Engaging patients to recover life projectuality: an Italian cross-disease framework

Barello, Serena; Graffigna, Guendalina

doi:10.1007/s11136-014-0846-x

Cited by 71 publications

(54 citation statements)

References 32 publications

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“…To obtain the PHE-s level, the median of the row PHE-s scores should be calculated. And with a simple conversion it is possible to transform the row PHE-s scores in the corresponding patient’s engagement position [50,53–55]. …”

Section: Methodsmentioning

confidence: 99%

“…We have described this process in its four evolving phases (blackout, arousal, adhesion, eudaimonic project) and termed it the Patient Health Engagement Model (PHE-model). [44,47–50] This model highlights how patients emotionally elaborate and give sense their illness status and patients’ identity, and it may be considered a crucial precursor of their ability and willingness to play a more active role in self-management. A previous study has highlighted how PHE-model plays a mediating role in the activation of type-2 diabetes patients.…”

Section: Introductionmentioning

confidence: 99%

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The role of Patient Health Engagement Model (PHE-model) in affecting patient activation and medication adherence: A structural equation model

2017

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BackgroundIncreasing bodies of scientific research today examines the factors and interventions affecting patients’ ability to self-manage and adhere to treatment. Patient activation is considered the most reliable indicator of patients’ ability to manage health autonomously. Only a few studies have tried to assess the role of psychosocial factors in promoting patient activation. A more systematic modeling of the psychosocial factors explaining the variance of patient activation is needed.ObjectiveTo test the hypothesized effect of patient activation on medication adherence; to test the the hypothesized effects of positive emotions and of the quality of the patient/doctor relationship on patient activation; and to test the hypothesized mediating effect of Patient Health Engagement (PHE-model) in this pathway.Material and methodsThis cross-sectional study involved 352 Italian-speaking adult chronic patients. The survey included measures of i) patient activation (Patient Activation Measure 13 –short form); ii) Patient Health Engagement model (Patient Health Engagement Scale); iii) patient adherence (4 item-Morinsky Medication Adherence Scale); iv) the quality of the patients’ emotional feelings (Manikin Self Assessment Scale); v) the quality of the patient/doctor relationship (Health Care Climate Questionnaire). Structural equation modeling was used to test the hypotheses proposed.ResultsAccording to the theoretical model we hypothesized, research results confirmed that patients’ activation significantly affects their reported medication adherence. Moreover, psychosocial factors, such as the patients’ quality of the emotional feelings and the quality of the patient/doctor relationship were demonstrated to be factors affecting the level of patient activation. Finally, the mediation effect of the Patient Health Engagement model was confirmed by the analysis.ConclusionsConsistently with the results of previous studies, these findings demonstrate that the Patient Health Engagement Model is a critical factor in enhancing the quality of care. The Patient Health Engagement Model might acts as a mechanism to increase patient activation and adherence.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The role of Patient Health Engagement Model (PHE-model) in affecting patient activation and medication adherence: A structural equation model

2017

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“…The concept of relationship-based care constitutes a milestone of the nursing care paradigm with several theories supporting the nurse-patient partnership as the foundation for effective care delivery (Koloroutis, 2004; McCormack and McCance, 2006; Sahlsten et al, 2007; Barello and Graffigna, 2015b). Through the relational and educational aspects of nursing care, nurses have the opportunity to build care relationships that support patient engagement, which ultimately lead to improved patients' quality of life even when life-threatening chronic conditions occur (Gruman et al, 2010; Jerofke et al, 2014; Barello and Graffigna, 2015a; Jenerette and Mayer, 2016). In their clinical encounters, nurses are recognized to be key persons whose strategies might hugely affect the patient's level of engagement in the care process (Jordan et al, 2008; Kutney-Lee et al, 2009; Laschinger et al, 2010; Deyo et al, 2016; Morath and Braaten, 2016).…”

