Understanding the motivations of patients: A co-designed project to understand the factors behind patient engagement.
ABSTRACT: BACKGROUND:Large-scale transformation depends on effective engagement of diverse stakeholders. With the evolution of the role of the 'patient partner' in health-care decision making, understanding the motivations of these individuals is essential to the success of engagement initiatives. This study reports on motivational factors associated with patient engagement in health care. METHODS:Patient co-investigators and a researcher co-designed and conducted this study. A survey was administered to patients and family members. Key informant interviews and previous research informed the development of the survey tool. The survey data were analysed using exploratory factor analysis to identify the underlying dimensions in the data. Cronbach's alpha was used to determine reliability. RESULTS:A total of 1449 individuals participated in the survey. Of these, 543 completed and 427 partially completed the survey (67% complete rate). The mean age of the respondents was 54 years. The majority of participants were female, well-educated, retired, married and lived in an urban centre. Seven motivational factors explained 65% of the total variance. Analysis of internal consistency revealed acceptable reliability for all items. The seven motivations were as follows: Self-fulfillment, Improving Healthcare, Compensation, Influence, Learning New Things, Conditional and Perks. CONCLUSION:The results of this research describe a sample of patient and family members currently engaged with health systems. We identified seven motivational factors underlying their engagement. A deeper knowledge of volunteer motivations will not only create meaningful engagement opportunities for patients, but also enable health organizations to gain from the experience of these individuals, thereby enhancing quality and sustainability of patient engagement programmes.
Project description:<h4>Background</h4>US research organizations increasingly are supporting patient and stakeholder engagement in health research with a goal of producing more useful, relevant and patient-centered evidence better aligned with real-world clinical needs. The Patient-Centered Outcomes Research Institute (PCORI) engages patients, family caregivers and other health-care stakeholders, including clinicians, payers and policymakers, as active partners in prioritizing, designing, conducting and disseminating research as a key strategy to produce useful evidence for health-care decision making.<h4>Objective</h4>To inform effective engagement practices and policies, we sought to understand what motivates patients and caregivers to engage as partners on PCORI-funded research projects and how such engagement changed their lives.<h4>Methods</h4>We conducted thematic analysis of open-ended survey responses from 255 patients, family caregivers and individuals from advocacy and community-based organizations who engaged as partners on 139 PCORI-funded research projects focusing on a range of health conditions.<h4>Results</h4>Partners' motivations for engaging in research were oriented primarily towards benefiting others, including a desire to improve patients' lives and to support effective health-care interventions. In addition to feeling they made a positive difference, many partners reported direct benefits from engagement, such as new relationships and improved health habits.<h4>Discussion and conclusions</h4>By identifying patient and caregiver motivations for engaging in research partnerships and what they get out of the experience, our study may help research teams and organizations attract partners and foster more satisfying and sustainable partnerships. Our findings also add to evidence that engagement benefits the people involved as partners, strengthening the case for more widespread engagement.
Project description:CONTEXT:As public health needs and priorities evolve, maintaining a trained public health workforce is critical to the success of public health efforts. Researchers have examined training needs in various contexts and subpopulations, but a nationally representative study of what motivates public health workers to seek out training has yet to be conducted. By understanding these motivations, public health agencies and policy makers can appeal to worker motivations in both training programs and organizational incentives. OBJECTIVE:The purpose of this article was to describe overall training motivations and identify patterns of training motivations among public health workers. This study also explored whether or not training needs differ across prevalent motivational patterns. DESIGN AND PARTICIPANTS:Using data from the 2017 Public Health Workforce Interests and Needs Survey (PH WINS), the study used latent class analysis (LCA) to identify motivational patterns and logistic regression to analyze associations with training needs. RESULTS:The most prominent motivation to seek training was personal growth (82.7% of respondents). LCA identified 4 motivational classes of public health workers: those motivated by organizational pressure and requirements (31.8%), those motivated indiscriminately by all factors (28.4%), those motivated primarily by personal growth (21.7%), and those motivated by organizational accommodations and supports (18.2%). Motivational class was not associated with indicating training needs in any of 8 training domains, nor was it associated with indicating any training need in any domain. CONCLUSIONS:Public health agencies should consider the different motivational classes present in the public health workforce. In particular, motivational classes that represent organizational choices suggest that public health agencies should both motivate workers with organizational requirements and pressure from managers and offer institutional support via paid travel and covered time for training.
