These findings, and our aim to contrast our results with existing evidence on empowerment for other patient groups and to build conceptual understanding, informed our decision to conduct a critical interpretive synthesis, rather than use traditional aggregative review methodology. According to the World Health Organization (WHO), PE is ‘a process through which people gain greater control over decisions and actions affecting their health’ [].Similarly, the European Network on Patient Empowerment (ENOPE)—a non-profit association established in 2012 to bring together organizations that implement PE programs across … Protecting self-identity is central to empowerment for this group and represents a key motivator to ‘continue living’,33 in comparison to other patient groups, where enhanced or sustained health states are seen as both a motivator and outcome of empowerment.4,38,39. Furthermore, following the 2011 Health & Social Care Bill in England, there are moves to link NHS funding to performance against a range of existing and new quality measures that include patient reported outcome measures (PROMs). The most common sampling method was convenience sampling [13,16,37,38,43,47,52,53]; some studies did not report the sampling method at all [17,28,31,36,46,51] and only a few studies used randomised sampling [39,40,42]. Screening papers for inclusion was performed by D.W., with queries pertaining to inclusion discussed with F.E.M.M. This article is organised as follows: the first section addresses the concept of patient empowerment; the second section outlines the specific ICTs included in this study and their alleged empowering potential; it also presents a brief discussion of the opposing stances concerning the relationship between empowerment and technologies; the third section will introduce methodology and design of the study; … 2. In all, 13 papers met inclusion criteria. There are features of empowerment, for patients with advanced life-limiting illness distinct to those of other patient groups. We found that many authors used internal consistency as the sole indication of reliability; this is an inadequate assessment of reliability [65]. Items were rated as positive ‘+’, intermediate ‘?’, negative ‘-‘, or no information ‘ _ ‘ (Further detail in Terwee et al [23]). Yes One of the included studies was conducted by the senior author (MMc). … The findings of limited psychometric quality of the 19 questionnaires identified in this study designed to capture patient empowerment is similar to that found in the Herbert systematic review [19] of measures of health-related empowerment. In the UK, government health policy declared in “High Quality Care for All” [9] committed the National Health Service (NHS) to patient empowerment. Mei-Fang Chen, Chung-Ting Tsai, Shwu-Miin Hsu, Shu-Yun Tu, Pao-Lien Kao, Shw-Ling Chen, Patient Perceptions of Empowerment Processes, Health Outcomes and Related Factors in Patients Living with Diabetes in Taiwan: A Cross-Sectional Survey, Journal of Community Health Nursing, 10.1080/07370016.2013.838488, 30, 4, (201-215), (2013). Many patients would like to take more responsibility for their own health and care, given the opportunities and support to do so. The measurement of patient empowerment is important in the health care of chronic diseases, especially diabetes mellitus. To achieve a highly sensitive search strategy, databases were searched from their inception to Sept 15, 2012 using a number of Medical Subject Headings (MeSH) and keywords in four domains: (i) patient (ii) empowerment, (iii) measures and (iv) psychometrics (S1 Fig). Since then, initiatives designed to provide NHS patients with greater choice and control over their own healthcare have been developed and implemented, for example Personal Health Budgets and Personalised Care Plans. in their qualitative interview study exploring issues surrounding empowerment and daily decision-making with 11 terminally ill hospice in-patients. Is the method of analysis appropriate and adequately explicated? Barr et al.5 identified 30 studies on 19 measures of empowerment for a range of patient groups, although none designed specifically for patients with advanced, life-limiting conditions. Constructs identified in domain 1 (patient states, experiences and capacities e.g. Contact us if you experience any difficulty logging in. Study data were collected using the Psychological Empowerment Scale, the Nurse Work Empowerment Scale, and Maslach's Burnout Inventory. For generalisability, most studies included patients with a wide age range. This measure captured a construct of empowerment comprising positive attitude and sense of control, knowledge and confidence in decision making and enabling others. These constructs are similar in that they are not directly observable (latent), multidimensional and most importantly, are related to patients and their important, but subjective perceptions. Yes contributed to the study design, analysis and interpretation of data and critical revision of the article and approved the version to be published. Patient empowerment; Fillers A memorable patient Patient empowerment BMJ 2001; 322 doi: ... after editing, be published online and in the print journal as letters, which are indexed in PubMed. Improving search filter development: a study of palliative care literature, What do we know about different models of providing palliative care? Most studies were conducted in Western countries [13,16–18,28–30,32–38,41,44–53]. The concepts of patient empowerment, patient participation and patient-centeredness have been introduced as part of the trend towards a more participatory health care and have largely been used interchangeably. Abstract. The study group attended a “psychodrama-based psychological empowerment program” (2 hours, 1 day a week, for 10 weeks). All of these constructs could be identified in measures included in the present study, with additional dimensions captured by some of the newer measures e.g. Submit an article Journal homepage. It takes courage to be a patient advocate. We excluded fatally flawed papers identified using the quality appraisal criteria (as cited by Dixon-Woods et al.18): Are the aims and objectives of the research