appraise, and summarize instruments that measure patients' preferences for engagement in health care.

DESIGN

Psychometric systematic literature review.

DATA SOURCES

PubMed, Embase, CINAHL, and PsycINFO were searched from inception to March 2019.

REVIEW METHODS

Three reviewers independently evaluated the 'methodological quality' and the 'measurement properties' of the included instruments using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and Terwee's quality criteria. Each instrument was given a Grading of Recommendations Assessment, Development and Evaluation (GRADE) score. The review was registered at PROSPERO (registry number CRD42018109253).

RESULTS

A total of 16 studies evaluating 8 instruments measuring patients' preferences for engagement in health care were included. All instruments were downgraded for their 'methodological quality' or 'measurement properties', or a combination of both. Common concerns were lack of theoretical basis, absence of patient input during development, incorrect usage and reporting of validity measures and absence of a priori hypotheses to test validity.

CONCLUSIONS

There were no identified instruments that demonstrated adequate evidence for all measurement properties. The Patient Preferences for Patient Participation Scale (4Ps) and 10-item Decisional Engagement Scale (DES-10) had the highest overall GRADE scores; however, each had some underlying developmental or methodological issues.

IMPACT

Assessing how patients prefer to engage in their care is a critical first step to truly individualize engagement interventions to meet patient expectations. Systematic reviews of measures of patient experience with engagement in health care have been undertaken but none are available on measures of patient preferences for engagement. The results highlight the need to further develop and test instruments that measure patients' preferences for engagement in health care within a framework for consumerism. Involving the consumer in the instrument development process will ensure that engagement strategies used by healthcare providers are relevant and individualized to consumer preferences.

A co-designed framework to support and sustain patient and family engagement in health-care decision making

Background

Patient and family engagement in health care has emerged as a critical priority. Understanding engagement, from the perspective of the patient and family member, coupled with an awareness of how patient and family members are motivated to be involved, is an important component in increasing the effectiveness of patient engagement initiatives. The purpose of this research was to co‐design a patient and family engagement framework.

Methods

Workshops were held to provide additional context to the findings from a survey. Participants were recruited using a convenience sampling strategy. Workshop data collected were analysed using a modified constant comparative technique. The core research team participated in a workshop to review the findings from multiple inputs to inform the final framework and participated in a face validity exercise to determine that the components of the framework measured what they were intended to measure.

Results

The framework is organized into three phases of engagement: why I got involved; why I continue to be involved; and what I need to strengthen my involvement. The final framework describes seven motivations and 24 statements, arranged by the three phases of engagement.

Conclusion

The results of this research describe the motivations of patient and family members who are involved with health systems in various roles including as patient advisors. A deeper knowledge of patient and family motivations will not only create meaningful engagement opportunities but will also enable health organizations to gain from the voice and experience of these individuals, thereby enhancing the quality and sustainability of patient and family involvement.

A web application to involve patients in the medication reconciliation process: a user-centered usability and usefulness study

Objective

Medication reconciliation (MedRec) can improve patient safety by resolving medication discrepancies. Because information technology (IT) and patient engagement are promising approaches to optimizing MedRec, the SEAMPAT project aims to develop a MedRec IT platform based on two applications: the "patient app" and the "MedRec app." This study evaluates three dimensions of the usability (efficiency, satisfaction, and effectiveness) and usefulness of the patient app.

Methods

We performed a four-month user-centered observational study. Quantitative and qualitative data were collected. Participants completed the system usability scale (SUS) questionnaire and a second questionnaire on usefulness. Effectiveness was assessed by measuring the completeness of the medication list generated by the patient application and its correctness (ie medication discrepancies between the patient list and the best possible medication history). Qualitative data were collected from semi-structured interviews, observations and comments, and questions raised by patients.

Results

Forty-two patients completed the study. Sixty-nine percent of patients considered the patient app to be acceptable (SUS Score ≥ 70) and usefulness was high. The medication list was complete for a quarter of the patients (7/28) and there was a discrepancy for 21.7% of medications (21/97). The qualitative data enabled the identification of several barriers (related to functional and non-functional aspects) to the optimization of usability and usefulness.

Conclusions

Our findings highlight the importance and value of user-centered usability testing of a patient application implemented in "real-world" conditions. To achieve adoption and sustained use by patients, the app should meet patients' needs while also efficiently improving the quality of MedRec.

