Competent Health Care Research Articles

An innovative curriculum development experience: Emergency Medical Dispatch role in the Healthcare Transformation Vision of Saudi Arabia

Background Healthcare medical dispatch systems play a fundamental role in the daily operations of prehospital services. This includes facilitating the interpretation of various dispatch-related systems, receiving incident calls, categorizing cases, guiding proper resources deployment, and providing proper instructions before the arrival of healthcare providers. Considering the Kingdom of Saudi Arabia's (KSA's) health sector transformation plan as part of Vision 2030, developing an Emergency Medical Dispatch (EMD) Program as part of essential prehospital services will allow rapid and competent healthcare delivery. In this study, our purpose is to describe the curriculum development of the EMD Program to improve the training of dispatchers and to share the experience in the interest of better prehospital dispatch systems. Methods A selected group of education experts and academics in emergency medical services dispatch were assigned to develop an EMD curriculum over six months. This study aims to describe the approach followed in developing an innovative EMD Program to share the experience and ultimately standardize dispatch-related training programs. The data of this study was collected by reviewing approved documents of the EMD Program including program curriculum, syllabus, logbook, and exam blueprint after approval letters were received from the Health Academy, Saudi Commission for Health Specialties. Results The development of the EMD program utilized a consecutive mixed approach starting with a competency-based with backward design method to ensure the achievement of targeted outcomes followed by the Kern Six-step curriculum development model, namely: (1) problem identification and general need assessment; (2) targeted need assessment; (3) goals and objectives; (4) educational strategies; (5) implementation; and (6) evaluation and feedback. This resulted in four comprehensive modules and seventeen competencies in interpreting various dispatch systems, prioritizing incidents, deploying proper resources, and providing pre-arrival instructions throughout the fourteen-week EMD Program. Conclusion As part of the health sector transformation plan in KSA, EMD services play a fundamental role in the daily operations of prehospital healthcare services. Developing an EMD Program with a consecutive mixed approach might improve the current operations of EMD services.

Enhancing Nursing Education to Address LGBTQ+ Healthcare Needs: Perspectives from the Philippines.

Enhancing healthcare professionals' education and training to effectively manage the healthcare needs of People Identifying as Lesbian, Gay, Bisexual, Transgender, Queer, and other Sexual and Gender Minorities (LGBTQ+) is imperative. Recognizing the importance of mitigating LGBTQ+ health disparities, healthcare associations have affirmed their commitment to providing inclusive and culturally competent healthcare. However, despite these efforts, there is still a gap in LGBTQ+-specific teaching within nursing and other healthcare professionals' schools, resulting in healthcare professionals being ill-equipped to meet the unique needs of LGBTQ+. To address this gap, we suggest integrating LGBTQ+ health content into healthcare training programs, focusing on the Philippine nursing curriculum. Drawing from various reports, including insights from discussions with the local LGBTQ+, the suggested topics include LGBTQ+ identities, sexual health, trans health, mental health, and social determinants of LGBTQ+ health. By fostering understanding and competence through education, equitable and inclusive healthcare practices for LGBTQ+ can be better cultivated, helping to ensure that the unique healthcare needs of LGBTQ+ are met effectively. Furthermore, it is necessary to share best practices for providing health services to LGBTQ+ people. Additionally, future studies can explore the median time allocated to LGBTQ+ teaching, the optimal number of teaching hours for LGBTQ+ content, and the specific contents of local nursing curricula that can better address their needs. By undertaking these steps, we can move toward effectively addressing the unique healthcare needs of LGBTQ+.

Psychodiagnostic Determinants (Criteria) of the Determined Level of Formation of Health and Safety Competence of Future Speakers of Foreign Language

The current school gives priority to a competent approach, which plays an important role in the conceptual changes that are taking place in the field of lighting. The current highly qualified fakhivets, who have mastered the educational program, are guilty of a mother of low competencies, which is typical for other types of activities. Among them is the health-care competence of the teacher, as an integrative professional-special skill that ensures the protection of life and health, the formation of a culture of healthy and safe way of life for subjects of the educational process. In the minds of European integration of the modern world, the contribution of foreign language, which is oriented not only towards the development of communicative and linguistic competencies of workers, but also and on the implementation of health-care activities in the current world environment. In statistics, there is a need for a structural-functional model of health-care competence of the future input of foreign language. This model is presented as a central system, which includes a number of mutually deterministic components: value-motivational, cognitive, epistemological, active, communicative and reflective. A description of the model components and their characteristics is provided. A similar structural-functional model is used as the basis for developing diagnostic criteria for analyzing the level of formation of health and safety competence of a future reader of a foreign language. With the help of a fragmented system of criterion-visual tools, it is possible to evaluate the level of formation of both other components of the health-careful competence of the next generation, and also evaluate the level of the preparation.

