Assessing the predictive power of psychological empowerment and health literacy for older patients' participation in health care: a cross-sectional population-based study (original) (raw)
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What role does health literacy play in patients' involvement in medical decision-making
Patients vary in their preferences towards involvement in medical decision-making. Previous research, however, gives no clear explanation for this observed variation in their involvement. One possible explanation might be health literacy. Health literacy refers to personal characteristics and social resources needed for people to access, understand and use information to make decisions about their health. This study aimed to examine the relationship between health literacy and self-reported patient involvement. With respect to health literacy, we focused on those competences relevant for medical decision-making. We hypothesized that people with higher health literacy report that they are more involved in medical decision-making. A structured questionnaire was sent to members of the Dutch Health Care Consumer Panel in May 2015 (response 46%, N = 974). Health literacy was measured using five scales of the Health Literacy Questionnaire. A regression model was used to estimate the relationship between health literacy and self-reported involvement. In general, our results did not show a relationship between health literacy and self-reported involvement. We did find a positive significant association between the health literacy scale appraisal of health information and self-reported involvement. Our hypothesis was partly confirmed. The results from this study suggest that higher order competences, that is to say critical health literacy, in particular, are important in reporting involvement in medical decision-making. Future research is recommended to unravel further the relationship between health literacy and patient involvement in order to gain insight into whether health literacy might be an asset to enhance patient participation in medical decisionmaking.
Previous research suggests that older adults prefer less information and involvement in medical decision-making scenarios than younger adults. No previous research has empirically explored the factors that might influence the information and involvement preferences of older adults in medical decision-making scenarios. The present study involved an investigation of the influence of four factors on information and involvement needs: the complexity of the medical information, cognitive abilities, attitudes toward medical authority and health locus of control beliefs. Complexity was defined by contrasting reading levels (i.e., medical scenarios written at the 4 th -vs. 11 th -grade reading level). Cognitive abilities were measured using the Logical Memory subscale from the Wechsler Memory Scale and the following subscales from Wechsler Adult Intelligence Scale -Third Edition: Matrix Reasoning, Digit-Symbol Coding, Vocabulary and Digits Forward and Backward. Attitudes toward medical authority were assessed using an adaptation of a questionnaire developed by . Health locus of control beliefs were assessed using the Multidimensional Health Locus of Control scale and the God Locus of Health Control scale (Wallston et al., 1999). Two, written medical scenarios were used; one involved breast cancer while the other involved cervical cancer. Sixty women, aged 60 years and over, participated in the study. Using Likerttype scales, participants were asked to rate how involved they would prefer to be in treatment and how much information they would prefer regarding nine topic areas (i.e., diagnosis, side effects of treatment, what the treatments do, likelihood of a cure, potential consequences of metastases, what the treatments do inside the body, effectiveness of treatment for other patients, examples of cases of treatment effectiveness and ineffectiveness). Principal component analyses were conducted to yield predictors that were subsequently used in multiple regression analyses. Results revealed that none of the four factors were significantly related to preferences for information in the two scenarios. Similarly, performance on the cognitive variables and manipulations of the complexity of the scenario were not related to preferences for involvement in the two scenarios. However, beliefs that one's health is controlled by external agents (e.g., a Higher Power, chance or powerful others) were related to preferences for less involvement within the cervical cancer scenario. In addition, preferences for less involvement were significantly correlated with decreased tendencies to believe in a patient's rights (i.e., rights to challenge medical authority, obtain information and make medical decisions) in medical settings. Implications of these results and suggestions for future research are provided.
Social Science & Medicine, 2009
Education and health literacy potentially limit a person's ability to be involved in decisions about their health. Few studies, however, have explored understandings and experiences of involvement in decision making among patients varying in education and health literacy. This paper reports on a qualitative interview study of 73 men and women living in Sydney, Australia, with varying education and functional health literacy levels. Participants were recruited from a community sample with lower educational attainment, plus an educated sample of University of Sydney alumni. The transcripts were analysed using the 'Framework' approach, a matrix-based method of thematic analysis. We found that participants with different education conceptualised their involvement in decision making in diverse ways. Participants with higher education appeared to conceive their involvement as sharing the responsibility with the doctor throughout the decision-making process. This entailed verifying the credibility of the information and exploring options beyond those presented in the consultation. They also viewed themselves as helping others in their health decisions and acting as information resources. In contrast, participants with lower education appeared to conceive their involvement in terms of consenting to an option recommended by the doctor, and having responsibility for the ultimate decision, to agree or disagree with the recommendation. They also described how relatives and friends sought information on their behalf and played a key role in their decisions. Both education groups described how aspects of the patientpractitioner relationship (e.g. continuity, negotiation, trust) and the practitioner's interpersonal communication skills influenced their involvement. Health information served a variety of needs for all groups (e.g. supporting psychosocial, practical and decision support needs). These findings have practical implications for how to involve patients with different education and literacy levels in decision making, and highlight the important role of the patient-practitioner relationship in the process of decision making.
