Abstract
BackgroundIn 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.MethodsA 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.ResultsThe 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.ConclusionA 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 materialThe online version of this article (doi:10.1186/s12913-015-0907-z) contains supplementary material, which is available to authorized users.
Highlights
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
In Europe, patient empowerment is supported by the European Union (EU) through the European Patients Forum which aims to “... promote the development and implementation of policies, strategies and healthcare services that empower patients to be involved in the decision-making and management of their condition...”
The aim of this research was to develop a conceptual map of patient empowerment, identifying components of patient empowerment and relationship with other constructs e.g., health literacy, self-management and shared decision-making, with a focus on primary care because many patients affected by Long term condition (LTC) primarily use healthcare services in this context
Summary
Interventions and health policy programmes have been established to promote patient empowerment, with a particular focus on patients affected by long-term conditions. The National Health Service (NHS) in England initiated a cross-governmental strategy for tackling LTCs [11], including a mandate to involve people in making decisions about their own care [12]. This is likely to include developing primary care interventions to empower patients to self-manage LTCs, since this is a key aspect of policy strategies to control healthcare costs [13,14,15]. Promote the development and implementation of policies, strategies and healthcare services that empower patients to be involved in the decision-making and management of their condition...”. There are some generic validated questionnaires that capture similar constructs, but that do not claim to capture patient empowerment e.g., The Patient Activation Measure, which captures ability and willingness of patients to manage their own health and health care [19] and the Patient Enablement Instrument, which captures patients’ capacity to understand and cope with their health issues [20]
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