Communicative competence in healthcare and linguistic theories: Insights and applications.

IntroductionPhysician–patient relationship has evolved from paternalistic model to cooperative one, known as patient-centered, where patients are experts on themselves in the socio-psychological, cultural, and material contexts. This transformed role has led physicians to adapt their highly specialized knowledge to effective communication pattern which is now a focal point in achieving therapeutic relationships in clinical context. Communicative competencies are of particular importance in medical practice and teaching medicine. Educational background derives from theories and foundations of linguistics and psycholinguistics.AimThe article presents main linguistic communicative theories that highly influence communicative competencies in medicine. It provides pragmatic guide to what is achieved from the principles of linguistic communicative competence in the current patient-centered model of communication in healthcare.Material and methodsMost important linguistic theories that have their applicative use in teaching medical communication are presented. It is a part of a larger project aimed at bridging the gap between linguistic principles and clinical practice.Results and discussionIn medical discourse, several types of message content funtions are distinguished: informative, emotive, directive, motivational, and therapeutic to influence patients’ emotional state. These discourse skills and associated motivational, volitional, and social abilities to use problem-solving successfully and responsibly, impact compliance, adherence, and concordance process.ConclusionsEfficient communication in medicine consists of several important competencies, but in order to be properly developed, mastering linguistic communicative competence is neccessary. Mastering them jointly with medical expertise is essential for helathcare professionals.

THE PERCEIVED PSYCHOLOGICAL WELL-BEING OF LGBTQ INDIVIDUALS IN MALAYSIA

This study explores the psychological well-being of lesbian, gay, bisexual, and transgender (LGBTQ) individuals in Malaysia, focusing on their experiences of identity formation, societal understanding, and the impact of prevailing attitudes on their mental health. Through qualitative methods, including in-depth interviews with nine participants from the LGBTQ community in Kuantan, Pahang, this research delves into the personal narratives of two lesbians, two gay individuals, two bisexuals, and three transgender persons, to understand the complexities of living as an LGBTQ individual in a society marked by religious and legal considerations. .The findings reveal that participants recognized their LGBTQ identity during adolescence, often, navigating societal expectations discreetly to avoid backlash. Despite challenges, participants demonstrated resilience and found support within familial and community networks. Notably, the study highlights a shift towards greater understanding of LGBTQ individuals in Malaysia, potentially reducing instances of psychological distress within the community. This research underscores the importance of supportive environments and the need for culturally competent mental health care for LGBTQ individuals. It also calls for further studies to include broader societal perspectives and professional insights to enrich the discourse on LGBTQ mental well-being. This study contributes valuable insights into the evolving landscape of LGBTQ perceptions and the factors influencing the psychological health of LGBTQ individuals in Malaysia.

Understanding Evolving Perspectives on Mental Health

This study investigates the evolving perspectives on intellectual fitness through a quantitative analysis of responses from three hundred contributors. The findings monitor a fine shift in ancient attitudes, with participants recognizing the historical stigmatization of intellectual health at the same time as strongly agreeing at the growing popularity of its significance. Cultural impacts emerge prominently, emphasizing the importance of cultural competence in intellectual health care. Generational shifts, specially amongst Millennials and Generation Z, suggest a greater openness to discussing mental health troubles. Additionally, participants explicit a effective notion of the effect of era on mental health, showcasing a willingness to embrace digital interventions. These evolving perspectives advocate development towards a stigma-unfastened destiny, necessitating ongoing efforts to destigmatize intellectual health, tailor interventions to diverse populations, and leverage era for inclusivity. The observe contributes to the information of societal shifts, supplying insights for shaping extra inclusive intellectual health interventions.