Measuring triadic decision making in older patients with multiple chronic conditions: Observer OPTIONMCC

OBJECTIVE

To develop a valid and reliable tool to measure triadic decision making between older adults with multiple chronic conditions (MCC), their informal caregivers and geriatricians.

METHODS

Video observational study with cross-sectional assessment of interaction during medical consultations between geriatricians (n = 10), patients (n = 108) and informal caregivers (68) by three calibrated raters at the geriatric outpatient department of two Dutch hospitals. The Observer OPTION^MCC instrument was developed, based on the 'Dynamic model of SDM in frail older patients' and the 'Observing Patient Involvement in Decision Making - 5 item scale' (Observer OPTION-5).

RESULTS

Factor analysis confirms that it is acceptable to regard the new scale as a single construct. The 7-item single factor solution explained 62.76% of the variability for geriatricians, 61.60% of the variability for patients and 54.32% of the variability for informal caregivers. The inter-rater ICC for the total Observer OPTION^MCC score was .96, .96, and .95 (resp. geriatricians, patients, informal caregivers), with values ranging from .60 to .95 for individual items, showing good levels of agreement.

CONCLUSION AND PRACTICE IMPLICATIONS

We conclude that Observer OPTION^MCC is sufficiently valid and reliable to be used for the assessment of triadic SDM in populations of older patients with MCC.

A Systematic Review Protocol Investigating Community Gardening Impact Measures

Existing community gardening research has tended to be exploratory and descriptive, utilising qualitative or mixed methodologies to explore and understand community garden participation. While research on community gardening attracts growing interest, the empirical rigour of measurement scales and embedded indicators has received comparatively less attention. Despite the extensive body of community gardening literature, a coherent narrative on valid, high quality approaches to the measurement of outcomes and impact across different cultural contexts is lacking and yet to be comprehensively examined. This is essential as cities are becoming hubs for cultural diversity. Systematic literature reviews that explore the multiple benefits of community gardening and other urban agriculture activities have been undertaken, however, a systematic review of the impact measures of community gardening is yet to be completed. This search protocol aims to address the following questions: (1) How are the health, wellbeing, social and environmental outcomes and impacts of community gardening measured? (2) What cultural diversity considerations have existing community garden measures taken into account? Demographic data will be collected along with clear domains/constructs of experiences, impacts and outcomes captured from previous literature to explore if evidence considers culturally heterogeneous and diverse populations. This will offer an understanding as to whether community gardening research is appropriately measuring this cross-cultural activity.

Understanding the motivations of patients: A co-designed project to understand the factors behind patient engagement

Background

Large‐scale transformation depends on effective engagement of diverse stakeholders. With the evolution of the role of the ‘patient partner’ in health‐care decision making, understanding the motivations of these individuals is essential to the success of engagement initiatives. This study reports on motivational factors associated with patient engagement in health care.

Methods

Patient co‐investigators and a researcher co‐designed and conducted this study. A survey was administered to patients and family members. Key informant interviews and previous research informed the development of the survey tool. The survey data were analysed using exploratory factor analysis to identify the underlying dimensions in the data. Cronbach's alpha was used to determine reliability.

Results

A total of 1449 individuals participated in the survey. Of these, 543 completed and 427 partially completed the survey (67% complete rate). The mean age of the respondents was 54 years. The majority of participants were female, well‐educated, retired, married and lived in an urban centre. Seven motivational factors explained 65% of the total variance. Analysis of internal consistency revealed acceptable reliability for all items. The seven motivations were as follows: Self‐fulfillment, Improving Healthcare, Compensation, Influence, Learning New Things, Conditional and Perks.

Conclusion

The results of this research describe a sample of patient and family members currently engaged with health systems. We identified seven motivational factors underlying their engagement. A deeper knowledge of volunteer motivations will not only create meaningful engagement opportunities for patients, but also enable health organizations to gain from the experience of these individuals, thereby enhancing quality and sustainability of patient engagement programmes.

