Promote Patient Participation Research Articles

RehabApp to promote patient participation in the rehabilitation process after HIP replacement: Development and usability study

ObjectiveThis study aims to present the developmental stages of a Mobile App Prototype designed to enhance patient participation in the rehabilitation process after hip replacement. MethodsTo ensure effective interaction between the system and the end user, a User-Centered Design methodology was followed, encompassing three phases: Requirements gathering, Prototyping, and Evaluation. Usability tests were conducted to assess the usability of the developed system. ResultsThe RehabApp for mobile devices was created, and the testing results were positive. Users expressed satisfaction with the outcome, deeming it a valuable tool for their recovery. This outcome demonstrates the high receptiveness of these technologies in the healthcare sector, making it a project that can readily be expanded into other areas of rehabilitation. ConclusionThis study demonstrated the potential of the RehabApp in the rehabilitation process after hip replacement surgery. This accomplishment was realized by ensuring the active participation of patients, potential users, and healthcare professionals throughout the app's development. InnovationThe RehabApp is a mobile application to provide users with all the necessary knowledge, enabling them to undergo a smoother and safer rehabilitation. Feedback from both patients and healthcare professionals played a crucial role in refining the app's features and addressing usability concerns.

Mediating effects of patient safety perception and willingness to participate in patient safety on the relationship between health literacy and patient participation behavior among inpatients.

In recent years, patient safety activities have shifted from being centered on healthcare providers to involving patients themselves. Health literacy of inpatients has a direct impact on patient participation behavior. Patient safety perception was also associated with willingness to participate in patient safety and patient participation behavior. Therefore, this study aimed to investigate the mediating effects of patient safety perception and willingness to participate in patient safety on the relationship between health literacy and patient participation behavior among inpatients. This cross-sectional study was conducted to confirm the relationship between study variables. A total of 262 inpatients were recruited from patients admitted to the ward of a tertiary general hospital between October and November 2023. Participants were invited to complete self-reported questionnaires that measured health literacy, patient safety perception, willingness to participate in patient safety, patient participation behavior, and demographic information. Data were analyzed using a dual mediation model applying the PROCESS macro (Model 6) with 95% bias-corrected bootstrap confidence intervals. This study analyzed the direct effects of health literacy on patient safety perceptions and patient participation behavior. Health literacy indirectly affected patient participation behavior through patient safety perceptions and willingness to participate in patient safety. Regarding the relationship between health literacy and patient participation behavior, patient safety perceptions and willingness to participate in patient safety showed a significant dual mediating effect. This study identified the factors that promote patient participation behavior among inpatients. The mediating effect of patient safety perception on the relationship between health literacy and patient participation behavior was found to be strong. Building health literacy among inpatients ensures patient safety by increasing patient safety perceptions.

Patient Care Boards - A tool to promote patient participation during hospital ward rounds.

This pre-post intervention study investigated the effectiveness of the Patient Care Board (PCB) as a tool to increase the participation of patients and relatives during hospital ward rounds. Using The Activity Barometer (TAB), we rated 121 video-recorded rounds to compare participation before and after implementing the PCB into clinical practice. Associations between scores for the extent to which patients ask questions or express preferences and concerns were tested with multiple linear regression. TAB-scores tended to be higher after implementing the PCB, especially for the relatives. However, no significant differences were found. The greatest impact on participation was time spent on rounds (p < 0.001). Preparing questions in advance of the round, as well as using anatomical drawings for explanations, increased patient participation (p = 0.041, 0.024). Furthermore, the implementation of the PCB led to higher nurse attendance (p = 0.003). Although we found tendencies towards higher participation, the study could not confirm a significant impact of the overall intervention. Our results suggest that further research is needed, to ensure a higher degree of preparation among the patients, better opportunities for relatives to participate as well as integration of visual information in the rounds.

Psychiatry Nurses’ Experiences of Patient-Initiated Brief Admission from Inpatient and Outpatient Perspectives: A Qualitative Exploratory Study

Patient-initiated brief admission (PIBA) allows patients to decide when admission to psychiatric care is necessary. This may prevent long-term hospitalisation and promote patient participation. Research on psychiatric nurses’ experiences with PIBA is lacking, therefore 11 nurses were interviewed and data analysed using content analysis. Prominent categories were: improved personal development for the patient, more equal nurse-patient relationship, rapid access to a safe environment and strengthened professional collaboration. PIBA is a helpful intervention for patients in crisis, giving both patients and nurses a sense of security. Future studies should explore how this impacts nurses’ work environment and job satisfaction.