Collecting patient-reported outcome measures in the electronic health record: Lessons from the NIH pragmatic trials Collaboratory

The NIH Pragmatic Trials Collaboratory supports the design and conduct of 27 embedded pragmatic clinical trials, and many of the studies collect patient reported outcome measures as primary or secondary outcomes. Study teams have encountered challenges in the collection of these measures, including challenges related to competing health care system priorities, clinician's buy-in for adoption of patient-reported outcome measures, low adoption and reach of technology in low resource settings, and lack of consensus and standardization of patient-reported outcome measure selection and administration in the electronic health record. In this article, we share case examples and lessons learned, and suggest that, when using patient-reported outcome measures for embedded pragmatic clinical trials, investigators must make important decisions about whether to use data collected from the participating health system's electronic health record, integrate externally collected patient-reported outcome data into the electronic health record, or collect these data in separate systems for their studies.

Cultural context index: A geospatial measure of social determinants of health in the United States

Minority populations will continue to grow in the United States. Such pluralism necessitates iterative, geospatial measurements of cultural contexts. Our objective in this study was to create a measure of social determinants of health in geographic areas with varying ethnic, linguistic, and religious diversity in the United States. We extracted geographic information systems data based on community characteristics that have known associations with population health disparities from 2015 to 2019. We used principal component analysis to construct a Cultural Context Index (CCI). We created the CCI for 73,682 census tracts across 50 states and five inhabited territories. We identified hot and cold spots that are the highest and lowest CCI quintile, respectively. Hot spots census tracts were mostly located in metropolitan areas (84.8%), in the Southern census region (41.5%), and also had larger Black and Hispanic populations. The census tracts with the greatest need for culturally competent health care also had the sickest populations. Census tracts with a CCI rank of 5 (‘greatest need’) had higher prevalences of self-reported poor physical health (17.2%) and poor mental health (17.4%), compared to either the general population (13.9% and 14.5%) or to CCI rank of 1 (‘lowest need’) (11.9% and 10.8%). The CCI can pinpoint census tracts with a need for culturally competent health care and inform supply-side policy planning as healthcare and social service providers will inevitably come in contact with consumers from different backgrounds.

Ensuring delivery of medical education in conflict-affected nations

Medical education refers to the process wherein freshly passed school students are transformed into competent healthcare professionals after being subjected to a structured training program. The emergence or continuation of a conflict is expected to interrupt the ongoing civic activity, and is expected to result in the delay, decline, or complete interruption of the training activities and delivery of medical education in the medical institutions. All the above factors and existing realities call for the need to ensure that the process of medical education has to continue even during the conflicts and this essentially will require understanding and mutual agreement between the conflicting stakeholders. To conclude, conflicts have become a part of the current era with millions of people experiencing them. As these conflicts tend to influence each and every sector, even the area of medical education has been significantly affected. However, as most of the affected nations cannot afford the shortage of healthcare providers, there is an indispensable need to continue the training process even during conflicts and expose the medical students to conflict-related curriculum.

Evaluation of an OSCE's implementation and a two-step approach for a theoretical and practical training program in Obstetrics and Gynecology.

Objective structured clinical examination (OSCE) is a well-known assessment method to evaluate clinical skills and competence in healthcare. Following the recently reformed National Competence-Based Catalog of Learning Objectives in Medicine, the implementation of this assessment method in the training program for medical students is now obligatory in Germany. This major change requires a reorganization not only of the training programs but also of the students themselves and the way they learn. We performed a poll evaluating the students' opinions regarding these major changes and the implementation of the OSCE with a new training program. To implement this assessment method and to evaluate the OSCE, Kern's six-step approach comprising (1) problem identification and general needs assessment, (2) needs assessment of the targeted learners, (3) goals and objectives, (4) educational strategies, (5) implementation, and (6) evaluation and feedback was applied. To evaluate and gather feedback, a poll was used to analyze the student's opinions regarding OSCE in gynecology and obstetrics and OSCE in general, in addition to the regular analysis of the students' results. To reform the educational strategy, a two-step approach was developed: First, the students completed the regular training program and a written examination, and second, they participated in a 1-week clerkship, in small group teaching, and in the OSCE. The OSCE stations were developed primarily based on the National Competence-Based Catalog and the German Catalog of Learning Objectives in Medicine, as well as on the feedback of experts reflecting their expectations for physicians beginning their careers. The students performed well in the OSCE and gave positive feedback regarding this examination method. Furthermore, they welcomed the upcoming changes by considering OSCE a valuable assessment tool, and they showed appreciation for the two-step approach by supporting the combination of an OSCE and a written examination. Thus, this article presents the implementation of an OSCE and a strategy for the adaptation of the curriculum to fulfill the new OSCE requirements and-to our knowledge-reveals students' primary opinions regarding the changes in their medical training program for the first time.