From Craft to Reflective Art and Science Comment on "Metrics and Evaluation Tools for Patient Engagement in Healthcare Organization- and System-Level Decision-Making: A Systematic Review"

Patient engagement practices are increasingly incorporated in health research, governance, and care. More recently, a large number of evaluation tools and metrics have been developed to support engagement evaluation. This growing interest in evaluation reflects a maturation of the patient engagement field, moving from a "craft" to a reflective "art and science," with more explicit expected benefits and risks, better understood conditions for success and failure, and increasingly rigorous evaluation instruments to improve engagement theories and interventions. It also supports a more critical view of engagement science, moving beyond reductionist views of engagement as a "black box technology" to a more subtle view of this broad category of complex interventions. Structured evaluation can advance patient engagement by supporting more reflective partnerships between patients, clinicians, health system leaders and citizens. This can help clarify mutual (and potentially contradictory) expectations toward engagement, provide a reality check toward claims of benefits and harms, and increase health systems’ capacity to implement effective engagement practices over time. To do so, closer collaborations are required between engagement scientists and practitioners to align the theories, practice and evaluation of patient and community engagement.

How is patient involvement measured in patient centeredness scales for health professionals? A systematic review of their measurement properties and content

BACKGROUND

Patient centeredness is an important component of patient care and healthcare quality. Several scales exist to measure patient centeredness, and previous literature provides a critical appraisal of their measurement properties. However, limited knowledge exists regarding the content of the various scales in terms of what type of patient centeredness they represent and how they can be used for quality improvement. The aim of this study was to explore the measurement properties of patient centeredness scales and their content with a special focus on patient involvement, and assess whether and how they can be used for quality improvement.

METHODS

A systematic review of patient centeredness scales was conducted in Medline, CINAHL, Embase, and SCOPUS in April and May 2017. Inclusion criteria were limited to articles written in English published from 2005 to 2017. Eligible studies were critically appraised in terms of internal consistency and reliability, as well as their content, structural, and cross-cultural validity. Type of studies included were scale-development articles and validation studies of relevant scales, with healthcare personnel as respondents. We used directed content analysis to categorize the scales and items according to Tritter's conceptual framework for patient and public involvement.

RESULTS

Eleven scales reported in 22 articles were included. Most scales represented individual, indirect, and reactive patient involvement. Most scales included items that did not reflect patient centeredness directly, but rather organizational preconditions for patient centered practices. None of the scales included items explicitly reflecting the use of patient experiences of quality improvement.

CONCLUSIONS

There is a lack of patient centeredness scales focusing on direct and proactive involvement of patients in quality improvement. It would be useful to develop such instruments to further study the role of patient involvement in quality improvement in healthcare. Furthermore, they could be used as important tools in quality improvement interventions.

Validation of two PROMIS item banks for measuring social participation in the Dutch general population

BACKGROUND

The Patient-Reported Outcomes Measurement Information System (PROMIS) item banks 'Ability to Participate in Social Roles and Activities' (35 items) and 'Satisfaction with Social Roles and Activities' (44 items) were developed to measure (satisfaction with) participation more efficiently and precisely than current instruments, by using Computerized Adaptive Testing (CAT). We validated these item banks in a Dutch general population.

METHODS

Participants in an internet panel completed both item banks. Unidimensionality, local dependence, monotonicity, Graded Response Model item fit, Differential Item Functioning (DIF) for age, gender, education, region, ethnicity, and language (Dutch compared to US Social Supplement), and reliability were assessed.

RESULTS

A representative Dutch sample of 1002 people participated. We found for the Ability to Participate and Satisfaction with Participation item banks, respectively, sufficient unidimensionality (CFI: 0.971, 0.960; TLI: 0.970, 0.958; RMSEA: 0.108, 0.108), no local dependence, sufficient monotonicity (H: 0.75, 0.73), good item fit (2 out of 35 items, 1 out of 44 items with S-X2p-value < 0.001). No DIF was found. We found a reliability of at least 0.90 with simulated CATs in 86% and 94% of the participants with on average 4.7 (range 2-12) and 4.3 (range 3-12) items, respectively.

DISCUSSION

The PROMIS participation item banks showed sufficient psychometric properties in a general Dutch population and can be used as CAT. PROMIS CATs allow reliable and valid measurement of participation in an efficient and user-friendly way with limited administration time.