Project description:<h4>Objective</h4>The aim of the study was to evaluate the psychometric properties of a newly developed survey tool measuring omissions in primary care.<h4>Methods</h4>The Errors of Care Omission Survey (ECOS) is the only known tool to measure critical omissions ("errors") in primary care from the perspectives of primary care providers (PCPs), both physicians and nurse practitioners. The tool has 31 items grouped into the following four subscales: Self-Management Support, Follow-up, Emotional Health Support, and Care Integration. A cross-sectional survey design was used to mail the tool to PCPs and 582 PCPs in one state in the U.S. completed and returned the survey. Exploratory factor analysis with target rotation was carried out. Internal consistency reliability of identified subscales was investigated.<h4>Results</h4>Four factors emerged representing domains of omissions in primary care. The original Follow-up and Care Integration subscales were retained. The items on Self-Management Support and Emotional Health Support subscales loaded differently on two factors, which were labeled Patient Self-Management and Family Engagement subscales, suggesting that conceptually PCPs separate patient and family involvement in patient care. Seven poorly performing or redundant items were removed. The remaining 24 items measure patient self-management, family engagement, follow-up, and care integration domains of omissions in primary care. The ECOS subscales have acceptable internal consistency reliability with Cronbach's ? ranging from 0.90 to 0.97.<h4>Conclusions</h4>The ECOS can be used in primary care to identify critical omissions, so actions can be taken by clinicians and administrators to prevent them before they result in patient harm. Further testing of the ECOS is recommended with diverse samples.
Project description:OBJECTIVES:Participation in the arts has well-documented benefits for health. However, participation in the arts is socially patterned, and it remains unclear why this is: what factors act as barriers or enablers of individual arts engagement. Therefore this study explored how individual characteristics predict individuals' capabilities, opportunities and motivations to engage in participatory arts activities. METHODS:We analysed data from 6,867 adults in the UK (61.2% female, average age 46.7 years) who engage infrequently in performing arts, visual arts, design and crafts, literature-related activities, or online, digital and electronic arts. We constructed a structural equation model to explore the relationship between demographic factors (including age, sex, ethnicity or socio-economic status), health factors (including physical and mental health) or social factors (including living alone, urban density, loneliness or socialising) and perceived barriers to arts engagement. RESULTS:Individuals with poorer physical and mental health experienced more barriers affecting their perceived capabilities to engage in the arts, whilst individuals with poorer mental health also described experiencing more barriers affecting their motivations to engage. Individuals of lower SES reported more barriers in terms of opportunities to engage, whilst loneliness was related to more barriers around opportunities and motivations and living alone was associated with more opportunity barriers. Interestingly, adults who were older experienced fewer barriers relating to capabilities or opportunities, as did men, whilst being of white ethnicity was associated with fewer barriers across all three domains. Adults who were more socially engaged or who had poorer physical health experienced fewer barriers relating to motivations. Geographical area of dwelling was not related to any barriers. CONCLUSIONS:This study has shown for the first time where the barriers leading to differential patterns of arts engagement lie. The findings could inform future behaviour change interventions designed to encourage arts engagement amongst individuals who are least likely to engage.
