Assessment of Patient Empowerment - A Systematic Review of Measures

Abstract

BackgroundPatient empowerment has gained considerable importance but uncertainty remains about the best way to define and measure it. The validity of empirical findings depends on the quality of measures used. This systematic review aims to provide an overview of studies assessing psychometric properties of questionnaires purporting to capture patient empowerment, evaluate the methodological quality of these studies and assess the psychometric properties of measures identified.MethodsElectronic searches in five databases were combined with reference tracking of included articles. Peer-reviewed articles reporting psychometric testing of empowerment measures for adult patients in French, German, English, Portuguese and Spanish were included. Study characteristics, constructs operationalised and psychometric properties were extracted. The quality of study design, methods and reporting was assessed using the COSMIN checklist. The quality of psychometric properties was assessed using Terwee’s 2007 criteria.Findings30 studies on 19 measures were included. Six measures are generic, while 13 were developed for a specific condition (N=4) or specialty (N=9). Most studies tested measures in English (N=17) or Swedish (N=6). Sample sizes of included studies varied from N=35 to N=8261. A range of patient empowerment constructs was operationalised in included measures. 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. Quality assessment revealed several flaws in methodological study quality with COSMIN scores mainly fair or poor. The overall quality of psychometric properties of included measures was intermediate to positive. Certain psychometric properties were not tested for most measures.DiscussionFindings provide a basis from which to develop consensus on a core set of patient empowerment constructs and for further work to develop a (set of) appropriately validated measure(s) to capture this. The methodological quality of psychometric studies could be improved by adhering to published quality criteria.

Measurement issues of shared decision making in mental health: challenges and opportunities

“…The active participation of 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Finally, from an organizational perspective, although there is no universally agreed measure of SDM, there are some proposed solutions at different levels (micro, meso or macro level) to overcome key challenges to measure SDM (Barr, Scholl, et al 2016). In particular, it would be useful for organizations: to involve patients and healthcare professionals in designing, developing and testing measures; to build strategies to include patient-reported outcomes in organizational registries (e.g., electronic medical records); to set up automated analysis methods to provide rapid feedback and methods of monitoring SDM in clinical encounters (to service users, mental health professionals, multidisciplinary teams care, organizations and health care systems); to set aside staff time to measure and monitor key outcomes; and finally, to promote tools as a component of a continuous monitoring set of routines, and build the tools into balanced scorecard when the value of measuring may not be recognized (Barr et al, 2015;Metz et al, 2015).…”

“…In particular, it would be useful for organizations: to involve patients and healthcare professionals in designing, developing and testing measures; to build strategies to include patient-reported outcomes in organizational registries (e.g., electronic medical records); to set up automated analysis methods to provide rapid feedback and methods of monitoring SDM in clinical encounters (to service users, mental health professionals, multidisciplinary teams care, organizations and health care systems ); to set aside staff time to measure and monitor key outcomes; and finally, to promote tools as a component of a continuous monitoring set of routines, and build the tools into balanced scorecard when the value of measuring may not be recognized (Barr et al 2015;Metz et al 2015).…”

“…Studies assessing empowerment also were excluded, since this concept comprises indistinctly several dispositions and skills related to the SDM process and outcome, and currently there is no consensus about its operationalization (Barr et al, 2015;Bravo et al, 2015). We also excluded studies that applied preference elicitation techniques (e.g., discrete choice experiments, conjoint analysis) to assess treatment preferences, or studies where the SDM construct was assessed qualitatively (by means of conversation analysis, thematic analysis or other qualitative techniques).…”

Patient empowerment in Europe: is no further research needed?

“…However, a previous review [16] found significant methodological shortcomings in the available measures, mainly due to a lack of clarity on the PE concept. Finally, despite all these efforts to improve PE definitions and measures, the latest (Canadian) review concluded that there is still a lack of conceptual clarity in PE research [17].…”

Relationship Between Patient-Reported Outcome Measures and the Severity of Chronic Obstructive Pulmonary Disease in the Context of an Innovative Digitally Supported 24-Hour Service: Longitudinal Study (Preprint)

“…It was also developed using a validity driven approach [12], and measures proximal outcomes related to selfmanagement behavior across 8 dimensions. The heiQ has been found to capture dimensions strongly related to empowerment [21]. A Canadian study [22] and a recent Danish review suggests that five of the eight dimensions of heiQ, including; 3.…”