Patients’ perceptions of participation: Pilot validation study of the FI-PPRQ questionnaire in Finnish primary healthcare settings

Patient participation is is a highly valued goal within healthcare. The aim of this study was to assess the validity of a Finnish version of the Participation in Rehabilitation Questionnaire (FI-PPRQ) developed to measure patients’ perceptions of the importance and their experience of participation in care. The original PPRQ was translated from Swedish into Finnish, then subjected to psychometric pilot testing using data acquired in a cross-sectional survey with a sample of adult patients in eight primary healthcare units (n = 88). The importance and experience ratings were evaluated separately, by calculating distributions of item and scale scores, Cronbach’s alpha coefficients, and correlations between items and scales. In addition, experience ratings were subjected to exploratory factor and multi-trait scaling analyses. The results of this study support the validity and reliability of the instrument for use in clinical settings to provide information about patient participation. However, further studies are needed with more varied settings.

Individual user involvement at Healthy Life Centres: a qualitative study exploring the perspective of health professionals

The aim of this study was to explore how professionals experience user involvement at an individual level and how they describe involving users at Healthy Life Centres. Four focus group interviews were conducted with a total of 23 professionals. Data were analysed using systematic text condensation. Four themes were identified: (1) Involving users through motivational interviewing; (2) Building a good and trustful relation; (3) Assessing and adjusting to the user’s needs and life situation; and(4) Strengthening the user’s ownership and participation in the lifestyle change process. Motivational interviewing was described by the professionals as a way to induce and ensure user involvement. However, seeing motivational interviewing and user involvement as the same concept might reduce user involvement from being a goal in itself and evolve into a means of achieving lifestyle changes. The professionals might be facing opposing discourses in their practice and a dilemma of promoting autonomy and involvement and at the same time promoting change in a predefined direction. Greater emphasis should thus be put on systematic reflection among professionals about what user involvement implies in the local Healthy Life Centre context and in each user’s situation.

Abbreviations: HLC: Healthy Life Centre; MI: Motivational Interviewing; NCD: Non-communicable diseases; STC: Systematic Text Condensation. SDT: Self-determination theory

Effects of a self-management programme on patient participation in patients with chronic heart failure or chronic obstructive pulmonary disease: A randomized controlled trial

Background:

Self-management strategies are crucial to patients with long-term conditions and can presumably promote patient participation, given that to patients, patient participation connotes opportunities for self-care (along with being engaged in an exchange of knowledge, a phrasing of joint goals and planning of care). So far, limited attention has been given to what components support self-management and what outcomes can be achieved. An exclusive self-management programme in primary healthcare entailed assessing its influence on patient participation.

Aim:

To describe the effects of a self-management programme on preferences for, and experiences of, patient participation in patients with chronic obstructive pulmonary disease or chronic heart failure.

Methods:

A randomized controlled trial with a six session intervention programme, including phrasing of individual action plans and group discussions on the patients’ issues. The intervention group ( n=59) received standard care and the self-management programme, and the control group ( n=59) received standard care only. Data was collected at baseline and at three months and 12 months after the intervention started, using the Patient Preferences for Patient Participation (the 4Ps) measure.

Results:

No significant differences were found within the groups, or between the groups, in preferences and experiences of patient participation, either in summary score or at an item level.

Conclusion:

A self-management group programme led by trained primary healthcare staff in primary care did not serve as means to influence patients’ experience of patient participation in the care of their long-term condition. Further studies are needed in regard to what facilitates patient participation in this setting and beyond.

Patient participation in patient safety-An exploration of promoting factors

AIMS

To study how internal medicine patients experienced patient safety during their recent periods of care and to identify explanatory factors for patient participation.

BACKGROUND

Patient participation is recognized as one of the main factors promoting quality and safety and the identification of effective interventions that encourage safe care.

METHODS

A cross-sectional survey of patients (n = 462) in the internal medicine wards (n = 18) of all five Finnish university hospitals. Data were analysed using principal component analysis and multiple linear regression.

RESULTS

Most patients (78%) assessed the level of patient safety on their ward as "very good" or "excellent," 20% of patients assessed it as acceptable or worse. The following were considered to be the most important factors explaining higher patient participation: informing patients about the research and encouraging them to participate (β = 0.378, p < 0.001), providing necessary information promptly and comprehensibly (β = 0.393, p < 0.001), and enhancing patients' ability to identify patient safety incident(s) (β = 0.186, p < 0.001).