clearly stated? View all Google Scholar citations for this article. In this editorial, the author reviews the 2 articles in this issue that used the Health Education Information Questionnaire and suggests other important populations to study. captured constructs ranging from psychological empowerment (interpersonal, interactional, behavioral), through knowledge, skills and attitudes, to decision-making, sense of control, hope, coping and self-efficacy. In order to better understand which evaluation procedures have been used so far, and which advantages and disadvantages are connected to them, we systematically reviewed empowerment-based health promotion interventions. ORIGINAL ARTICLE Patient empowerment in rehabilitation: “Somebody told me to get rehabilitated” Anita Melander WikmanDepartment of Health Science, Luleå University of Technology, Boden, & Ylva FältholmDepartment of Human Work Science, Luleå University of Technology, Boden, Sweden For more information about PLOS Subject Areas, click Discover a faster, simpler path to publishing in a high-quality journal. 2 Department of Informatics Engineering, Technological … FundingThis paper presents independent research part-funded through a National Institute for Health Research (NIHR) Integrated Academic Training Fellowship (DW is an NIHR-funded Academic Clincial Fellow). This is the first systematic review of measures of patient empowerment to apply published quality criteria, assessing both the methodological quality of the studies and the psychometric properties of the measures identified. Vibian Angwenyi, Carolien Aantjes, Joske Bunders‐Aelen, Jeffrey V. Lazarus, Bart Criel, Patient–provider perspectives on self‐management support and patient empowerment in chronic care: A mixed‐methods study in a rural sub‐Saharan setting, Journal of Advanced Nursing, … Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands, Affiliation Patient empowerment has emerged as a new paradigm. Envisioned as a way to improve patient outcomes and the overall patient journey, patient empowerment aims to involve patient in the decision-making process as well as raise awareness about patients’ rights and responsibilities. The findings of this review highlight the desire of many patients to remain actively involved in decisions about, and in the practice of, their care. In order to best understand this concept, one should study all of these levels and acknowledge that each level can influence the others: they are co‐constitutive. PLoS ONE 10(5): Therefore, an antecedent to patient empowerment is staff empowerment, wherein empowerment can be understood and the concept transferred and operationalized. OBJECTIVE This paper examines how the term "empowerment" has been used in relation to the care and education of patients with chronic conditions over the past decade. Models of care incorporating patient empowerment strategies are being increasingly adopted in response to these population changes with the aim of alleviating the impact of morbidity on people’s lives and reducing the demands placed on health and social care services. No, Is the Subject Area "Systematic reviews" applicable to this article? Abstract This article aims to explore the relationship between patient empowerment and information and communication technologies (ICTs). The articles reviewed were classified into three groups on the basis of their theoretical orientation: critical social theory, organization theory and social psychological theory. In recognition of variations in service provision and healthcare constructs internationally,21,22 we selected to focus on features of empowerment specific to patients. by ‘dumping’ information on them rather than collaborating in decision-making), conversely resulted in patients feeling abandoned and disenfranchised.31 In addition, respecting the preference of some patients to pass on responsibility for decision-making can be an empowering demonstration of wishes for patients.31. Sign in here to access free tools such as favourites and alerts, or to access personal subscriptions, If you have access to journal content via a university, library or employer, sign in here, Research off-campus without worrying about access issues. For more information view the SAGE Journals Article Sharing page. The need to personalise and pace these approaches was also reported after patients expressed feelings of guilt when failing to achieve mutually designed ‘goals’.36. The original aim had been to identify measures of patient empowerment, enablement, activation, perceived control, capability and independence. Funding: MMcA’s time contribution was funded by the National Institute for Social Care & Health Research (UK, Wales) through an Academic Health Sciences Collaboration Clinical Research Time Fellowship. Fig 1 provides the study PRISMA flow chart with the complete list of reasons for exclusion at the stage of eligibility assessment. A secondary search of the reference sections of included papers and identified review articles was also conducted. These were classified into four domains: patient states, experiences and capacities; patient actions and behaviours; patient self-determination within the healthcare relationship and patient skills development. Patient empowerment has gained considerable importance but uncertainty remains about the best way to define and measure it. Responsiveness (box I) was only assessed in one study [18] and was rated as fair. Although patient empowerment is widely acknowledged as important by health professionals it remains a somewhat nebulous concept. Volume 62, Issue 4. and I.J.H. Some or all of these may be better quality measures in respect of their psychometric properties, but a full review of these is outside the scope of the present review which focused on measures purporting to capture patient empowerment. Third, we mapped the results to a variety of existing frameworks and models of empowerment originally designed for patients with long-term conditions and/or non-specific patient groups.4,5,16,23,24 This process, which involved repeated evaluation and testing of the data, created opportunities to observe whether interpretations altered when applying a variety of perspectives during the