A systematic review of reliable and valid tools for the measurement of patient participation in healthcare

INTRODUCTION: Patient participation in healthcare is recognised internationally as essential for consumer-centric, high-quality healthcare delivery. Its measurement as part of continuous quality improvement requires development of agreed standards and measurable indicators. AIM: This systematic review sought to identify strategies to measure patient participation in healthcare and to report their reliability and validity. In the context of this review, patient participation was constructed as shared decision-making, acknowledging the patient as having critical knowledge regarding their own health and care needs and promoting self-care/autonomy. METHODS: Following a comprehensive search, studies reporting reliability or validity of an instrument used in a healthcare setting to measure patient participation, published in English between January 2004 and March 2014 were eligible for inclusion. RESULTS: From an initial search, which identified 1582 studies, 156 studies were retrieved and screened against inclusion criteria. Thirty-three studies reporting 24 patient participation measurement tools met inclusion criteria, and were critically appraised. The majority of studies were descriptive psychometric studies using prospective, cross-sectional designs. Almost all the tools completed by patients, family caregivers, observers or more than one stakeholder focused on aspects of patient-professional communication. Few tools designed for completion by patients or family caregivers provided valid and reliable measures of patient participation. There was low correlation between many of the tools and other measures of patient satisfaction. CONCLUSION: Few reliable and valid tools for measurement of patient participation in healthcare have been recently developed. Of those reported in this review, the dyadic Observing Patient Involvement in Decision Making (dyadic-OPTION) tool presents the most promise for measuring core components of patient participation. There remains a need for further study into valid, reliable and feasible strategies for measuring patient participation as part of continuous quality improvement.

Nurses' views of patient participation in nursing care

AIMS: To explore nurses' views of patient participation in nursing care on medical wards. BACKGROUND: Nurses have frequent contact with patients, highlighting their potential role in enabling patient participation. However, some nurses' actions and attitudes act as barriers, failing to achieve core requirements of patient participation. Discovering nurses' views may assist in developing strategies to encourage patient participation in hospitals. DESIGN: Interpretive study. METHODS: Twenty nurses were recruited from four medical wards, located in two Australian hospitals. In-depth semi-structured interviews were conducted between November 2013-March 2014 and analysed using content analysis. FINDINGS: Five categories emerged from the nurses' views. The first category, acknowledging patients as partners, showed nurses respected patients as legitimate participants. In the second category, managing risk, nurses emphasized the need to monitor participation to ensure rules and patient safety were maintained. Enabling participation was the third category, which demonstrated nurses' strategies that enhanced patients' participation. The fourth category was hindering participation; encapsulating nurses' difficulty in engaging patients with certain characteristics. In the final category, realizing participation, nurses believed patients could be involved in physical activities or clinical communication. CONCLUSION: Nurses have a crucial role in promoting patient participation. Through acknowledging and enabling participation, nurses may facilitate patient participation in a range of nursing activities. The nurse's role in enacting participation is complex, having to accommodate each patient's risks and characteristics, highlighting the need for good assessment skills. Education, policy and research strategies are essential to foster nurses' pivotal role in patient participation.

Transition to retirement and participation in mainstream community groups using active mentoring: a feasibility and outcomes evaluation with a matched comparison group

BACKGROUND: This paper reports on the feasibility and outcomes of a transition to retirement programme for older adults with disability. Without activities and social inclusion, retirees with disability are likely to face inactivity, isolation and loneliness. METHODS: Matched intervention and comparison groups each consisted of 29 older individuals with disability. There were 42 men and 16 women with a mean age of 55.6 years While attending their individual mainstream community group 1 day per week, intervention group participants received support from community group members trained as mentors. We assessed participants' loneliness, social satisfaction, depression, life events, quality of life, community participation, social contacts, and work hours before and 6 months after joining a community group. RESULTS: Twenty-five (86%) of the intervention group attended their community group weekly for at least 6 months. They increased their community participation, made an average of four new social contacts and decreased their work hours. Intervention participants were more socially satisfied post-intervention than comparison group members. CONCLUSIONS: The results demonstrate that participation in mainstream community groups with support from trained mentors is a viable option for developing a retirement lifestyle for older individuals with disability.

Entrepreneurs, organizational members, political participation and preferential treatment: Evidence from China

Drawing on survey data from 150 small and medium-sized Chinese enterprises, this article examines whether the political participation of entrepreneurs and other members of the firm improves the chances of obtaining preferential treatment from government authorities. Entrepreneurs that

Contribution of the after-school period to children’s daily participation in physical activity and sedentary behaviours