Patient Education and Counseling, 2007
Objective: The aim of the study was to explore the views of people aged over 70 years on involvement in their primary health care in 11 different European countries. Methods: Older patients were asked about their views on patient involvement in a face-to-face interview. All interviews were audio-recorded, transcribed and analysed in accordance with the principles of 'qualitative content analysis'. An international code list was used. Results: Four hundred and six primary care patients aged between 70 and 96 years were interviewed. Their views could be categorized into four major groups: doctor-patient interaction, GP related topics, patient related issues and contextual factors. Conclusion: People over 70 do want to be involved in their care but their definition of involvement is more focussed on the 'caring relationship', 'person-centred approach' and 'receiving information' than on 'active participation in decision making'. Practice implications: The desire for involvement in decision making is highly heterogeneous so an individual approach for each patient in the ageing population is needed. Future research and medical education should focus on methods and training to elicit older patients' preferences.
Patient empowerment in long-term conditions: development and preliminary testing of a new measure
BMC Health Services Research, 2013
Background: Patient empowerment is viewed by policy makers and health care practitioners as a mechanism to help patients with long-term conditions better manage their health and achieve better outcomes. However, assessing the role of empowerment is dependent on effective measures of empowerment. Although many measures of empowerment exist, no measure has been developed specifically for patients with long-term conditions in the primary care setting. This study presents preliminary data on the development and validation of such a measure. Methods: We conducted two empirical studies. Study one was an interview study to understand empowerment from the perspective of patients living with long-term conditions. Qualitative analysis identified dimensions of empowerment, and the qualitative data were used to generate items relating to these dimensions. Study two was a cross-sectional postal study involving patients with different types of long-term conditions recruited from general practices. The survey was conducted to test and validate our new measure of empowerment. Factor analysis and regression were performed to test scale structure, internal consistency and construct validity.
Effect of Health Literacy on Decision-Making Preferences among Medically Underserved Patients
Medical Decision Making, 2016
Introduction-Participation in the decision-making process and health literacy may both affect health outcomes; data on how these factors are related among diverse groups are limited. This study examined the relationship between health literacy and decision-making preferences in a medically underserved population. Methods-We analyzed a sample of 576 primary care patients. Multivariable logistic regression was used to examine the independent association of health literacy (measured by the Rapid Estimate of Adult Literacy in Medicine-Revised) and patients' decision-making preferences (physician-directed or patient-involved), controlling for age, race/ethnicity, and gender. We tested whether having a regular doctor modified this association. Results-Adequate health literacy (OR=1.7; p=0.009) was significantly associated with preferring patient-involved decision-making, controlling for age, race/ethnicity, and gender. Having a regular doctor did not modify this relationship. Males were significantly less likely to prefer patient-involved decision-making (OR=0.65; p=0.024). Discussion-Findings suggest health literacy affects decision-making preferences in medically underserved patients. More research is needed on how factors, such as patient knowledge or confidence, may influence decision-making preferences, particularly for those with limited health literacy.
