The development and validation of the SOLES, a new scale measuring engagement with mental health services in people with psychosis

A conceptual review of engagement in healthcare and rehabilitation

“…Had there been more consideration of patient perspectives in the design process, and had the item development been based on robust empirical and/or theoretical studies of engagement, as done by Macgowan [38] and as recommended by McDowell [39], they may be considered more reliable and valid. Four measures did not explicitly define engagement, the construct at the center of the measure [32,34,35,40]. The lack of a conceptual base and lack of clarity around the construct may limit how much these indicators can be said to be reliable indicators of engagement [22].…”

“…The clinician appeared to have a crucial role in the process of engagement [30, 31, 43-45, 48, 49, 51, 52]; several authors suggested this required significant skill [31,50]. Communication appeared central [10,48] with the patient feeling able to talk and tell their story and sensing this was listened to [40,43,45,48,50] and understood [48,50]. Also identified as key to 'engaging with' were responsiveness to the patient [50], seeing them as a person rather than a diagnosis or impairment [30,43,45,46,48,49,52,53], demonstrating a genuine interest in getting to know the person and their story [50,53], addressing core needs [33,47], valuing their expertise [29,30,43,46] and strengths [31].…”

“…We would argue that clinicians are not well-positioned to judge this subjective, internal state and that their 'assessment' of a patient's engagement may at best provide only a partial view of engagement and at worst, reflect an inaccurate picture [45]. It could be anticipated that the patient may have a different perspective that should be considered [32,40,57,66]. …”

“…In a group situation, engagement also involved the development of relationships with other patients and active collaborative work to address each other's needs [38]. It was said to be influenced by environmental factors [54,58] and intrinsic factors such as accepting the need for treatment, perceiving the benefits of treatment [40,58] and self-efficacy [54].A number of behaviors have been suggested as markers of patient engagement, predominantly in published measures of engagement. These include: willingness to participate [33], contributions to the session [38], retention in a service [51] and attendance at therapy [2,34,38,40,55].…”

“…It did not appear to cease once the patient became involved with the service or in a therapy task; instead it was fluid and could further develop, or in fact diminish over time without on-going work and from both parties [10,30,43,44,48,58]. It was said to be maintained through an internal feedback loop, which involved the patient making on-going decisions to remain engaged [58] and through the clinician's way of working [52,57]; this could include periods of intermittent disengagement from services [43].With regard to published measures of engagement, the interaction and relationship between clinician and patient was considered within some measures, for example, the 'quality of the relationship' [32,34] 'attitudes toward staff ' [33], and the 'client's perception of being listened to' [40]. Of note is that items in the measures commonly focused on the patient's actions and perceived attitudes despite the body of evidence detailed above emphasizing the clinician's actions and perceived attitudes.…”