The development and initial validation of an observational tool for measuring patient participation in clinical consultations

Abstract

Objective: The aim of this study was to further develop and test The Activity Barometer (TAB) as a tool for measuring patient participation in clinical consultations. Methods: The tool was further developed and tested by double coding 18 audio recordings from consultations between nurses and patients and by qualitative discussions between 3 raters. The raters discussed the face and content validity of the tool and the inter-rater reliability was calculated. To assess the construct validity, it was hypothesised that the tool could be used to expose a difference in the patients’ participation before and after the nurses had participated in communication skills training. This was assessed based on 31 audio recordings. Results: All of the 3 raters found the items relevant for measuring patient participation. However, to get reliable ratings, an extended guide for coding was necessary. According to the content validity, we found that by taking a treatment-oriented perspective, core components of patient participation were not included in the tool. To capture the whole concept, the coding should be done from a holistic perspective, including the patients’ everyday life. The inter-rater reliability for the total score (0.85), the questions (0.92) and the preferences/concerns (0.6) were all above acceptable thresholds. The construct validation showed that the tool could expose differences in the patients’ participation before and after the nurses had participated in the communication skills training. Conclusion: TAB is a promising tool for measuring patient participation. However, further validation of the tool in a larger sample is recommended prior to its use in research settings.

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

“…The two raters were trained using TAB, and we added coding instructions to ensure reliable ratings in this new setting. Testing the inter-rater reliability showed that the raters were able to reliably score the video recordings with inter-rater reliabilities comparable with our previous study [17]. This finding indicates that TAB can be used as a reliable tool for the assessment of participation during rounds.…”

“…TAB was developed based on a literature review of existing, validated measuring instruments, feedback from an expert and a patient panel, and a pilot test [15,16]. In a previous study [17], the authors (HP, EI and JA) have further developed and tested TAB by examining the face and content validity, reliability, and construct validity of the tool, by rating audio recordings of clinical consultations. In this process, a codebook was developed to ensure reliable ratings.…”

“…Video recordings of rounds were collected from October to December 2016 (pre-intervention) and from April to June 2017 (post-intervention). A power calculation was made based on the differences found in previous studies using TAB [16,17]. A mean improvement in participation of 25-30 points (sd: 70) was assumed, giving a sample size of 100 video recordings pre-and post-intervention.…”

Codebook for rating clinical communication skills based on the Calgary-Cambridge Guide

“…The two coders had similar characteristics (e.g., training, experience, and gender) and previous experience in coding [32]. However, they had different professional backgrounds (e.g., a nurse and a doctor).…”