CONCLUSIONS

Healthcare workers must improve by encouraging patient participation and providing relevant information to patients.

IMPLICATION FOR NURSING MANAGEMENT

Nursing leaders must be competent to support, lead, and allocate resources for the creation of an environment where patient participation can occur and is valued by health care workers.

A network perspective of engaging patients in specialist and chronic illness care: The 2014 International Health Policy Survey

Background

Patient engagement helps to improve health outcomes and health care quality. However, the overall relationships among patient engagement measures and health outcomes remain unclear. This study aims to integrate expert knowledge and survey data for the identification of measures that have extensive associations with other variables and can be prioritized to engage patients.

Methods

We used the 2014 International Health Policy Survey (IHPS), which provided information on elder adults in 11 countries with details in patient characteristics, healthcare experiences, and patient-physician communication. Patient engagement or support was measured with eight variables including patients’ treatment choices, involvement, and treatment priority setting. Three types of care were identified: primary, specialist and chronic illness care. Specialists were doctors specializing in one area of health care. Chronic illness included eight chronic conditions surveyed. Expert knowledge was used to assist variable selection. We used Bayesian network models consisting of nodes that represented variables of interest and arcs that represented their relationships.

Results

Among 25,530 participants, the mean age was 68.51 years and 57.40% were females. The distributions of age, sex, education, and patient engagement were significantly different across countries. For chronic illness care, written plans provided by professionals were linked to treatment feasibility and helpfulness. Whether professionals contacted patients was associated with the availability of professionals they could reach for chronic illness care. For specialist care, if specialists provided treatment choices, patients were more likely to be involved and discuss about what mattered to them.

Conclusion

The strategies to engage patients may depend on the types of care, specialist or chronic illness care. For the study on the observational IHPS data, network modeling is useful to integrate expert knowledge. We suggest considering other theory-based patient engagement in major surveys, as well as engaging patients in their healthcare by providing written plans and actively communicating with patients for chronic illnesses, and encouraging specialists to discuss and provide treatment options.

A Concept Analysis of Patient Participation in Intermediate Care

OBJECTIVE

Although the concept of patient participation has been discussed for a number of years, there is still no clear definition of what constitutes the multidimensional concept, and the application of the concept in an intermediate care (IC) context lacks clarity. Therefore this paper seeks to identify and explore the attributes of the concept, to elaborate ways of understanding the concept of patient participation for geriatric patients in the context of IC.

METHODS

Walker and Avant's model of Concept analysis [1] based on a literature review.

RESULTS

Patient participation in the context of IC can be defined as a dynamic process emphasizing the person as a whole, focusing on the establishment of multiple alliances that facilitate individualized information and knowledge exchange, and ensuring a reciprocal engagement in activities within flexible and interactive/dynamic organizational structures.

CONCLUSION

Patient participation in IC means involving patients and their relatives in holistic interdisciplinary collaborative decision-making. The results highlight the complexity of patient participation and contribute to a greater understanding of the influence of organizational structure and management.

PRACTICAL IMPLICATIONS

The present study may provide a practical framework for researchers, policy makers and health professionals to facilitate patient participation in IC services.

Development and initial validation of the Swedish Family Satisfaction Intensive Care Questionnaire (SFS-ICQ)

OBJECTIVES

Measuring patients satisfaction is an important part of continuous quality improvement in health care. In intensive care, family satisfaction is often used as a proxy for patient experience. At present, no suitable instrument to measure this has been fully validated in Sweden. The purpose of this study was to develop and validate a questionnaire intended to evaluate families' satisfaction of quality of care in Swedish intensive care units.

METHODS

Based on literature and the modification of pertinent items in two existing North American questionnaires, a Swedish questionnaire was developed. Content validity was assessed by experts, and the cognitive method Think Aloud was used with twelve family members of intensive care patients in two different intensive care units. Data was analysed using qualitative content analysis.

FINDINGS

Seven items in the questionnaire were identified as problematic, causing eight problems concerning questioning of content and 23 concerning misunderstanding. Six of these items were changed in order to be understood the way they were intended, and one item was removed.

CONCLUSION

A family satisfaction questionnaire applicable in Swedish intensive care units has been developed and validated for respondents' understanding of the questions being asked. However, further psychometric testing should be performed when more data are available.

