Abstract
To review how enablement is conceptualized and practiced in primary health care and to explore the factors that influence patient enablement in this setting. A narrative integrative literature review was undertaken. Twenty-four articles specifically relating to enablement in primary health care were identified. Three literature reviews, 4 qualitative studies, and 17 quantitative studies were included in the analysis. In the primary health care setting, the concept of enablement is well defined as an outcome measure of quality. The literature exploring the practice of enablement is sparse, but 2 randomized controlled trials suggest enablement is linked to better outcomes for patients with asthma and diabetes. Primary factors influencing enablement included the practitioners' open communication style, the degree to which the practitioner is patient centered, and longer consultations. Other factors found to be associated with enablement were the presenting health issue, general state of health, ethnicity, the patient's own coping strategies and degree of independence, and socioeconomic status. The association between enablement and patients' expectations and satisfaction is less clear. The majority of research on enablement was carried out among general practitioners. Further research into the degree to which patients are enabled by a wider range of health care providers is needed. Additional qualitative research would provide a deeper understanding of the attributes of enablement in the primary health care setting.
Highlights
Primary health care (PHC) systems play a crucial role in preventing disease and helping people to better manage their health in many countries
Consultations in the PHC settings differ from consultations in the hospital setting and so patient-reported outcome measures (PROMs) used in hospitals are not always transferrable
The concept of enablement is well defined as a quality outcome measure in PHC
Summary
Primary health care (PHC) systems play a crucial role in preventing disease and helping people to better manage their health in many countries. One of the aims of a consultation is to help patients better manage their own health. Several PROMs are used to assess the quality of PHC consultations one of which, patient enablement (hereafter enablement), has been found to be useful.[3] Enablement can be defined as “an intervention by which the health care provider recognises, promotes and enhances a patient’s ability to manage their own health.”4(p1) Enablement is the result of individual empowerment[5] and involves building on a person’s strengths.[4] In 1997, Howie et al[6] used enablement as an outcome measure in a study designed to determine the quality of consultations in the general practice setting. Enablement is recognized internationally as a valid measure of the quality of a consultation with a general practitioner (GP).[7,8]
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