Conceptualising patient empowerment: a mixed methods study
Conceptualising patient empowerment: a mixed methods study
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DOI：
10.1186/s12913-015-0907-z
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发表时间：
2015-07-01
影响因子：
2.8
通讯作者：
McAllister, Marion
中科院分区：
文献类型：
--
作者：
Bravo, Paulina;Edwards, Adrian;McAllister, Marion
背景：近年来，制定了干预措施和保健政策方案，以促进赋予患者权力，特别注重受长期疾病影响的患者。然而，缺乏对患者赋权的明确定义，因此难以评估旨在促进患者赋权的干预措施的有效性。本研究的目的是建立一个病人赋权的概念图，包括病人赋权的组成部分以及与健康素养、自我管理和共同决策等其他结构的关系。方法：进行了一项混合方法研究，包括：(i)范围界定文献综述，以确定和绘制支持已发表的患者赋权定义的组成部分；（ii）与关键利益相关者（患者、患者代表、卫生管理人员和卫生服务研究人员）进行定性访谈，以进一步绘制概念图。采用定性方法对资料进行分析。主题和框架分析的结合被用来整合和映射主题，支持发表的患者赋权定义与英国主要利益相关者的观点。结果：范围文献综述确定了67篇包含患者授权定义的文章。提取了一系列不同的患者授权定义。专题分析确定了关键的基础主题，这些主题被用于开发用于分析访谈数据的初始编码框架。与主要持份者进行了19次半结构化访谈。使用初始编码框架对转录本进行分析，结果用于进一步开发概念图。由此产生的概念图描述了可以将患者授权视为从低到高的患者授权范围内的状态，并且可以使用一组指标来测量患者授权的水平。确定了概念图的五个关键组成部分：基本精神、调节者、干预措施、指标和结果。概念图说明了与卫生知识、自我管理和共同决策等其他概念的关系。结论：本文描述了基于已发表的患者赋权定义和对英国利益相关者的定性访谈的患者赋权的新概念图，这可能对医疗保健提供者和研究人员设计、实施和评估促进患者赋权的干预措施有用。
Background: In recent years, interventions and health policy programmes have been established to promote patient empowerment, with a particular focus on patients affected by long-term conditions. However, a clear definition of patient empowerment is lacking, making it difficult to assess effectiveness of interventions designed to promote it. The aim in this study was to develop a conceptual map of patient empowerment, including components of patient empowerment and relationships with other constructs such as health literacy, self-management and shared decision-making.Methods: A mixed methods study was conducted comprising (i) a scoping literature review to identify and map the components underpinning published definitions of patient empowerment (ii) qualitative interviews with key stakeholders (patients, patient representatives, health managers and health service researchers) to further develop the conceptual map. Data were analysed using qualitative methods. A combination of thematic and framework analysis was used to integrate and map themes underpinning published definitions of patient empowerment with the views of key UK stakeholders.Results: The scoping literature review identified 67 articles that included a definition of patient empowerment. A range of diverse definitions of patient empowerment was extracted. Thematic analysis identified key underpinning themes, and these themes were used to develop an initial coding framework for analysis of interview data. 19 semi-structured interviews were conducted with key stakeholders. Transcripts were analysed using the initial coding framework, and findings were used to further develop the conceptual map. The resulting conceptual map describes that patient empowerment can be conceived as a state ranging across a spectrum from low to high levels of patient empowerment, with the level of patient empowerment potentially measurable using a set of indicators. Five key components of the conceptual map were identified: underpinning ethos, moderators, interventions, indicators and outcomes. Relationships with other constructs such as health literacy, self-management and shared decision-making are illustrated in the conceptual map.Conclusion: A novel conceptual map of patient empowerment grounded in published definitions of patient empowerment and qualitative interviews with UK stakeholders is described, that may be useful to healthcare providers and researchers designing, implementing and evaluating interventions to promote patient empowerment.