Is patient participation in hypertension care based on patients' preferences? - A cross-sectional study in primary healthcare.

AIM: The purpose of this study was to address the need to improve opportunities for patient participation in their health and health services. This paper reports if and how patients' preferences matched their experiences of participation in treatment for hypertension in primary healthcare, and what factors were linked with having had opportunities for participation that matched one's preferences. METHODS AND RESULTS: A total of 949 adult patients treated for hypertension completed the 4Ps (Patient Preferences for Patient Participation) tool, with which they ranked their preferences for and experiences of patient participation. Descriptive and comparative analyses of 4Ps data were performed to identify patient characteristics associated with preference-based participation.Approximately half of the participants experienced patient participation to the extent that they preferred. Women were more likely to have had less patient participation than their preference compared to men. Women were also more likely to prefer being more engaged in hypertension care than men. There were also marked associations between age and educational level with the extent of participation preferred and experienced, leaving patients younger than or with lower education than the mean in this study with more insufficient conditions for patient participation. CONCLUSION: There is a lack of concurrence between patients' preferences for, and experiences of, patient participation, especially for women. Further efforts to facilitate person-centred engagement are required, along with research on what strategies can overcome human and organisational barriers. REGISTRATION: The PERHIT- trial was registered with ClinicalTrials.gov: NCT03554382.

Effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients living with hypertension - a randomized controlled trial in primary care.

OBJECTIVE: To estimate the effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients with hypertension treated in primary care (compared with standard hypertensive care only). DESIGN: A parallel group, non-blinded, randomized controlled trial, conducted October 2018-February 2021. Besides standard hypertensive care, the intervention group received eight weeks of support via mobile phone to facilitate self-monitoring and self-management, tentatively providing for augmented patient engagement. SETTING: 31 primary healthcare centers in Sweden. SUBJECTS: 949 patients treated for hypertension. MAIN OUTCOME MEASURES: The effects on preference-based patient participation, that is, the match between a patient's preferences for and experiences of patient participation in their health and healthcare. This was measured with the 4Ps (Patient Preferences for Patient Participation) tool at baseline, after 8 weeks, and at 12 months. Data were registered electronically and analyzed with multilevel ordinal regression. RESULTS: At baseline, 43-51% had a complete match between their preferences for and experiences of patient participation. There was an indication of a positive effect by a higher match for 'managing treatment myself' at 8-weeks in the intervention group. Such preference-based participation in their health and healthcare was reversed at 12 months, and no further effects of the intervention on preference-based patient participation persisted after 12 months. CONCLUSION: The interactive web-based support system via mobile phone had a wavering effect on preference-based patient participation. There is a prevailing need to better understand how person-centered patient participation can be facilitated in primary care.

Although patient participation is essential when having a long-term condition, interventions optimizing individuals' engagement have not been fully identified.About half of the patients with hypertension in this study did not experience participation in the manner and extent they preferred.A web-based support system via mobile phone improved some aspects of patient participation in the short- but not long term.Strategies to better identify patients' preferences for patient participation are needed, to evaluate and improve the outcome of care.

Can participation in documentation influence experiences of involvement in care decision-making?

INTRODUCTION: Patients have the right to influence the care they receive, but their wish to participate in care decision-making is unclear. AIM: This study investigates whether participation in nursing documentation influences patient participation in care decision-making, mastery, self-esteem, empowerment and depressive feelings among adult in-patients with chronic disease. MATERIALS AND METHODOLOGY: Adult patients (n=39) with chronic diseases were randomized. The intervention group participated in nursing documentation. Upon departure, patients filled in questionnaires about participation in care decision-making, mastery, self-esteem, empowerment and depressive feelings. RESULTS: The majority of the patients preferred a collaborative or passive role regarding care decision-making. Lack of knowledge was one reason for non-participation. Having been diagnosed more than five years previously meant stronger empowerment. CONCLUSION: It is a challenge for nurses to find strategies to assess patients' wishes regarding participation in care decision-making. Nurses must support patients' knowledge of their disease and empowerment.