Analyzing the Role of Language and Religion in Culturally Competent Healthcare: An Interdisciplinary Perspective

Cultural competence in healthcare refers to the ability of providers and organizations to effectively deliver healthcare services that meet the social, cultural, and linguistic needs of patients. The current interdisciplinary approach aims to elucidate the critical roles of language and religion in healthcare, focusing on their impact on communication, patient satisfaction, health literacy, and cultural competence in healthcare delivery. Through meticulous analysis of academic databases, health organization reports, and religious institution publications, this literature review consolidates findings from few peer-reviewed articles published in English. Findings reveal that effective healthcare communication is significantly hampered by language barriers, leading to risks of misdiagnoses, improper treatments, and diminished patient satisfaction. The review highlights the indispensable roles of language and religious competence in healthcare, advocating for their integration into healthcare practice, education, and policy to enhance the quality and cultural competence of healthcare delivery for diverse patient populations. Future research should continue to explore and expand on these findings, contributing to the development of practical strategies and theoretical frameworks supporting culturally competent healthcare.

Stakeholder development of an implementation strategy for fall prevention in Norwegian home care – a qualitative co-creation approach

BackgroundThe uptake of fall prevention evidence has been slow and limited in home care services. Involving stakeholders in the implementation process is suggested as a method to successfully tailor implementation strategies. The aim of this study was to develop an implementation strategy for fall prevention, targeting healthcare providers working in home care services.MethodsThis study used an explorative qualitative approach in a five-step co-creation process to involve researchers, service users, and healthcare providers. The first two steps consisted of workshops. This was followed by focus group interviews and individual interviews with key informants as steps three and four. Data from the first four steps were analyzed using reflexive thematic analysis. The fifth and final step was a workshop finalizing a strategy for implementing fall prevention evidence in home health services.ResultsOverall, our findings, resulted in an implementation strategy for fall prevention with four components: (1) Empower leaders to facilitate implementation, operationalized through what managers pay attention to regularly, resource priorities, and time spent on fall prevention, (2) Establish implementation teams, consisting of multidisciplinary healthcare providers from different levels of the organization, with formalized responsibility for implementation, (3) Tailor dual competence improvement, reflecting the need for knowledge and skills for fall prevention and implementation among healthcare providers and users, and (4) Provide implementation support, representing guidance through the implementation process.ConclusionsThis study advances our understanding of implementation in home care services. Implementation of fall prevention requires an implementation strategy involving a blend of essential components targeting leaders, competent healthcare providers and users, and establishing structures enhancing the implementation process.

Access to healthcare services and confidence in healthcare professionals’ management of malaria: the views of Francophone sub-Saharan African Immigrants living in western Canada

BackgroundThere is a paucity of knowledge about the healthcare attitudes and practices of French-speaking immigrants originating from Sub-Saharan Africa (FISSA) living in minority settings. The purpose of this study was to characterize FISSA healthcare experiences and confidence in the malaria-related knowledge of health professionals in Edmonton.MethodsA structured survey was used to examine a cohort of 382 FISSA (48% female; 52% male) living in Edmonton. FISSA general healthcare attitudes, experiences and satisfaction with the Canadian healthcare system were studied. Healthcare Competency Perception (HCP) was characterized by using an index score. Statistical analyses were performed to evaluate the impact of healthcare experiences and other outcomes.ResultsIntriguingly, while only 42% of FISSA had a French-speaking family physician, 83% (197/238) of those who had received health care services in Alberta found that access to medical treatment was easy, and 77% (188/243) were satisfied with received care. Although 70% (171/243) of FISSA did not receive services in French, 82% (199/243) surprisingly reported having good levels of comprehension during their visits. Satisfaction with care was associated with having a family physician (p = 0.018) and having health insurance (p = 0.041). Nevertheless, confidence in the healthcare system’s ability to treat malaria effectively was significantly lower, with only 39% (148/382) receiving a positive score on the HCP index.ConclusionThis study provides an important insight into FISSA experience with and perception of the Alberta’s healthcare system.