The Use of Sports Rehabilitation Robotics to Assist in the Recovery of Physical Abilities in Elderly Patients with Degenerative Diseases: A Literature Review.

The increase in the number of elderly patients with degenerative diseases has brought additional medical and financial pressures, which are adding to the burden on society. The development of sports rehabilitation robotics (SRR) is becoming increasingly sophisticated at the technical level of its application; however, few studies have analyzed how it works and how effective it is in aiding rehabilitation, and fewer individualized exercise rehabilitation programs have been developed for elderly patients. The purpose of this study was to analyze the working methods and the effects of different types of SRR and then to suggest the feasibility of applying SRR to enhance the physical abilities of elderly patients with degenerative diseases. The researcher's team searched 633 English-language journal articles, which had been published over the past five years, and they selected 38 of them for a narrative literature review. Our summary found the following: (1) The current types of SRR are generally classified as end-effector robots, smart walkers, intelligent robotic rollators, and exoskeleton robots-exoskeleton robots were found to be the most widely used. (2) The current working methods include assistant tools as the main intermediaries-i.e., robots assist patients to participate; patients as the main intermediaries-i.e., patients dominate the assistant tools to participate; and sensors as the intermediaries-i.e., myoelectric-driven robots promote patient participation. (3) Better recovery was perceived for elderly patients when using SRR than is generally achieved through the traditional single-movement recovery methods, especially in strength, balance, endurance, and coordination. However, there was no significant improvement in their speed or agility after using SRR.

Current situation of shared decision making in osteoporosis: A comprehensive literature review of patient decision aids and decision drivers.

Osteoporosis is a systemic skeletal disease characterized by low bone mass and microstructural deterioration of bone tissues, resulting in bone fragility and increased fracture risk. It is the most common bone-related disease in the population. However, the proportion of patients who start treatment but discontinue it during the first year is very high (around 50%). Endeavors are made to promote patient participation in treatment by implementing patient decision aids (PDA), whose function is to help the patient make disease-related decisions. We aim to summarize the characteristics of the currently available PDA for osteoporosis, as well as deciding factors. Comprehensive review of the literature. Currently, eleven PDAs can be found for osteoporosis. These PDA have different characteristics or options such as information about treatments tailored to patient needs, graphic information of the results (to facilitate understanding), personal histories (learning), tests to check the knowledge acquired, provision of evidence, clinical practice guidelines or a final summary to share with their doctor. Only five of these PDAs can be considered complete since they provide relevant disease information and therapeutic options to the patient, promote patient's reflection and foment patient-physician discussion. This study provides an update on the current state of decision making on osteoporosis and available PDA, which can help engage the patient through shared decision-making by considering, among other things, patient preferences. Physicians should consider PDA, as it may promote adherence and effectiveness of treatment.

Asking questions can help: development and preliminary evaluation of a question prompt list for patients living with Heart Failure

Abstract Funding Acknowledgements Type of funding sources: None. Background Discussing disease trajectories with patients living with chronic illnesses is recommended in guidelines worldwide and Heart Failure [HF] is no different. Discussions are centered around day-to-day disease management and less on illness trajectory including prognosis, symptoms, treatment options, preferences, and advanced care planning. Lack of open communication is common leading to prolonged suffering and unnecessary admissions [1] and can be improved when patients are able to initiate discussions, ask questions that are of concern to them, and engage in healthcare decision making [2,3]. A range of approaches have been employed to promote patient participation and empowerment. One such approach is the use of Question Prompt Lists [QPL]. Studies show that QPLs are linked to more questions asked, increased satisfaction, and reduced unmet information needs [3,4]. Despite this, they are less commonly used in non-oncology contexts and not available in Lebanon. Health system differences and cultural factors may influence content and impact of QPLs and as such cross-cultural adaptation is essential [5]. As the need for disclosure can vary among cultures, examining QPLs through an anthropological lens is imperative. Purpose To develop a culturally sensitive QPL designed to improve communication about HF illness trajectory. Methods A review of literature on HF QPLs was done. To address cultural and country specific needs, studies on HF from Lebanon and the Middle East were reviewed. This comprised the initial draft of a QPL that included context specific challenges and concerns. A Delphi survey inviting an interdisciplinary team of healthcare providers caring for HF patients was used to seek expert consensus regarding the draft. Sixteen experts rated each question for relevance, using a Likert scale from 0 to 4, clarity, and need to rephrase and suggested additional questions. Ratings were analyzed to determine the level of consensus. Questions that received less than 80% favorable answers [Very Relevant/Relevant and/or more than 20% indicated lack of clarity or the need to rephrase] were discussed in the second round of Delphi. Experts met and reviewed the comments provided on some questions and questions that were rated unfavorably, suggested for deletion, as well as those added by the panelists. Clarity of questions and suggestions for wording improvements was ensured. Results During the second round of Delphi, 12 questions were rephrased, one was dropped, and one was added. A final QPL of 42 questions and 6 categories was reached. Conclusion This is the first step of more research work that will aim at developing Arabic QPLs in the Middle East. The immediate next step would be repeating the Survey with patients, caregivers, and HF providers. Data will be analyzed using central tendency and levels of dispersion to assess consensus. The final QPLs will be translated to Arabic, culturally validated, and pilot tested in Lebanon.