Engaging Older Adults in Health Care Decision-Making: A Realist Synthesis
The Patient - Patient-Centered Outcomes Research, 2016
Background Engagement in healthcare decision making has been recognized as an important, and often lacking, aspect of care, especially in the care of older adults who are major users of the healthcare system. Objective We aimed to conduct a review of available knowledge on engagement in healthcare decision making with a focus on older patients and their caregivers. Methods We conducted a realist synthesis focusing on strategies for engagement of older patients and their caregivers in healthcare decision making. The synthesis encompassed theoretical frameworks and both peer-reviewed and grey literature. Expert consultations included interviews (n = 2) with academics and group consultations (n = 3) with older adults and their caregivers. Abstracts that reported description, assessment, or evaluation of strategies for engagement of adult patients, families, or caregivers (i.e., that report on actual experiences of engagement) were included. Results The search generated 15,683 articles, 663 of which were pertinent to healthcare decision making. Theoretical and empirical work identified a range of strategies and levels of engagement of older patients and their families in healthcare decision making. The importance of communication emerged as a key recommendation for meaningful engagement among providers and patients and their caregivers. The principles developed in this study should be implemented with consideration of the context in which care is being provided. Conclusions We have developed a framework that promotes the engagement of patients and their caregivers as equal partners in healthcare decision making. Future research should implement and test the framework in various clinical settings.
Older Patients’ Involvement in Shared Decision-Making—A Systematic Review
Open Journal of Nursing, 2016
Shared decision-making has been described as allowing patients to gain more control over their life situation and feel less helpless. The aim of this systematic review was to describe the involvement of older patients in shared decision-making in community settings. In accordance with the systematic review method, a total of 2468 abstracts were read, after which nine quantitative studies were included. A qualitative thematic analysis was performed and two themes emerged; increased understanding of self-management and a desire to strengthen one's position in relationship with professionals, both of which were essential for empowering older patients to participate in shared decision-making. Older patients' shared decision-making was seen as a struggle to maintain their autonomy in different areas of everyday life. Emotional and psychological problems made their position more difficult. In order to empower them in relationships with healthcare professionals, older patients require more knowledge (self-efficacy) and information about their illness, which could strengthen their position in the decision-making process. They also need a greater awareness of decisional conflicts that may arise. Age, gender and health status influence older patients' chance of being respected and taken seriously in relationship with professionals.
BMC Geriatrics, 2011
Background: Medical decision making has long been in focus, but little is known of the preferences and conditions for elderly people with co-morbidities to participate in medical decision making. The main objective of the present study was to investigate the preferred and the actual degree of control, i.e. the role elderly people with co-morbidities wish to assume and actually had with regard to information and participation in medical decision making during their last stay in hospital. This study was a cross-sectional survey including three Swedish hospitals with acute admittance. The participants were patients aged 75 years and above with three or more diagnoses according to the International Classification of Diseases (ICD-10) and three or more hospitalisations during the last year. Methods: We used a questionnaire combined with a telephone interview, using the Control Preference Scale to measure each participant's preferred and actual role in medical decision making during their last stay in hospital. Additional questions were asked about barriers to participation in decision making and preferred information seeking role. The results are presented with descriptive statistics with kappa weights. Results: Of the 297 elderly patients identified, 52.5% responded (n = 156, 46.5% male). Mean age was 83.1 years. Of the respondents, 42 of 153 patients said that they were not asked for their opinion (i.e. no shared decision making). Among the other 111 patients, 49 had their exact preferred level of participation, 37 had less participation than they would have preferred, and 23 had more responsibility than they would have preferred. Kappa statistics showed a moderate agreement between preferred and actual role (w = 0.57; 95% CI: 0.45-0.69). Most patients wanted to be given more information without having to ask. There was no correlation between age, gender, or education and preferred role. 35% of the patients agreed that they experienced some of the various barriers to decision making that they were asked about: 1) the severity of their illness, 2) doctors with different treatment strategies, 3) difficulty understanding the medical information, and 4) difficulty understanding doctors who did not speak the patient's own language. Conclusions: Physicians are not fully responsive to patient preferences regarding either the degree of communication or the patient's participation in decision making. Barriers to participation can be a problem, and should be taken into account more often when dealing with hospitalised elderly people.
Empowerment Interventions for Older Adults
Western Journal of Nursing Research, 2010
There has been much discussion regarding the need to empower older adults to make informed health decisions and to test interventions targeting empowerment to promote health among older adults. It has been suggested that an empowerment approach may nurture an older adult's participation in health care decisions and promote positive health outcomes. The purpose of this article is to report the findings of a critical review of published empowerment intervention studies with community-dwelling older adults. A descriptive literature review was conducted to examine how empowerment is conceptualized across interventions, the guiding theoretical frameworks, the outcomes measured, as well as the health outcomes of these interventions. Based on the findings from this review, recommendations for future empowerment intervention research with older adults as well as implications for practice are proposed.