Patient safety on psychiatric wards: A cross-sectional, multilevel study of factors influencing nurses' willingness to share power and responsibility with patients

The World Health Organization highlights the need for more patient participation in patient safety. In mental health care, psychiatric nurses are in a frontline position to support this evolution. The aim of the present study was to investigate the demographic and contextual factors that influence the willingness of psychiatric nurses to share power and responsibility with patients concerning patient safety. The patient participation culture tool for inpatient psychiatric wards was completed by 705 nurses employed in 173 psychiatric wards within 37 hospitals. Multilevel modelling was used to analyse the self-reported data. The acceptance of a role wherein nurses share power and responsibility with patients concerning patient safety is influenced by the nurses' sex, age, perceived competence, perceived support, and type of ward. To support nurses in fulfilling their role in patient participation, patient participation-specific basic and continuing education should be provided. Managers and supervisors should recognize and fulfil their facilitating role in patient participation by offering support to nurses. Special attention is needed for young nurses and nurses on closed psychiatric wards, because these particular groups report being less willing to accept a new role. Ward characteristics that restrict patient participation should be challenged so that these become more patient participation stimulating. More research is needed to explore the willingness and ability of psychiatric nurses to engage in collaborative safety management with patients who have specific conditions, such as suicidal ideation and emotional harm.

A framework of comfort for practice: An integrative review identifying the multiple influences on patients' experience of comfort in healthcare settings

Purpose

Comfort is central to patient experience but the concept of comfort is poorly defined. This review aims to develop a framework representing patients' complex perspective of comfort to inform practice and guide initiatives to improve the quality of healthcare.

Data sources

CINAHL, MEDLINE Complete, PsycINFO and Google Scholar (November 2016); reference lists of included publications.

Study selection

Qualitative and theoretical studies advancing knowledge about the concept of comfort in healthcare settings. Studies rated for methodological quality and relevance to patients' perspectives.

Data extraction

Data on design, methods, features of the concept of comfort, influences on patients' comfort. Data were systematically coded and categorized using Framework method.

Results of data synthesis

Sixty-two studies (14 theoretical and 48 qualitative) were included. Qualitative studies explored patient and staff perspectives in varying healthcare settings including hospice, emergency departments, paediatric, medical and surgical wards and residential care for the elderly. From patients' perspective, comfort is multidimensional, characterized by relief from physical discomfort and feeling positive and strengthened in one's ability to cope with the challenges of illness, injury and disability. Different factors are important to different individuals. We identified 10 areas of influence within four interrelated levels: patients' use of self-comforting strategies; family presence; staff actions and behaviours; and environmental factors.

Conclusion

Our data provide new insights into the nature of comfort as a highly personal and contextual experience influenced in different individuals by different factors that we have classified into a framework to guide practice and quality improvement initiatives.

A Mobile Phone App to Support Young People in Making Shared Decisions in Therapy (Power Up): Study Protocol

BACKGROUND

Evidence suggests that young people want to be active participants in their care and involved in decisions about their treatment. However, there is a lack of digital shared decision-making tools available to support young people in child and adolescent mental health services (CAMHS).

OBJECTIVE

The primary aim of this paper is to present the protocol of a feasibility trial for Power Up, a mobile phone app to empower young people in CAMHS to make their voices heard and participate in decisions around their care.

METHODS

In the development phase, 30 young people, parents, and clinicians will take part in interviews and focus groups to elicit opinions on an early version of the app. In the feasibility testing phase, 60 young people from across 7 to 10 London CAMHS sites will take part in a trial looking at the feasibility and acceptability of measuring the impact of Power Up on shared decision making.

RESULTS

Data collection for the development phase ended in December 2016. Data collection for the feasibility testing phase will end in December 2017.

CONCLUSIONS

Findings will inform the planning of a cluster controlled trial and contribute to the development and implementation of a shared decision-making app to be integrated into CAMHS.

TRIAL REGISTRATION

ISRCTN77194423; http://www.isrctn.com/ISRCTN77194423 (Archived by WebCite at http://www.webcitation.org/6td6MINP0). ClinicalTrials.gov NCT02987608; https://clinicaltrials.gov/ct2/show/NCT02987608 (Archived by WebCite at http://www.webcitation.org/6td6PNBZM).