Why patients decline participation in an intervention to reduce re-hospitalization through patient activation: whom are we missing?

Flink, Maria; Brandberg, Carina; Ekstedt, Mirjam

doi:10.1186/s13063-019-3187-9

Cited by 20 publications

(23 citation statements)

References 24 publications

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“…The reason why more men declined is unknown. This contradicts two previous studies in which there was either no significant gender difference [ 47 ] or more females than males who declined participation [ 48 ]. A majority of the interviews were 25-45 minutes long, and all of them contributed to the depth of the material.…”

Section: Discussioncontrasting

confidence: 99%

Perceptions of Home Telemonitoring Use Among Patients With Chronic Obstructive Pulmonary Disease: Qualitative Study

Lundell

Modig

Holmner

et al. 2020

JMIR Mhealth Uhealth

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Background Chronic obstructive pulmonary disease (COPD) is a major health problem and an economic burden globally. There is growing interest in how electronic health (eHealth) can be used to provide efficient health care. Telemonitoring, where the patient’s health-related data is transmitted to a health care provider, can be used to detect early signs of exacerbations. A successful implementation of telemonitoring systems into clinical practice requires in-depth knowledge of the users’ preferences. Objective The aim of this study was to explore perceptions of the use of a home telemonitoring system among patients with COPD. Methods Semistructured individual interviews were carried out with 8 women and 5 men who were participants in a project aimed at developing and evaluating a telemonitoring system. The web-based telemonitoring system measured pulmonary function, subjective symptoms, and oxygen saturation. Participants were interviewed after having used the system for 2-4 months. Interview transcripts were analyzed with qualitative content analysis. Results The analysis resulted in the theme A transition toward increased control and security and four categories: using with (in)security, affecting technical concern or confidence, providing easy access to health care, and increasing control over the disease. The participants reported various perceptions of using the telemonitoring system. They expressed initial feelings of insecurity, both in terms of operating the system and in terms of their disease. However, the practical management of the telemonitoring system became easier with time; the participants gradually gained confidence and improved their self-management. New technology was perceived as an important complement to existing health care, but the importance of maintaining a human contact in real life or through the telemonitoring system was emphasized. Conclusions This study captured a transition among the participants from being insecure and experiencing technical concerns to acquiring technical confidence and improving disease management. Telemonitoring can be a valuable complement to health care, leading to increased self-knowledge, a sense of security, and improved self-management. Suggestions to improve the further development and implementation of telemonitoring systems include better patient education and the involvement of end users in the technical development process. Additional research is needed, particularly in the design of user-friendly systems, as well as in developing tools to predict which patients are most likely to find the equipment useful, as this may result in increased empowerment, improved quality of life, reduced costs, and a contribution to equity in health.

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Section: Discussioncontrasting

confidence: 99%

Perceptions of Home Telemonitoring Use Among Patients With Chronic Obstructive Pulmonary Disease: Qualitative Study

Lundell

Modig

Holmner

et al. 2020

JMIR Mhealth Uhealth

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“…To our knowledge, few studies have analyzed participation in post-hospitalization physical exercise programs for patient’s receiving care in internal medicine and neurology departments. Further, other studies analyze only qualitative and socioeconomic parameters for older adults’ non-participation [ 44 , 45 ]. The main limitations of this study relate to it being a secondary analysis of an RCT.…”

Section: Discussionmentioning

confidence: 99%

Determinants of participation in a post-hospitalization physical exercise program for older adults