Project description:Involving groups of community stakeholders (e.g., steering committees) to lead community-wide health interventions appears to support multiple outcomes ranging from policy and systems change to individual biology. While numerous tools are available to measure stakeholder characteristics, many lack detail on reliability and validity, are not context specific, and may not be sensitive enough to capture change over time. This study describes the development and reliability of a novel survey to measure Stakeholder-driven Community Diffusion via assessment of stakeholders' social networks, knowledge, and engagement about childhood obesity prevention.This study was completed in three phases. Phase 1 included conceptualization and online survey development through literature reviews and expert input. Phase 2 included a retrospective study with stakeholders from two completed whole-of-community interventions. Between May-October 2015, 21 stakeholders from the Shape Up Somerville and Romp & Chomp interventions recalled their social networks, knowledge, and engagement pre-post intervention. We also assessed one-week test-retest reliability of knowledge and engagement survey modules among Shape Up Somerville respondents. Phase 3 included survey modifications and a second prospective reliability assessment. Test-retest reliability was assessed in May 2016 among 13 stakeholders involved in ongoing interventions in Victoria, Australia.In Phase 1, we developed a survey with 7, 20 and 50 items for the social networks, knowledge, and engagement survey modules, respectively. In the Phase 2 retrospective study, Shape Up Somerville and Romp & Chomp networks included 99 and 54 individuals. Pre-post Shape Up Somerville and Romp & Chomp mean knowledge scores increased by 3.5 points (95% CI: 0.35-6.72) and (-?0.42-7.42). Engagement scores did not change significantly (Shape Up Somerville: 1.1 points (-?0.55-2.73); Romp & Chomp: 0.7 points (-?0.43-1.73)). Intraclass correlation coefficients (ICCs) for knowledge and engagement were 0.88 (0.67-0.97) and 0.97 (0.89-0.99). In Phase 3, the modified knowledge and engagement survey modules included 18 and 25 items, respectively. Knowledge and engagement ICCs were 0.84 (0.62-0.95) and 0.58 (0.23-0.86).The survey measures upstream stakeholder properties-social networks, knowledge, and engagement-with good test-retest reliability. Future research related to Stakeholder-driven Community Diffusion should focus on prospective change and survey validation for intervention effectiveness.
Project description:PURPOSE:Reducing the spread of infection during the COVID-19 pandemic prompted recommendations for individuals to socially distance. Little is known about the extent to which youth are socially distancing, what motivations underlie their social distancing, and how these motivations are connected with amount of social distancing, mental health, and social health. Using a large sample of adolescents from across the United States, this study examined adolescents' motivations for social distancing, their engagement in social distancing, and their mental and social health. METHODS:Data were collected on March 29th and 30th, 2020, two weeks after COVID-19 was declared a national emergency in the United States. The sample consisted of 683 adolescents recruited using social media. A series of multiple linear regressions examined unique associations among adolescents' motivations to engage in social distancing, perceived amount of social distancing, anxiety symptoms, depressive symptoms, burdensomeness, and belongingness. RESULTS:Almost all respondents (98.1%) reported engaging in at least a little social distancing. The most commonly reported motivations for social distancing concerned social responsibility and not wanting others to get sick. Motivations concerning state or city lockdowns, parental rules, and social responsibility were associated with greater social distancing, whereas motivations concerning no alternatives were associated with less social distancing. Specific motivations for social distancing were differentially associated with adolescents' anxiety symptoms, depressive symptoms, burdensomeness, and belongingness. CONCLUSIONS:Understanding adolescents' motivations to engage in social distancing may inform strategies to increase social distancing engagement, reduce pathogen transmission, and identify individual differences in mental and social health during the COVID-19 pandemic.
Project description:BACKGROUND:There is a large literature on the health benefits of engagement with the arts. However, there are also well-recognised challenges in ensuring equity of engagement with these activities. Specifically, it remains unclear whether individuals with poor mental health experience more barriers to participation. This study used a behaviour change framework to explore barriers to engagement in participatory arts activities amongst people with either depression or anxiety. METHODS:Data were drawn from a large citizen science experiment focused on participation in creative activities. Participants who reported engaging infrequently in performing arts, visual arts, design and crafts, literature-related activities, and online, digital and electronic arts were included and categorised into no mental health problems (n?=?1851), depression but not anxiety (n?=?873) and anxiety but not depression (n?=?808). Barriers and enablers to engagement were measured using an 18-item scale based on the COM-B Self-Evaluation Questionnaire, with subscales assessing psychological and physical capabilities, social and physical opportunities, and automatic and reflective motivations. Logistic regression analyses were used to identify whether individuals with either depression or anxiety reported greater barriers across any of the six domains than individuals without any mental health problems. Where differences were found, we calculated the percentage of protective association explained by various demographic, socio-economic, social, physical or geographical factors. RESULTS:Individuals with depression and anxiety felt they would be more likely to engage in arts activities if they had greater psychological and physical capabilities, more social opportunities, and stronger automatic and reflective motivations to engage. However, they did not feel that more physical opportunities would affect their engagement. Covariates explained only 8-37% of the difference in response amongst those with and without anxiety and depression. CONCLUSIONS:Findings suggest that for individuals with poor mental health, there are certain barriers to participation that are not felt as strongly by those without any mental health problems. Mapping the behaviour change domains to potential interventions, activities that focus on increasing perceived capabilities, providing social opportunities, and reinforcing both automatic and reflective motivations to engage has the potential to help to redress the imbalance in arts participation amongst those with poor mental health.