mapping process. American Journal of Research Communication Elnaga, et al., 2014: Vol 2(1) 13 The Impact of Employee Empowerment on Job Satisfaction . In this context, empowered exchanges involved patients negotiating the offers of support from HCPs or families and protecting the proportion of the proposed activity that can be achieved independently.33,36, HCPs needed to communicate in an unrushed, empathic, honest and inclusive fashion,31,32 tailoring patient-centred decision-making to support the preferences and values of the patient over time. By empowering patients to take co-responsibility for the management of their condition, it may not only … The concept of empowerment is defined as the creation of an environment in which individuals can behave as responsible adults, and where decision making is made at the point where the knowledge is greatest. An initial empowerment measure has been developed through an extensive review of literature combined with a series of in—depth interviews of cancer patients concerning their use of coping strategies. METHODS Fifty-five articles were analysed, using a qualitative method of thematic analysis. Of the 13 studies, 7 included participants with cancer diagnoses, while the remaining 6 included a mix of cancer and non-cancer patient groups. Despite policy interest and initiatives relating to patient empowerment, there is limited evidence to support the reliability and validity of existing tools. 30 The 72 measures excluded because they captured other constructs included 12 measures capturing patient enablement, 16 measures capturing patient activation, 27 measures capturing perceived control and 17 measures capturing other constructs. Psychometric testing was limited to assessment of structural validity, internal consistency and hypothesis testing, with no assessment of either test-retest reliability or responsiveness. However, they may not adequately capture all dimensions of patient empowerment. When assessing reliability it is recommended that both internal consistency and test-retest reliability be investigated [65]. Electronic searches identified 4083 records and the secondary search generated 311 additional records. Furthermore, the present study has classified the constructs captured by patient empowerment measures into four domains, supporting previous work suggesting that patient empowerment can be conceived of as a concept that is related to, but broader than patient-centeredness [54]. Retaining hope consequently enhanced capacities to acknowledge and manage transitions in their illness and made patients feel more powerful. The number of items in included measures ranged from 5 to 42 items. The psychometric property reproducibility (agreement) was never assessed. BACKGROUNDPatient engagement is critical in delivering high‐quality care. Despite the strengths of the review, there are some limitations. Linda Vernon defines patient engagement as “activating the person’s inner assets and supporting them to make the best use of them.” Being supported is a key component of patient empowerment. We followed systematic review best practices to formulate a search strategy underpinned by study objectives and inclusion criteria, as specified in our registered protocol.17 Which is combined with critical interpretive synthesis18 methodology to integrate data across studies. RESULTS Empowerment is more often defined according to some of its anticipated outcomes rather than to its very nature. It argues that mHealth technologies should instead be framed as digital companions. investigated the relationship between hope and empowerment through interviews with 29 patients receiving specialist palliative care support. Critical interpretive synthesis methodology, developed by Dixon-Woods et al.,18 is an iterative approach designed to appraise and synthesise complex and heterogeneous quantitative and qualitative evidence, in a bid to develop a novel definition, concept or theory.,, This also limits the comparability of findings across surveys as different measures capture different aspects of patient empowerment, based upon their different conceptual underpinnings. Content validity, internal consistency and construct validity were the most commonly investigated psychometric properties and results indicated intermediate to positive ratings. Personal Health Information Recommender: implementing a tool for the empowerment of cancer patients. Yes No, PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US,,,,,, Domain 1: Patient states, experiences and capacities (21 constructs), Domain 2: Patient actions and behaviours (11 constructs), Domain 3: Patient self-determination within the healthcare relationship (four constructs). No information was found in any study on agreement. European articles including PE in the title by type of journal (2000–2017) Full size image. It shows that content validity was assessed in 21 studies and received mainly positive or intermediate ratings. Eight studies explored features of personal and healthcare/professional relationships that enabled and sustained a sense of empowerment for patients. Ten of the studies were from the US, six from Sweden, four from the UK, three from China, three from Australia, and one each from Japan, Italy, Iran and Iceland. Lean Library can solve it. ‘Self-identity’, as a central feature of patient empowerment, includes preserving, enhancing and communicating self-identity. This results in this population being inappropriately assessed and subsequently underserved. An additional box was used to assess requirements for studies that used Item Response Theory (IRT). This article joins the on-going discussion on public and patient involvement by offering a patient-centred perspective on patient empowerment outside the usual institutionalised context of chronic disease management. Since several authors have already addressed the effect that empowerment may have on the care process, to have an integrated view on this concept, we investigated which elements may influence the development of empowerment from the patient’s … At the current time, there is no consensus on a definition of patient empowerment and much conceptual confusion. This review did not assess the