STRATEGY TO PROMOTE PATIENT CENTERED CARE PCC FOR IMPROVING PATIENT SATISFACTION: A LITERATURE REVIEW

Background: Patient satisfaction is playing an increasingly important role in care-quality reforms and healthcare delivery in general. Patient dissatisfaction with nursing services was still a problem in Indonesia and in other developing countries. Patient Centered Care (PCC) as one of the six dimensions of improving the quality of care.&#x0D; Objectives: The purpose of this study aimed to analyse Strategy to Promote PCC for Improving Patient Satisfaction.&#x0D; Design: This study using systematic review design refers to The Center for Review and Dissemination and the Joanna Briggs Institute Guideline.&#x0D; Data Sources: Search for articles was conducted from 14 December 2020 to 28 April 2021 by accessing four electronic databases (Scopus, PubMed, ProQuest, Sage). The article year is limited from 2015-2021. Keywords: “Strategy” OR “Promote” OR “Intervention” AND “Patient Centred Care” OR “Patient Care Management” AND “Patient Satisfaction” OR “Patient Acceptance”.&#x0D; Review Methods: Assessing the quality of articles using the JBI Critical Appraisal Tool and PRISMA checklist as a guide in article screening.&#x0D; Results: A total of 15 article were analyzed according to inclusion criteria. The selected article is divided in five broad themes about strategy to promote patient centered care. The five broad themes are enhanced communication (n=4), promoting patient participation (n=4), emotional support (n=2), intervention to enhanced patient centered care (n=3) and organizational culture (n=2).&#x0D; Conclusion: There are 5 strategies to promote patient centered care for improving patient satisfaction. Five patient centered care strategies to improve patient satisfaction involve enhance communication, promoting patient participation, emotional support, intervention to enhanced patient centered care and organizational culture.

Patients’ Experiences of Participation in High-Security, Forensic Psychiatric Care

The role of patient participation in forensic psychiatric care is unclear, but has been emphasised as important in recent research. This study aims to describe patients’ lived experiences of participation in high-security, forensic psychiatric settings. Sixteen patient interviews were performed in this phenomenological study and analysed with a Reflective Lifeworld Research approach (RLR). Results show that participation must be understood in relation to its opposite construct, non-participation. Participation can thus be explained as situations where non-participation is less visible. Actions to develop the training of patient-staff interactions for forensic psychiatric staff to promote patient participation are called for.

Advance care planning and health literacy in older dialysis patients: qualitative interview study

ObjectivesLow health literacy among older adults is associated with limited engagement in end-of-life care planning, higher hospitalisation rates and increased mortality. Frequently, older dialysis patients derive no survival benefit from...

Advance care planning in older dialysis patients: health care literacy qualitative study

ObjectivesLow health literacy among older adults is associated with limited engagement in end-of-life care plans, more hospitalisations and excess mortality. Frequently, older patients derive no survival benefit from dialysis and...

