Patient Participation and the Environment: A Scoping Review of Instruments

Abstract

Patient participation and the environment are critical factors in achieving qualitative healthcare. We conducted a systematic scoping review using Arksey and O’Malley’s framework to identify instruments intended to measure patient participation. We assessed those instruments’ characteristics, which areas of the healthcare continuum they target, and whether environmental factors are considered. Instruments were considered eligible if they represented the patient perspective and measured patient participation in healthcare. The search was limited to articles written in English and published in the last 10 years. We extracted concepts (i.e., patient empowerment, patient participation, and patient-centeredness) based on the framework developed by Castro et al. and outcomes of significance regarding the review questions and specific objectives. The search was conducted in PsycINFO, CINHAL/EBSCO, and PubMed in September 2019 and July 2020. Of 4802 potential titles, 67 studies reported on a total of 45 instruments that met the inclusion criteria for this review. The concept of patient participation was represented most often in these studies. Although some considered the social environment, no instrument was found to incorporate and address the physical environment. Thirteen instruments were generic and the remaining instruments were intended for specific diagnoses or healthcare contexts. Our work is the first to study instruments from this perspective, and we conclude that there is a lack of instruments that measure aspects of the social and physical environment coherently as part of patient participation.

Patient activation in adults with visual impairment: a study of related factors

“…The model prioritizes patients as the focal point of the system and employs patient-centered outcome research theory to elucidate how individualized patient activation and empowerment may be achieved [76]. Furthermore, the environment encompasses a wide range of elements that might either impede or facilitate patients' engagement, performance, and entitlement to preserve their dignity [77]. For example, the International Classification of Functioning, Disability, and Health (ICF) defines environmental factors as "those that constitute the physical, social, and behavioral environment in which people live and lead their lives.…”

“…The impact of the environment on an individual's life and ability to function depends on the degree of support or demand (e.g., accessibility, usability) that the physical environment may have [78]. For example, person-environment adaptation theories explain that the adequacy of the fit between a person's functional abilities and their environment can affect a person's level of independence, participation, and overall health and well-being [77]. In our research, it was seen that patient activation levels of clients with vision loss were related to the environment sub-dimension of quality of life and that the environment was an effective factor in the established regression model.…”

Housing Accessibility at Home and Rehabilitation Outcomes After a Stroke: An Explorative Study

“…The physical home environment is seldom considered, and it might be easier to address environmental factors when the practitioners meet the person at home when they can observe the environment as the person moves around and performs daily activities ( Kylén et al, 2021 ). However, a recent review of instruments aiming to measure patient participation in healthcare ( Kylén et al, 2022 ) revealed that few reflected participation and environmental aspects. In fact, the authors did not find a single patient reported instrument that incorporated the physical home environment as part of patient participation.…”