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von Thiele Schwarz U, Roczniewska M, Pukk Härenstam K, Karlgren K, Hasson H, Menczel S, Wannheden C. The work of having a chronic condition: development and psychometric evaluation of the distribution of co-care activities (DoCCA) scale. BMC Health Serv Res 2021; 21:480. [PMID: 34016102 PMCID: PMC8138998 DOI: 10.1186/s12913-021-06455-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic care involves multiple activities that can be performed by individuals and healthcare staff as well as by other actors and artifacts, such as eHealth services. Thus, chronic care management can be viewed as a system where the individual interacts with people and eHealth services performing activities to maintain or improve health and functioning, called co-care. Yet, the system perspective is not reflected in concepts such as person-centered care and shared decision making. This limits the understanding of individuals' global experience of chronic care management and subsequently the ability to optimize chronic care. The aim of this study was threefold: (1) to propose a theory-based operationalization of co-care for chronic care management, (2) to develop a scale to measure co-care as a distributed system of activities, and (3) to evaluate the scale's psychometric properties. With the theory of distributed cognition as a theoretical underpinning, co-care was operationalized along three dimensions: experience of activities, needs support, and goal orientation. METHODS Informed by the literature on patient experiences and work psychology, a scale denoted Distribution of Co-Care Activities (DoCCA) was developed with the three conceptualized dimensions, the activities dimension consisting of three sub-factors: demands, unnecessary tasks, and role clarity. It was tested with 113 primary care patients with chronic conditions in Sweden at two time points. RESULTS A confirmatory factor analysis showed support for a second-order model with the three conceptualized dimensions, with activities further divided into the three sub-factors. Cronbach's alpha values indicated a good to excellent reliability of the subscales, and correlations across time points with panel data indicated satisfactory test-retest reliability. Convergent, concurrent and predictive validity of the scale were, overall, satisfactory. CONCLUSIONS The psychometric evaluation supports a model consisting of activities (demands, unnecessary tasks, and role clarity), needs support and goal orientation that can be reliably measured with the DoCCA scale. The scale provides a way to assess chronic care management as a system, considering the perspective of the individuals with the chronic condition and how they perceive the work that must be done, across situations, either by themselves or through healthcare, eHealth, or other means.
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Affiliation(s)
- Ulrica von Thiele Schwarz
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden.
- Procome, Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Marta Roczniewska
- Procome, Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
- Psychology Department, SWPS University of Social Sciences and Humanities, 81-745, Sopot, Poland
| | - Karin Pukk Härenstam
- Clinical Management, Medical Management Centre, LIME, Karolinska Institutet, 171 77, Stockholm, Sweden
- Paediatric Emergency Department, Astrid Lindgren's Children's Hospital, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Klas Karlgren
- MINT, LIME, Karolinska Institutet, 171 77, Stockholm, Sweden
- Department of health and functioning, Faculty of Health and Social Sciences, The Western Norway University of Applied Sciences, 5063, Bergen, Norway
- Department of Research, Education, Development and Innovation, Södersjukhuset, 118 83, Stockholm, Sweden
| | - Henna Hasson
- Procome, Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Stockholm Region, 171 29, Stockholm, Sweden
| | - Sivan Menczel
- Procome, Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Carolina Wannheden
- Procome, Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
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