Practices of patient participation: Getting a turn during hospital ward rounds

Patient participation is a fundamental principle in modern Western health care, but not necessarily simple to achieve. During hospital ward rounds, patient participation is further hindered by the multi-party nature of the encounter: at times, members of the medical team talk with each other rather than with the patient. This article examines patients’ opportunities to participate in ward round conversations when the patient is not the addressed recipient. The data consist of 3 hours of video-recorded ward rounds in a Finnish hospital. Using conversation analysis, we study patients’ practices for getting a turn in different sequential environments. The patients monitor the ongoing conversation and exploit its sequential organisation by producing responsive turns and repair initiations, thus becoming active participants. They also produce their own initiatives, although sequential and multimodal constraints affect their possibilities for modifying the participation framework. The results of this study can be exploited to promote patient participation.

Comparing Perceptions of Patient Nonparticipation in Nursing Care: A Secondary Analysis.

Patient participation is characterized by dyadic patient-nurse interactions that enable patients to passively or actively participate in communicative and physical care activities. Less research has been conducted on nonparticipation. Examining this phenomenon may highlight issues to address and identify strategies that may ultimately promote patient participation and move the rhetoric of patient participation to a reality. The aim of this secondary analysis was to explore hospital patients' and nurses' perceptions of nonparticipation in nursing care specifically focused on communication and self-care. Secondary supplementary analysis of qualitative data. We collated original transcripts from one dataset that included 20 patient and 20 nurse interviews conducted at two hospitals in Australia, in November 2013 to March 2014. Interviews were arranged into units of analysis dependent on group (patient/nurse) and setting (public/private hospital) and were reanalyzed using manifest, inductive content analysis. Two categories were found: (a) nurses impeding two-way clinical communication; and (b) patients and nurses disregarding patients' self-care efforts. These categories describe that nonparticipation occurred when nurses inhibited communication, and when patients were not involved in self-care while hospitalized or during discharge planning. Perceptions of nonparticipation differ across settings, having implications for how patient participation recommendations are enacted in different contexts. There is no one-size-fits-all approach; nurses need to identify common instances of nonparticipation within their setting and develop and implement strategies to promote patient participation that are suited to their context.

Partners' engagement in surveillance among survivors of colorectal cancer: A qualitative study.

ABSTRACTObjectivesFollowing treatment of Stage III colorectal cancer, guidelines recommend 3–5 years of surveillance for recurrence. However, over half of the 1.2 million U.S. survivors of colorectal cancer fail to receive guideline‐concordant surveillance. In light of growing recognition that members of couples are interdependent and influence each other's health behaviors, we sought to describe, in their own words, the perspectives of spouses/partners on their engagement in patients’ surveillance.MethodsWe conducted in‐person, semi‐structured interviews with 10 survivors of stage III colorectal cancer and their partners, together and separately. Interviews were transcribed verbatim, iteratively coded, and analyzed to identify emergent themes pertaining to partner engagement. Findings were validated through triangulation between study team members and triangulation between dyadic and individual interviews, and through an extensive search of transcripts for disconfirming evidence.ResultsWe identified three overarching domains of partner engagement in surveillance. First, psychosocial engagement included promoting patient participation in surveillance, showing care and concern, and attending to partner self‐care. Second, information‐seeking and dyadic communication focused on gathering information, staying informed about test results, and communicating about surveillance. Third, instrumental engagement referred to any explicit, objective activities such as scheduling appointments, attending appointments, and managing responsibilities at home. Participants shared strategies, examples, and in some cases unmet needs.ConclusionsThis study generated new, clinically meaningful knowledge about the ways in which partners engage in patients’ surveillance. Opportunities to leverage partners as informal resources in surveillance include development of dyadic interventions to help partners engage most effectively.

How do patients and health professionals perceive the role of family members in the decision-making process regarding the choice of a dialysis method? A qualitative study

BackgroundTherapeutic decisions often seem to be the product of interaction between health professionals and patients alone. However, some realities make it essential to consider family members when examining care of patients, especially in the construction of therapeutic choices. Implementation of measures such as therapeutic patient education to make the patient an actor in his own healthcare, and the impact of disease on the patient's social and professional activities mean there is an important place for family members in a patient's care pathway. This study aims to examine the role of family members and the family environment in decision-making on treatment for patients with chronic kidney disease. It also analyzes how they contribute to the construction of patients’ choices on dialysis methods through their involvement in a therapeutic patient education program. MethodsThis study involved thirty-six semi-structured interviews: sixteen with patients and twenty with health professionals. Therapeutic patient education sessions, interactions and information exchanges between patients and health professionals, as well as participant behaviours, were also observed. Analysis was thematic. ResultsResults indicate that the factors influencing the patient's choice of dialysis methods include the family environment as the place where the disease is experienced, the need to maintain family ties, the advice provided by family members and their active participation in therapeutic patient education sessions and partnership between family members and health professionals in the decision-making process. ConclusionThis study highlights the reality of decision-making processes that can start from a non-hospital setting. Furthermore, it argues for greater consideration of the needs, values, and preferences of family members in mechanisms designed to promote patient participation in therapeutic decisions.

