Patient activation and health literacy as predictors of health information use in a general sample of Dutch health care consumers.

In demand-led health care systems, consumers are expected to play an informed, active role in health care decisions by making use of health information. The ability to seek and use this information depends on specific knowledge, skills, and self-confidence. In this study, the authors validated a translated instrument to measure patient activation (Dutch PAM-13) in a general sample of Dutch health care consumers. Furthermore, the authors examined the relative contribution of patient activation and functional health literacy to the seeking and use of health information in The Netherlands. The mean patient activation score in the Dutch sample was higher for younger health care consumers and for those with a higher education, higher income, and better self-reported general and mental health status. More activated consumers were more likely to seek and use health information. Patient activation proved to be a stronger predictor for seeking and using health information than functional health literacy.

The relative effect of health literacy and patient activation on provider choice in the Netherlands.

Active provider choice by patients has become an important policy theme in western, countries over the last decades. However, not many patients and consumers exercise their right to, choose. Both health literacy and patient activation are likely to have an impact on the choice process. In, this article the relative effect of health literacy and patient activation on provider choice in the, Netherlands is studied. A questionnaire was sent to a representative sample of 2000 Dutch citizens. The questionnaire, included a measure of functional health literacy, the Dutch version of the Patient Activation Measure, and questions assessing active provider choice, reasons not to engage in it and other ways of provider, selection. The majority of respondents (59.6%) would not search for information on the basis of which they, could select the best provider or hospital. Most people rely on their general practitioner's advice. Both, low literacy and lower patient activation levels were negatively associated with active provider choice. In a regression analysis gender, education and patient activation proved the most important, predictors. The policy focus on active provider choice might result in inequity, with men, less educated, and less activated people being at a disadvantage.

Measuring patient activation in The Netherlands: translation and validation of the American short form Patient Activation Measure (PAM13).

BACKGROUND: The American short form Patient Activation Measure (PAM) is a 13-item instrument which assesses patient (or consumer) self-reported knowledge, skills and confidence for self-management of one's health or chronic condition. In this study the PAM was translated into a Dutch version; psychometric properties of the Dutch version were established and the instrument was validated in a panel of chronically ill patients. METHODS: The translation was done according to WHO guidelines. The PAM 13-Dutch was sent to 4178 members of the Dutch National Panel of people with Chronic illness or Disability (NPCD) in April 2010 (study A) and again to a sub sample of this group (N = 973) in June 2010 (study B). Internal consistency, test-retest reliability and cross-validation with the SBSQ-D (a measure for Health literacy) were computed. The Dutch results were compared to similar Danish and American data. RESULTS: The psychometric properties of the PAM 13-Dutch were generally good. The level of internal consistency is good (α = 0.88) and item-rest correlations are moderate to strong. The Dutch mean PAM score (61.3) is comparable to the American (61.9) and lower than the Danish (64.2). The test-retest reliability was moderate. The association with Health literacy was weak to moderate. CONCLUSIONS: The PAM-13 Dutch is a reliable instrument to measure patient activation. More research is needed into the validity of the Patient Activation Measure, especially with respect to a more comprehensive measure of Health literacy.

Educational inequalities in patient-centred care: patients' preferences and experiences.

BACKGROUND: Educational attainment is strongly related to specific health outcomes. The pathway in which individual patient-provider interactions contribute to (re)producing these inequalities has yet to be studied. In this article, the focus is on differences between less and more highly educated patients in their preferences for and experiences with patient-centred care., e.g. shared decision making, receiving understandable explanations and being able to ask questions. METHODS: Data are derived from several Consumer Quality-index (CQ-index) studies. The CQ-index is a family of standardized instruments which are used in the Netherlands to measure quality of care from the patient's perspective. RESULTS: The educational level of patients is directly related to the degree of importance patients attribute to specific aspects of patient-centred care. It has a minor influence on the experienced level of shared decision making, but not on experiences regarding other aspects of patient-centred care. CONCLUSIONS: All patients regard patient-centred care as important and report positive experiences. However, there is a discrepancy between patient preferences for patient-centred care on one hand and the care received on the other. Less educated patients might receive 'too much', and more highly educated patients 'too little' in the domains of communication, information and shared decision making.

The quality of radiation care: the results of focus group interviews and concept mapping to explore the patient's perspective.

BACKGROUND AND PURPOSE: In this study, we explore the quality aspects of radiation care from the patient's perspective in order to develop a draft Consumer Quality Index (CQI) Radiation Care instrument. MATERIALS AND METHODS: Four focus group discussions with (former) cancer patients were held to explore the aspects determining the quality of radiation care. The list of aspects generated was categorised based on similarity and importance in a concept mapping procedure. RESULTS: Four focus group discussions revealed seven main themes related to the quality of radiation care: information provision, a patient-centred approach, professional competence, planning and waiting times, accessibility, cooperation and communication, and follow-up care. Results of concept mapping procedures revealed which items the patients considered to be most important. A radiation oncologist who is up to date about the patient's file is of paramount importance for cancer patients receiving radiotherapy. CONCLUSIONS: The quality aspects found through focus group discussions provided useful insight into how patients experience radiation care. Furthermore, concept mapping made these results more solid. To evaluate the quality of radiation care from the patient's perspective, these quality aspects will be guiding in the development of a CQI Radiation Care.