Perceived control in health care: A conceptual model based on experiences of frail older adults

Abstract

Frail older adults are increasingly encouraged to be in control of their health care, in Western societies. However, little is known about how they themselves perceive control in health care. Therefore, this study aims to investigate the concept of health care-related perceived control from the viewpoint of frail older adults. A qualitative interview study was conducted following a Grounded Theory approach. Thirty-two Dutch frail older adults, aged 65 and over, participated in 20 in-depth interviews (n = 20) and three focus group discussions (n = 12). Data were analysed according to techniques of coding and constant comparison. From this analysis constituting factors of perceived control emerged, providing elements of a conceptual model. Perceived control reflects the feeling or belief that health care is under control, which is constituted by five, either internal or external, factors: (I) self-confidence in organising professional and/or informal care, (II) self-confidence in health management in the home setting, (III) perceived support from people in the social network, (IV) perceived support from health care professionals and organisations, and (V) perceived support from (health care) infrastructure and services. Therefore, the concept does not only consist of people's own perceived efforts, but also includes the influence of external sources. Our conceptual model points out what external factors should be taken into consideration by health care professionals and policy makers when enhancing older people's perceived control. Moreover, it can serve as the basis for the development of a measurement instrument, to enable future quantitative research on health care-related perceived control among older adults.

Resilience, not frailty: A qualitative study of the perceptions of older adults towards “frailty”

“…Perhaps the most salient finding in this study is the recurrent emergence of autonomy and independence as an integral part of positive perception of self and self‐health, a finding agreed upon by literature (Claassens et al, ; Ottenvall Hammar, Dahlin‐Ivanoff, Wilhelmson, & Eklund, ). This is vital in the light of the fact that independence is often seen as antithetical to frailty, with frailty leading to reduced perceived self‐determination (Ottenvall Hammar et al, ), and with frailty frequently conceptualised as the loss of independence, as described in our study and others (Faes et al, ).…”

Stakeholders’ views and experiences of care and interventions for addressing frailty and pre-frailty: A meta-synthesis of qualitative evidence

“…Here we present examples coming from sixteen papers, of how people aim to keep frailty at a distance or control it, for example, using strategies and behaviour to help cope with conditions which cannot be changed in themselves, changing their relationship with their conditions, indicating resilience [9,37,41,42,44,48,50,51,52,59,60,63,64,66,69,73]. …”

A concept analysis of confidence related to older people living with frailty

“…Acknowledging this, the concept of confidence is contextualized against the fluctuating physical, psychological and social domains (the columns connected to a range of attributes). The cross‐cutting characteristics of negative or positive inference features “control of physical and mental well‐being.” This control factor, or perceived control, be it explicit or implicit, appeared in several contemporary studies (Claassens et al, ; Parry, Steen, Galloway, Kenny, & Bond, ; Underwood, Kent, & James, ; Wallin et al, ; Yardley et al, ). It also was referred to indirectly in other studies referencing control associated perspectives within their text, using words such as participation, engagement, independence, self‐belief, knowledge, skills and security (Beesley, White, Alston, Sweetapple, & Pollack, ; McDougall & Balyer, ; B. McNamara et al, ; Sandberg et al, ).…”

“…However, fear also had a presence as a consequence, stimulating anxiety and subsequent confidence loss (Oliver, ; Parry et al, ), for example: “…fear, often but not always occasioned by a fall, is maintained by avoidance of activity, leading to loss of confidence, physical weakening and more fear of falling” (Parry et al, :7). Other consequences of confidence include the creation of personal barriers, for example stopping a social activity and creating mental challenges to overcome, such as setting personal achievement goal (Beesley et al, ; Claassens et al, ; Doughty et al, ; Lelard & Ahmaidi, ; McDougall, ; Peduzzi et al, ; Resnick, ; Skymne et al, ; Tung et al, ). All these contributed to a very complex analysis.…”