Proposed Additions to the NCCN Guidelines for Adult Medulloblastoma.

Medulloblastoma is a rare brain tumor that occurs in both children and adults, with patients aged 15 to 39 years accounting for 30% of all cases. In adults, guidelines for diagnosis and treatment are often based on retrospective data and extrapolated from the pediatric experience due to limited availability of prospective trials or registries involving adults. Importantly, adult patients differ from pediatric patients in many aspects, including the molecular features of the tumor and tolerance to treatment. In 2017, the NCI was granted support from the Cancer Moonshot initiative to address the challenges and unmet needs of adults with rare central nervous system (CNS) tumors through the NCI Comprehensive Oncology Network for Evaluating Rare CNS Tumors (NCI-CONNECT). On November 25, 2019, NCI-CONNECT convened a multidisciplinary workshop on adult medulloblastoma. Working groups identified unmet needs in clinical care and research and developed specific action items, including a proposal for inclusion of new items in the NCCN Guidelines for Adult Medulloblastoma, delineated in this review along with the evidence supporting their incorporation. Recommendations included facilitating referral of patients to centers of excellence; promoting patient participation in clinical trials or registries; encouraging use of DNA methylation for confirmation of diagnosis and subgrouping; offering counseling on contraception and fertility preservation; evaluating patients for symptoms and medical management of endocrine, vision, hearing, and neurocognitive deficits; providing psychosocial support and referral to neurorehabilitation; minimizing delays in therapy; and incorporating imaging standards and criteria for progression.

Through the lens of work-integrated learning: Staff experiences of participating in person-centredness coach training in a Swedish hospital

Background/Objective: Over the past decade, many scientific articles have focused on the importance of person-centred care (or person centredness) in the health care sector. In practice, however, person centredness is difficult to operationalise. Thus, the role of “person-centredness coach” was created in a Swedish hospital to provide information, education, and reflection on person centredness. The aim was to describe this new role of a person-centeredness coach, and how the coaches experienced the development of a person-centred working method.Methods: Qualitative semi-structured individual interviews were conducted with nine nursing staff. The data were analysed using inductive content analysis.Results: The analysis resulted in three categories with seven subcategories: an eye opener (with the subcategories of a welcome change and person centredness throughout the organisation); an obstacle with potential (with the subcategories of theoretical vs. practical development of person centredness, difficulties in developing person centredness and proposals for promoting patient participation); and a challenging role (with the subcategories of necessary but a role that takes a long time to develop and the importance of favourable conditions).Conclusions: The person-centredness coaches believed that the person-centred approach was important and that it should be the foundation of all care work within health care but, despite this, had difficulty in integrating person centredness into their practice. The person-centredness coaches found the coach training rewarding. They perceived that, from a learning perspective and through the lens of work-integrated learning, the results could be related to creating praxis, which may be seen as a development area for further research in operationalising person centredness.

Hospital patients' perceptions of using a technology-based intervention to participate in their nutrition care: A qualitative descriptive study.