Section: Introductionmentioning

confidence: 99%

An Educational Intervention to Train Professional Nurses in Promoting Patient Engagement: A Pilot Feasibility Study

et al. 2017

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Introduction: Growing evidence recognizes that patients who are motivated to take an active role in their care can experience a range of health benefits and reduced healthcare costs. Nurses play a critical role in the effort to make patients fully engaged in their disease management. Trainings devoted to increase nurses' skills and knowledge to assess and promote patient engagement are today a medical education priority. To address this goal, we developed a program of nurse education training in patient engagement strategies (NET-PES). This paper presents pilot feasibility study and preliminary participants outcomes for NET-PES.Methods: This is a pilot feasibility study of a 2-session program on patient engagement designed to improve professional nurses' ability to engage chronic patients in their medical journey; the training mainly focused on passing patient engagement assessment skills to clinicians as a crucial mean to improve care experience. A pre-post pilot evaluation of NET-PES included 46 nurses working with chronic conditions. A course specific competence test has been developed and validated to measure patient engagement skills. The design included self-report questionnaire completed before and after the training for evaluation purposes. Participants met in a large group for didactic presentations and then they were split into small groups in which they used role-play and case discussion to reflect upon the value of patient engagement measurement in relation to difficult cases from own practice.Results: Forty-six nurses participated in the training program. The satisfaction questionnaire showed that the program met the educational objectives and was considered to be useful and relevant by the participants. Results demonstrated changes on clinicians' attitudes and skills in promoting engagement. Moreover, practitioners demonstrated increases on confidence regarding their ability to support their patients' engagement in the care process.Conclusions: Learning programs teaching nurses about patient engagement strategies and assessment measures in clinical practice are key in supporting the realization of patient engagement in healthcare. Training nurses in this area is feasible and accepted and might have an impact on their ability to engage patients in the chronic care journey. Due to the limitation of the research design, further research is needed to assess the effectiveness of such a program and to verify if the benefits envisaged in this pilot are maintained on a long-term perspective and to test results by employing a randomized control study design.

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“…A recent model developed by Graffigna et al (2014) defined patient engagement as a dynamic process, in which patients experience four phases (blackout, arousal, adhesion, and eudaimonic project), each encompassing emotional, cognitive, and behavioral dimensions. According to this model, engagement is the final outcome of a series of emotional, cognitive, and behavioral reframing of the patient’s health condition (Barello and Graffigna, 2014). More specifically, fully engaged patients are able to integrate the disease into their identity and life, manage their own care and mobilize healthcare services proactively if needed.…”

Section: Introductionmentioning

confidence: 99%

Illness Representations of HIV Positive Patients Are Associated with Virologic Success

et al. 2016

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Introduction: It is important for HIV positive patients to be engaged in their care and be adherent to treatment in order to reduce disease progression and mortality. Studies found that illness representations influence adherence through the mediating role of coping behaviors. However, no study has ever tested if patient engagement to the visits mediate the relationship between illness perceptions and adherence. This study aimed to explore illness representations of HIV positive patients and test the hypothesis that illness representations predict adherence through the mediating role of a component of behavioral engagement.Methods: HIV-positive patients treated with highly active antiretroviral therapy (HAART) for at least one year and presenting to a check-up visit were eligible to participate in the study. Patients completed the Illness Perception Questionnaire-Revised. Behavioral engagement was measured based on the patients’ clinical attendance to the check-up visits; adherence to HAART was measured by viral load. Undetectable viral load or HIV-RNA < 40 copies/ml were considered indexes of virologic success.Results: A total of 161 patients participated in the study. Most of them coherently attributed the experienced symptoms to HIV/HAART; perceived their condition as chronic, stable, coherent, judged the therapy as effective, and attributed their disease to the HIV virus and to their behavior or bad luck. The majority of patients (80.1%) regularly attended check-up visits and 88.5% of them reached virologic success. The mediation model did not show good fit indexes. However, a significant direct effect of two independent variables on virologic success was found. Specifically, the perception that the disease does not have serious consequences on patient’s life and the prevalence of negative emotions toward HIV were associated with virologic success. On the contrary, the patient’s perception that the disease has serious consequences on his/her life and the prevalence of positive emotions were associated with virologic failure. This model showed good fit indexes (CFI = 1; TLI = 1; RMSEA = 0.00; and WRMSR = 0.309).Discussion: Results do not support the mediating role of behavioral engagement in the relationship between illness representations and adherence. As perception of serious consequences coupled with positive emotions are directly associated with virologic failure, clinicians should take them into account to promote treatment adherence.

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Engaging patients to recover life projectuality: an Italian cross-disease framework

Cited by 71 publications

References 32 publications

The role of Patient Health Engagement Model (PHE-model) in affecting patient activation and medication adherence: A structural equation model

The role of Patient Health Engagement Model (PHE-model) in affecting patient activation and medication adherence: A structural equation model

An Educational Intervention to Train Professional Nurses in Promoting Patient Engagement: A Pilot Feasibility Study

Illness Representations of HIV Positive Patients Are Associated with Virologic Success

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