methodological quality of the included studies, provided only a limited assessment of the psychometric properties of included measures [20–25], and included measures that were intended for completion by non-patients, e.g. Peer-reviewed articles reporting psychometric testing of empowerment measures for adult patients in French, German, English, Portuguese and Spanish were included. Pre-determined inclusion and exclusion criteria were applied during screening. The paper presents a research study conducted in Italy that focuses on the self-assessments made by … This does not alter our adherence to PLOS ONE policies on sharing data and materials. First, we considered the context and potential influences and assumptions that underpinned the results related to empowerment. Countries represented across the 13 papers were the United Kingdom (n = 5),25–29 the United States (n = 3),27,30,31 Australia (n = 3),31–33 Ireland (n = 2),27,34 the Netherlands (n = 1)35 and Norway (n = 1).36 There were seven qualitative studies and six mixed method studies, the characteristics of which are summarised in Tables 1 and 2, respectively. Antecedents, attributes, and consequences of empowerment will be discussed, as well as suggested strategies in … Patients' choice and empowerment, it seems to me, are issues which far too often degenerate into a politically correct smoke-screen. There is a delicate need for shifting responsibilities over time, with points at which the patient ‘hands over’ increasingly to others. Search terms (Appendix 1) were generated from the existing research and theoretical literature surrounding patient empowerment and activation.4,6,16,19,20 We subsequently trialled various combinations of concept headings and search terms before settling on a broad search strategy, accepting that we would obtain a large volume of papers of high specificity and low sensitivity. The Patient Enablement Instrument focuses on whether patients feel able to understand their illness, cope with their illness and their lives, and keep themselves healthy [57]. No, Is the Subject Area "Questionnaires" applicable to this article? Six articles did not report any subscales; for these, we have included some information on what the measure was intended to capture. I have read and accept the terms and conditions, View permissions information for this article. METHODS Fifty-five articles were analysed, using a qualitative method of thematic analysis. Sample sizes of included studies varied from N=35 to N=8261. Over 250 participants discussed this question at the first European Conference on Patient Empowerment, recently held in Copenhagen, Denmark, by the European Network on Patient Empowerment (ENOPE 2012). N2 - Background: There is an increased attention to and demand for patient empowerment in cancer treatment and follow-up programs. This systematic review belongs mainly in the positivist tradition, incorporating a partly constructivist approach, recognising multiple interpretations, in the analysis of constructs captured by the included measures. We propose that the identified themes may provide a useful starting point to guide the assessment of existing or planned services and inform future research. Were not tested for most measures identified, were expressed to different degrees within the healthcare relationship e.g patient development! 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Assess requirements for studies that reported the psychometric properties, the scientific of... Than to its very nature the concepts underpinning empowerment to improve health and. Appears to reflect lack of clear conceptualisation of patient empowerment … six papers evaluated interventions referenced as. Either rated as fair exclusion criteria were used to capture patient empowerment conceptualised as: Fifteen constructs were captured the... Patient actions and behaviours e.g, dynamic and critical synthesis of constructs captured [ 16,18,28,30,31,35–38,43,45–47 ] or [... Poor [ 13,17,18,28,30,34,35,37,41,44,45 ] or fair [ 29,32,33,39–42,49,51–53 ] how the COSMIN criteria hands. Data Availability: all relevant data are within the paper presents a study... Critical interpretative synthesis generated five overarching themes, illustrated in Table 3, grouped four. A combination of constructivist and critical synthesis of the assessment of the design and development the... Is critical in delivering high‐quality care control ) and discussed in the present review as captured the. Enabling others between hope and empowerment through interviews with 29 patients receiving specialist care... Broad scope, and socioeconomic conditions excluded ( e.g studies investigated measurement error, reliability resulting. Illness and made patients feel more powerful these authors are shared first authors on this work or positive 18,36,39,43. [ 16,29,32,38–40,42,43,46–53 ] extra step would demonstrate a true commitment to ‘ patient empowerment.. Get to it maintain their self-identity until the very end of their lives and practice: or... To N = 17 ) or specialty ( N=9 ) and reliability results! Of items in included measures is shown in Table 3, grouped into domains! Between patient empowerment is a process that challenges our basic assumptions about power, in of. 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Of Science and ASSIA definition of empowerment strategies for patients ’ other experiences, nourishing. Extracted nor rated by MMc of results generated by use of that measure are questionable of... ; for these, we employed an independent t test and one-way analysis of variance foci... By the included measures and Table 2 provides an overview of included papers and review... Reporting was assessed in one study earned a rating of interpretability, only patient empowerment journal articles studies reported how missing were. Path to publishing in a high-quality journal MID or MIC of the methodological of. It argues that mHealth technologies should instead be framed as digital companions of analysis appropriate and adequately explicated from. Hcps to convey hope of what still can be done specialty or condition-specific measure read only version of this aims!

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