et al. 2020

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Background Older patients often experience a decline in physical function and cognitive status after hospitalization. Although interventions involving physical exercise are effective in improving functional performance, participation in physical exercise interventions among older individuals is low. We aimed to identify factors that contribute to exercise refusal among post-hospitalized older patients. Methods A cross-sectional study of recruitment data from a randomized controlled trial was conducted involving 495 hospitalized people ≥70 years old. Sociodemographic and clinical data were obtained from the Basque Public Health System database. We determined physical function with the Short Physical Performance Battery (SPPB), nutritional status with the Mini-Nutritional Assessment, frailty according to the Fried phenotype criteria, and cognitive function with the Short Portable Mental Status Questionnaire (SPMSQ). Student’s t, Mann-Whitney U, or chi-squared tests were applied for bivariate analysis. Parameters significantly associated with participation were introduced in a logistic multivariate regression model. Results Among the analyzed patients, 88.8% declined participation in the physical exercise program. Multivariate regression revealed that older age (OR: 1.13; 95% CI: 1.07–1.19), poor nutritional status (OR: 0.81; 95% CI: 0.69–0.95), and reduced home accessibility (OR: 0.27; 95% CI: 0.08–0.94) were predictors of participation refusal. Moreover, patients who declined participation had worse performance on the SPPB (P < 0.05) and its tests of balance, leg strength, and walking speed (P < 0.05). No differences were found between groups in other variables. Conclusions This study confirms low participation of older adults in a post-hospitalization physical exercise program. Non-participation was associated with increased age, poor nutritional status, and reduced home accessibility. Our findings support the need for intervention design that accounts for these factors to increase older patient participation in beneficial exercise programs. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12619000093189, (date: January 22, 2019, retrospectively registered).

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“…To our knowledge, few studies have analyzed participation in post-hospitalization physical exercise programs in internal medicine and neurology departments. Further, those studies have usually analyzed qualitative and socioeconomic parameters for older adults' non-participation (12,13). Nonetheless, our study also has some limitations.…”

Section: Participant Characteristicsmentioning

confidence: 89%

“…Deer et al highlighted the importance of identifying potential barriers to developing post-hospitalization interventions (10). Studies exploring older patients' reasons for non-participation in clinical trials have been performed through surveys or interviews without accounting for clinical or functional variables (12,13). Therefore, the first aim of the present study was to identify older adults' reasons for rejecting participation in a physical exercise program after hospital discharge.…”

Section: Introductionmentioning

confidence: 99%

Determinants of Participation in A Post-Hospitalization Physical Exercise Program for Older Adults

Urquiza

Echeverria

Besga

et al. 2020

Preprint

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BACKGROUND: In older patients, functional and cognitive status often decline after hospitalization. Although interventions based on physical exercise can revert these effects, participation in physical exercise interventions is low. This study aimed to identify determinants of refusal to participate in a physical exercise program in post-hospitalized older patients. METHODS: Cross-sectional study of recruitment data from a randomized controlled trial. A total of 509 hospitalized people ≥70 years old participated in this study. Sociodemographic and clinical data were obtained from the Basque Public Health System database. We measured physical function with the Short Physical Performance Battery (SPPB), nutritional status by the Mini-Nutritional Assessment, frailty according to the Fried phenotype criteria, and cognitive function by the Short Portable Mental Status Questionnaire (SPMSQ). Student’s t, Mann-Whitney U or chi-squared tests were applied for bivariate analysis. Parameters significantly associated with participation were introduced in a logistic multivariate regression model. RESULTS: Of evaluated patients, 10.8% declined physical exercise program participation. Multivariate regression revealed that older age (OR: 1.13; 95% CI: 1.06 - 1.18), poor nutritional status (OR: 0.82; 95% CI: 0.69 - 0.96), and worse home accessibility (OR: 0.26; 95% CI: 0.07 - 0.9) were predictors of lower participation. Moreover, patients who declined participation had worse performance in SPPB ( p < 0.05) and its three tests: balance, leg strength and walking speed ( p < 0.05). No differences were found between groups in other variables. CONCLUSIONS: This study confirms low participation of older adults in a post-hospitalization physical exercise program. Non-participation was associated with higher age, poorer nutritional status, and reduced home accessibility. Our findings support the need to design interventions accounting for these determinants to increase older patient participation. TRIAL REGISTRATION: ACTRN12619000093189 (retrospectively registered): Registered January 22, 2019. KEY WORDS Physical exercise, older people, participation, post-hospitalization

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Why patients decline participation in an intervention to reduce re-hospitalization through patient activation: whom are we missing?

Cited by 20 publications

References 24 publications

Perceptions of Home Telemonitoring Use Among Patients With Chronic Obstructive Pulmonary Disease: Qualitative Study

Perceptions of Home Telemonitoring Use Among Patients With Chronic Obstructive Pulmonary Disease: Qualitative Study

Determinants of participation in a post-hospitalization physical exercise program for older adults

Determinants of Participation in A Post-Hospitalization Physical Exercise Program for Older Adults

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