Implementing LGBTQ Culturally Appropriate Affirmation Training in the Southern United States: An Evidence-Based Practice Project.

The lesbian, gay, bisexual, transgender, or queer (LGBTQ) community is diverse, and members have a shared need for culturally competent health care (CCH). Best practices show that culturally appropriate affirmation training (CAAT) bridges the sociocultural knowledge gap between patient and provider, resulting in increased access to CCH. The pre-/posttest project design used validated tools to measure group changes in knowledge, attitude, and skills before and after delivery of LGBTQ CAAT. The sample included staff interacting with or making decisions on behalf of patients (n = 11) at a nonprofit clinic in the southern United States. A Wilcoxon signed-rank test showed an increase in health care team scores for knowledge, attitude, and skills (knowledge, p = .006, r = -.59; attitude, p = .123, r = -.33; skills, p = .005, r = -.60). Qualitative analysis (thematic analysis) (a) showed that participants explored sensitive subjects in a nonjudgmental way; (b) connected the dots between minority stress, bias, and patient-provider trust; and (c) showed increased staff confidence in providing care to LGBTQ patients. As staff undergo LGBTQ CAAT, access to CCH will increase, health outcomes will improve, and LGBTQ health disparities will decrease. [J Contin Educ Nurs. 2024;55(3):121-129.].

Clinical teaching practices in maternal mental health care: An integrated review.

WHAT IS KNOWN ABOUT THE TOPIC?: Mental health-related problems in pregnancy are now becoming a global health concern. However, most studies have reported that midwives are unable to assess and support maternal mothers due to poor preservice education. The findings of these studies needed to be explored further from the available literature to address the gap. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The paper has identified maternal mental health core competencies and innovative clinical teaching strategies that nurse educators can utilize when supporting students theoretically and during clinical practice so that students should be adequately prepared for maternal mental health practice. Challenges and recommendations for clinical teaching were also identified. However, there are still gaps in the literature related to the effectiveness of teaching strategies to promote competence acquisition in maternal mental health. WHAT ARE THE IMPLICATIONS FOR EDUCATION?: The study results can be used by nurse educators to develop effective clinical teaching practices in maternal mental health care. The findings can be used in the development of best clinical teaching guidelines for maternal or perinatal mental health to be used by nurse educators for the undergraduate midwifery training programmes. ABSTRACT: Introduction Maternal mental health problems are commonly experienced by women; however, they are usually not adequately recognized and treated by midwives in Malawi. Evidence suggests poor preservice education by nursing colleges which affects the development of essential maternal mental health competencies. Aim The aim of the study was to review existing evidence on clinical teaching practices by nurse educators in teaching student midwives maternal mental health care. Method Integrative review method was used, and various databases were searched. Out of 1768 articles, 27 research articles met the inclusion criteria. The critical appraisal skills programme checklist tools were used to assess data quality. Thematic analysis was done by comparing, grouping and integrating data. Results Six themes emerged, namely: core maternal mental health competencies, professional regulation, interactive teaching strategies, collaborative partnerships, capacity building and shortage of resources. Discussion Clinical teaching is an important aspect of midwifery education. Utilizing student-centred teaching approaches helps students acquire competencies in maternal mental health care. Further research is required to identify the effectiveness of the clinical teaching methods. The Implication to Practice The study results can assist nurse educators to provide comprehensive clinical teaching practices in maternal mental health care which will aid in the development of maternal mental health competencies among student midwives.

Outcomes of an interprofessional peer facilitators program: Building a confident, competent, and collaboration ready healthcare workforce

Peer facilitation during interprofessional simulation-based learning enables students from diverse professions and backgrounds to enrich each other's learning in small groups. Peer facilitators are interprofessional role models and serve to maintain neutrality, listen actively, and respond to group dynamics supporting interprofessional education (IPE). This paper will report the outcomes of an interprofessional peer facilitation program as part of a larger IPE curriculum in a graduate program in the health professions. The authors conducted a mixed methods evaluation of peer facilitators' development measured through a peer facilitator knowledge and self-efficacy tool. Results of qualitative and quantitative data from four years of the program are discussed, documenting the outcomes serving as a peer facilitator has on entry-level health professions learners.