Promoting patient participation in health care is a worldwide health care priority. When patients participate in their nutrition care during hospitalisation, they are more likely to meet their dietary needs. Patient participation is a potential solution to hospital malnutrition, for which inadequate dietary intake is the major modifiable risk factor. Our team developed a health information technology (HIT) intervention aiming to improve patients' dietary intakes during hospitalisation by engaging them in their nutrition care. The aim of this study was to explore patient perceptions and acceptability of the intervention. This qualitative descriptive study was conducted at a tertiary teaching hospital in Australia. Participants were a subset of patients from a larger feasibility study, selected using maximum variation purposive sampling to include a broad representation of patients in terms of age, gender and experience with technology. All patients had used the HIT intervention to participate in their nutrition care in hospital, through nutritional goal setting and dietary intake monitoring. A semi-structured interview guide was used to collect qualitative data on patients' perceptions of the intervention, focusing on acceptability. Data were analysed thematically. 11 patients participated in interviews, from which two main themes emerged. The first captured patients' experiences and perceptions of using technology to participate in their nutrition care. Patients found it easy to use, useful and valuable, but still valued interaction with researchers and hospital staff. The second theme portrayed the spectrum of participation, from simply learning about nutrition, to self-monitoring and evaluating, to changing behaviour. Participants enjoyed gaining new knowledge and awareness around nutrition. Most self-monitored their food intake and evaluated their goals, and some changed what foods they ordered based on what they had learned. Patients responded positively to the intervention, likely because they found it valuable and easy to use. These findings are promising for potential future use of HIT to engage hospital patients in care. Future research should investigate the effects of HIT interventions on patient-centred outcomes in hospital.

Engagement in an Interactive App for Symptom Self-Management during Treatment in Patients With Breast or Prostate Cancer: Mixed Methods Study.

BackgroundUsing mobile technology for symptom management and self-care can improve patient-clinician communication and clinical outcomes in patients with cancer. The interactive app Interaktor has been shown to reduce symptom burden during cancer treatment. It includes symptom assessment, an alert system for contact with health care professionals, access to self-care advice, and visualization of symptom history. It is essential to understand how digital interventions operate; one approach is to examine engagement by assessing usage and exploring user experiences. Actual usage in relation to the intended use—adherence—is an essential factor of engagement.ObjectiveThis study aimed to describe engagement with the Interaktor app among patients with breast or prostate cancer during treatment.MethodsPatients from the intervention groups of two separate randomized controlled trials were included: patients with breast cancer receiving neoadjuvant chemotherapy (n=74) and patients with locally advanced prostate cancer receiving treatment with radiotherapy (n=75). The patients reported their symptoms daily. Sociodemographic and clinical data were obtained from baseline questionnaires and medical records. Logged data usage was retrieved from the server and analyzed descriptively and with multiple regression analysis. Telephone interviews were conducted with patients about their perceptions of using the app and analyzed using content analysis.ResultsThe median adherence percentage to daily symptom reporting was 83%. Most patients used the self-care advice and free text message component. Among the patients treated for breast cancer, higher age predicted a lower total number of free text messages sent (P=.04). Among the patients treated for prostate cancer, higher age (P=.01) and higher education level (P=.04), predicted an increase in total views on self-care advice, while higher comorbidity (P=.004) predicted a decrease in total views on self-care advice. Being married or living with a partner predicted a higher adherence to daily symptom reporting (P=.02). Daily symptom reporting created feelings of having continuous contact with health care professionals, being acknowledged, and safe. Being contacted by a nurse after a symptom alert was considered convenient and highly valued. Treatment and time-related aspects influenced engagement. Daily symptom reporting was perceived as particularly meaningful at the beginning of treatment. Requests were made for advice on diet and psychological symptoms, as well as for more comprehensive and detailed information as the patient progressed through treatment.ConclusionsPatient engagement in the interactive app Interaktor was high. The app promoted patient participation in their care through continuous and convenient contact with health care professionals. The predictive ability of demographic variables differed between patient groups, but higher age and a higher educational level predicted usage of specific app functions for both patient groups. Patients’ experience of relevance and interactivity influenced their engagement positively.

Exploring the Role of Social Support in Promoting Patient Participation in Health Care among Women with Breast Cancer

ABSTRACT Scholars have adopted Street’s (2003) ecological model of communication in medical encounters to investigate the factors promoting patient participation in health care. However, factors demonstrated in the ecological model were bounded in the context of medical care primarily focusing on health care providers and patients. Social factors, such as patients’ relationships and supportive communication with others outside the context of health care remain relatively unexplored. To expand the purview of our understanding of factors that influence patient participation, this research integrated social support literature into the research on physician-patient communication and proposed a model which described a process through which social support can enhance patient participation in health care. The data analyzed in this study were a part of two larger clinical trials in which 661 women with breast cancer were recruited from three cancer institutions in the United States. The results from structural equation modeling analysis from cross-sectional and longitudinal data provided strong evidence for the hypotheses predicting that perceived social support was positively associated with health information competence, which in turn fully mediated the association between social support and patient participation in health care. Theoretical and practical implications are discussed.