Project description:The Patient Health Engagement Scale (PHE-s) was designed to assess the emotional and psychological attitudes of patients' engagement along their healthcare management journey. The aim of this study was to validate a culturally adapted Chinese version of the PHE-s (CPHE-s). Three hundred and seventy-seven participants were recruited from eight community health centers in a sample of patients with chronic disease in Hunan Province, China. The original Italian PHE-s was translated into Mandarin Chinese using a standardized forward-backward translation. The Rasch model was utilized and presented uni-dimensionality and good items fitness of the PHE-s. The internal consistency was 0.89 and the weighted Kappa coefficients of the items (test-retest reliability) ranged from 0.52 to 0.79. Both principal component analysis and confirmatory factor analysis supported a single-factor structure of the PHE-s. In testing the external validity, the PHE-s showed a significant moderate correlation with patient activation but not with medicine adherence behavior, which requires further exploration. The result suggested that the PHE-s is a reliable and valid instrument to assess the level of patient engagement in his or her own health management among chronic patients in China. Further analysis of reliability and validity should be assessed among other patient cohorts in China, and future directions for testing changes after patient engagement interventions should be developed by exploring some clinical relevance.
Project description:OBJECTIVES:Task characteristics can alter motivation. Understanding how individuals respond to these characteristics is important in understanding how to adapt tasks to increase engagement of individuals with mental health problems. We describe the development of a self-report questionnaire quantifying individual differences in task-related motivation-The Child and Adolescent Motivational Profile (CHAMP). We explore the association with externalizing/internalizing problems. METHODS:A 64-item prototype scale was designed to measure how children and adolescents perceive the motivational significance of a range of task characteristics (n = 688; age range: 8-16 years). Parents completed the "Strengths and Difficulties Questionnaire" measuring externalizing and internalizing problems (Van Widenfelt, Goedhart, Treffers & Goodman, 2003). RESULTS:Exploratory factor analysis identified eight distinct task characteristics that affected motivation: (a) requiring focus, (b) predictable, (c) marked/graded, (d) rewarded, (e) socially evaluated, (f) cognitively challenging, (g) competitive, and (h) collaborative. A 32-item scale based on these factors was constructed. Internal consistency of each factor was high (Cronbach's alpha: .79-.91), and test-retest reliability was acceptable (SBC = .43-.65). Externalizing and internalizing problems were associated with a distinct motivational profile. CONCLUSION:These results highlight the multidimensional nature of children and adolescents' task-related motivation for tasks and the differential links to internalizing and externalizing problems.
Project description:Mindfulness has emerged as a potential motivator for sustainable lifestyles, yet few studies provide insight into the relationship between mindfulness practice levels and individual engagement in pro-environmental behaviors. We also lack information about the significance of meditators' behavioral differences in terms of their measurable environmental impact and the motivational processes underlying these differences in pro-environmental performance. We classified 300 individuals in three groups with varying meditation experience and compared their pro-environmental motivations and levels of animal protein consumption. Exceeding prior attempts to compare high-impact behaviors of mindfulness practitioners and non-practitioners, we created the most detailed classification of practice engagement by assessing frequency, experience and type of meditation practice. This nuanced view on mindfulness practice reveals that advanced meditators, who reported high levels of connectedness with nature (CWN), subjective happiness and dispositional mindfulness showed significantly more concern for the environment. They also demonstrated the lowest levels of greenhouse gas emissions, land occupation and water use related to their animal-protein consumption. This study is the first to follow a self-determination theory perspective to deepen our understanding of the motivational differences between meditator groups. We revealed that advanced meditators reported significantly more integrated motivation toward the environment than non-meditators. We also provided preliminary evidence for a new theoretical framework suggesting that experiential strategies such as mindfulness practices could strengthen the relational pathway of pro-environmental behaviors. Using sequential mediation analysis, we confirmed that the negative effect of mindful compassion practice on greenhouse gas emissions from animal-protein consumption is partially mediated by CWN and integrated motivation toward the environment. While our study does not support assumptions of causality, it shows that much can be learned by studying the motivations of advanced meditators for maintaining high levels of pro-environmental behavior.