Generic competence among health sciences students in higher education – A cross-sectional study

BackgroundHighly competent health care experts are needed for the development of the social and health care sectors. More knowledge is needed on the levels of generic competencies that health sciences experts possess, particularly in the context of complex decision-making. ObjectivesTo describe self-evaluated generic competence of health sciences students and its associated factors. DesignA cross-sectional observational study design. ParticipantsA total of 291 health science students in five universities in Finland participated in this study during the spring of 2022. MethodsThe data was collected by using the HealthGenericCom instrument with 88 items and 8 sum dimensions using a five-point Likert scale (1—poor to 5—excellent): 1) competence in leadership, administration, and finance; 2) people-centred guiding competence; 3) competence of health promotion; 4) competence of evidence-based practice; 5) digital competence; 6) competence in work well-being and self-management; 7) competence in collaboration and problem-solving, and 8) competence in societal interaction. The K-means cluster algorithm was used to classify generic competence profiles to identify the profiles of health sciences students. ResultsFour generic health sciences competence profiles (A = 18 %, B = 23 %, C = 33 %, D = 26 %) were identified. Profile A demonstrated the lowest level of most generic competencies in health sciences. Digital competence was shown to be at the lowest level among the participants, whereas competence in collaboration, problem-solving, and health promotion was evaluated as the highest competence level. The students evaluated their competence as being higher when they were older, were currently engaged in master's degree programmes, had completed work-based practical training in social and health care, and had varied work experiences or held leading positions. ConclusionsStudents need to improve their generic competencies in health sciences, with a particular focus on developing their digital competence. More focus should be given to work-based practical training.

Understanding the relevance of surgical specialties in undergraduate medical education: Insights of graduates.

The relevance of training medical students in surgical specialty services has been a matter of debate in contexts where the health care system focuses on primary health care. Some educators argue that medical students should be trained in primary care settings. Other educators assert that rotating in highly complex hospitals strengthens the competencies of future general practitioners. Nonetheless, little attention has been paid to the added value that rotations in surgical specialties have brought to newly graduated doctors' lives. In this study, we explored the perceptions of a group of graduates by focusing on the relevant experiences they had during their surgical specialty rotations in undergraduate medical training and how this training influenced their personal and professional life. We conducted a qualitative study using a convenience sampling strategy to recruit a total of seven junior doctors. Data were collected through semi-structured interviews in 2022. Thematic analysis was used to analyse the data until code saturation was reached. The recurring themes were (1) perception of rotations, (2) valuable learning for medical practice and (3) defining their professional future. Participants felt that their experiences in surgical specialty rotations were beneficial, as they gained confidence to perform professionally and decide on future employment and strengthened their research and primary healthcare competencies. Although training in primary healthcare centres is crucial in undergraduate medical education, these results suggest that including rotations in surgical specialties may be valuable in enhancing the future careers of junior doctors.

Total Quality Management, Safety and Stakeholders Satisfaction: Model for Healthcare Administration

Total Quality Management, Safety and Stakeholders Satisfaction: Model for Healthcare Administration

Feeling uncomfortable in your own skin: a qualitative study of problematic skin picking in Italian women

Skin picking disorder (SPD) is a body-focused repetitive behavior recently added to the DSM-V. It mainly affects women, with a prevalence ranging from 1.5 to 5.4%. Picking causes skin lesions that can lead to serious infections and permanent skin problems, usually on the face, scalp, arms, and legs. The behavior impairs quality of life and is associated with psychological distress and difficulties in managing emotions. The disorder causes social embarrassment, leading to avoidance and social withdrawal. As the literature on the perspectives of people with SPD is limited, our research aimed to analyze the meanings they attribute to the behavior and its consequences. A second aim was to explore how interacting with an online community can affect the management of the condition. Using a qualitative descriptive approach, we interviewed twenty-one Italian women (aged 18–50) who self-identified as having SPD and were recruited through an online forum dedicated to the disorder. Three themes framed our analysis: “A stick in the wheel of everyday life,” “Other people’s eyes make you realize what you are doing is wrong,” and “The struggling search for control.” These themes highlight the impact of SPD on different areas of life, the difficulties in accessing competent healthcare providers, the stigma experienced by participants, and the usefulness of the online group on an informative, emotional, and social level. A better understanding of these patients’ perspectives can be useful for those providing professional care and those planning services for them in a Health Co-Inquiry approach that values patients’ activation.