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      Conceptualising patient empowerment: a mixed methods study

      research-article
      , , , , , , the Cochrane Healthcare Quality Research Group, Cardiff University
      BMC Health Services Research
      BioMed Central
      Patient empowerment, Definition, Conceptual map, Scoping study, Framework analysis, Thematic analysis

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          Abstract

          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.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12913-015-0907-z) contains supplementary material, which is available to authorized users.

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          Most cited references37

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          Qualitative data analysis for applied policy research

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            Development and testing of a short form of the patient activation measure.

            The Patient Activation Measure (PAM) is a 22-item measure that assesses patient knowledge, skill, and confidence for self-management. The measure was developed using Rasch analyses and is an interval level, unidimensional, Guttman-like measure. The current analysis is aimed at reducing the number of items in the measure while maintaining adequate precision. We relied on an iterative use of Rasch analysis to identify items that could be eliminated without loss of significant precision and reliability. With each item deletion, the item scale locations were recalibrated and the person reliability evaluated to check if and how much of a decline in precision of measurement resulted from the deletion of the item. The data used in the analysis were the same data used in the development of the original 22-item measure. These data were collected in 2003 via a telephone survey of 1,515 randomly selected adults. Principal Findings. The analysis yielded a 13-item measure that has psychometric properties similar to the original 22-item version. The scores for the 13-item measure range in value from 38.6 to 53.0 (on a theoretical 0-100 point scale). The range of values is essentially unchanged from the original 22-item version. Subgroup analysis suggests that there is a slight loss of precision with some subgroups. The results of the analysis indicate that the shortened 13-item version is both reliable and valid.
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              An integrative model of shared decision making in medical encounters.

              Given the fluidity with which the term shared decision making (SDM) is used in teaching, assessment and research, we conducted a focused and systematic review of articles that specifically address SDM to determine the range of conceptual definitions. In April 2005, we ran a Pubmed (Medline) search to identify articles published through 31 December 2003 with the words shared decision making in the title or abstract. The search yielded 681 citations, 342 of which were about SDM in the context of physician-patient encounters and published in English. We read and reviewed the full text of all 342 articles, and got any non-redundant references to SDM, which yielded an additional 76 articles. Of the 418 articles examined, 161 (38.5%) had a conceptual definition of SDM. We identified 31 separate concepts used to explicate SDM, but only "patient values/preferences" (67.1%) and "options" (50.9%) appeared in more than half the 161 definitions. Relatively few articles explicitly recognized and integrated previous work. Our review reveals that there is no shared definition of SDM. We propose a definition that integrates the extant literature base and outlines essential elements that must be present for patients and providers to engage in the process of SDM. The integrative definition of SDM is intended to provide a useful foundation for describing and operationalizing SDM in further research.
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                Author and article information

                Contributors
                bravop17@gmail.com
                EdwardsAG@cardiff.ac.uk
                Paul.J.Barr@dartmouth.edu
                i.scholl@uke.de
                glynelwyn@gmail.com
                mcallistermf@cardiff.ac.uk
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                1 July 2015
                1 July 2015
                2015
                : 15
                : 252
                Affiliations
                [ ]Institute of Cancer & Genetics, Cardiff University, Heath Park, Cardiff, CF14 4XN UK
                [ ]School of Nursing, Pontificia Universidad Católica de Chile, Avenida Vicuña Mackenna 4860, Macul, Santiago Chile
                [ ]Cochrane Institute of Primary Care & Public Health, Neuadd Merionnydd, Cardiff University, Heath Park, Cardiff, UK CF14 4YS UK
                [ ]The Dartmouth Center for Health Care Delivery Science, Dartmouth College, 37 Dewey Field Road, 4th Floor, Hinman Box 7256, Hanover, NH 03755 USA
                [ ]Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
                Article
                907
                10.1186/s12913-015-0907-z
                4488113
                26126998
                ae97e558-c5e7-4985-a93d-afd555caa404
                © Bravo et al. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 14 April 2014
                : 5 June 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Health & Social care
                patient empowerment,definition,conceptual map,scoping study,framework analysis,thematic analysis

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