Objectives: Children’s after-school physical activity (PA) and sedentary behaviours (SB) are not well understood, despite the potential this period holds for intervention. This study aimed to describe children’s after-school physical activity and sedentary behaviours; establish the contribution this makes to daily participation and to achieving physical activity and sedentary behaviours guidelines; and to determine the association between after-school moderate- to vigorous-intensity physical activity (MVPA), screen-based sedentary behaviours and achieving the physical activity and sedentary behaviour guidelines.Methods: Children (n=406, mean age 8.1 years, 58% girls) wore an ActiGraph GT3X accelerometer. The percentage of time and minutes spent sedentary (SED), in light- physical activity (LPA) and MVPA between the end-of-school and 6pm (weekdays) was calculated. Parents (n=318, 40 years, 89% female) proxy-reported their child’s after-school participation in screen-based sedentary behaviours. The contribution that after-school SED, LPA, MVPA, and screen-based sedentary behaviours made to daily levels, and that after-school MVPA and screen-based sedentary behaviours made to achieving the physical activity/sedentary behaviour guidelines was calculated. Regression analysis determined the association between after-school MVPA and screen-based sedentary behaviours and achieving the physical activity/sedentary behaviours guidelines.Results: Children spent 54% of the after-school period SED and this accounted for 21% of children’s daily SED levels. Boys spent a greater percentage of time in MVPA than girls (14.9% vs. 13.6%; p<0.05) but this made a smaller contribution to their daily levels (27.6% vs 29.8%; p<0.05). After school, boys and girls respectively performed 18.8 minutes and 16.7 minutes of MVPA which is 31.4% and 27.8% of the MVPA (p<0.05) required to achieve the physical activity guidelines. Children spent 96 minutes in screen-based sedentary behaviours, contributing to 84% of their daily screen-based sedentary behaviours and 80% of the sedentary behaviour guidelines. After-school MVPA was positively associated with achieving the physical activity guidelines (OR: 1.31, 95%CI 1.18, 1.44, p<0.05) and after-school screen-based sedentary behaviours was negatively associated with achieving the sedentary behaviours guidelines (OR: 0.97, 95%CI: 0.96, 0.97, p<0.05).Conclusions: The after-school period plays a critical role in the accumulation of children’s physical activity and sedentary behaviours. Small changes to after school behaviours can have large impacts on children’s daily behaviours levels and likelihood of meeting the recommended levels of physical activity and sedentary behaviour. Therefore interventions should target reducing after-school sedentary behaviours and increasing physical activity.

Association between participation in outpatient cardiac rehabilitation and self-reported receipt of lifestyle advice from a healthcare provider: results of a population-based cross-sectional survey

We test the hypothesis that the odds of self-reported receipt of lifestyle advice from a health care provider will be lower among outpatient cardiac rehabilitation (OCR) nonattendees and nonreferred patients compared to OCR attendees. Logistic regression was used to analyse cross-sectional data provided by 65% (4971/7678) of patients aged 20 to 84 years discharged from public hospitals with a diagnosis indicating eligibility for OCR between 2002 and 2007. Among respondents, 71% (3518) and 55% (2724) recalled advice regarding physical activity and diet, respectively, while 88% (592/674) of smokers recalled quit advice. OCR attendance was low: 36% (1764) of respondents reported attending OCR, 11% (552) did not attend following referral, and 45% (2217) did not recall being invited. The odds of recalling advice regarding physical activity and diet were significantly lower among OCR nonattendees compared to attendees (OR 0.34, 95% CI 0.21, 0.56 and OR 0.33, 95% CI 0.25, 0.44, resp.) and among nonreferred respondents compared to OCR attendees (OR 0.10, 95% CI 0.07, 0.15 and OR 0.17, 95% CI 0.14, 0.22, resp.). Patients hospitalised for coronary heart disease should be referred to OCR or a suitable alternative to improve recall of lifestyle advice that will reduce the risk of further coronary events.

The book: production and participation

Purpose – The focus of this paper is on the benefits that may eventuate through new mechanisms of production and distribution. As we enter the twenty-first century, the nature of the book and the structure of the industry which produces it are undergoing radical transformation, as developments in information technology offer new mechanisms for production and distribution. Most of the discussion of these changes is conducted from the perspective of what has been lost through these changes. Design/methodology/approach – This paper reviews the history of the book from the perspective of the disruptive effects of the changes in production technology and impact on the roles involved in production, distribution and reading of books. Darnton’s Communication Circuit is updated to predict future limiting factors and opportunities for participation. Findings – The evolution of the book has seen successive categories of workers involved in book production supplanted by the adoption of new technology. The updated Darnton’s model suggests that the roles involved in the production and distribution of the book will, however, be supplanted in favour of authors and readers of the book in the future. Social implications – The predicted changes will alter the roles of authors and book users. Originality/value – This paper suggests a novel approach to the discussion of the future of book publication and suggests future developments.

The impact of leisure participation on mental health for older people with depression: a systematic review

Aims: This systematic review aimed to discover whether participation in individually chosen leisure activities improved mental health for people aged over 65 who have depression. Methods: Twenty-six potentially relevant studies were identified from an electronic database review. Of these 12 met the inclusion criteria and scope of the review. Results: The current evidence base is relatively small, and includes a diversity of subject groups, subject situations, and study designs. In all cases, participants were either directed to choose from a number of leisure activities, or provided with a pre-designed program that did not allow for individual choice. Conclusion: Currently, there is insufficient evidence available to determine whether participation in individually chosen leisure activities improves mental health for people aged over 65 who have depression.

A critical analysis of screening for skin cancer: participation among older males

 This thesis was a critical examination of participation in skin cancer screening for men over the age of 50 years. This research explored subjective experiences of skin cancer screening, participation in the process, perceptions of skin cancer and factors that influence men’s willingness to undergo skin cancer screening.

A Serious Gaming Approach For Serious Stakeholder Participation

Serious games are a category of games which are designed for a specific purpose other than for pure entertainment. It is not a new concept but serious games using real data, coupled with real time modelling and combining model results with social and economic factors opens up a new paradigm for active stakeholder participation. DHI and UNEP-DHI Centre initiated a project called Aqua Republica where a virtual world is developed which allows participants to develop a river basin and visualise the consequences of their decisions. The aim of this project is to raise awareness of the interconnectivity of water and educate on integrated water resources management. Aqua Republica combines a game layer with a water allocation model, MIKE BASIN, to create an interactive, realistic virtual environment where players play the role of a catchment manager of an undeveloped river catchment. Their main objective is to develop the river catchment to be as prosperous as it can be. To achieve that, they will need to generate a good economy in the catchment to provide the funds needed for development, have a steady food supply for their population and enough energy and water for the catchment. Through these actions by the player, a meaningful play is established to engage players and to educate them about the complex relationships between developmental actions in a river basin and the natural environment as well as their consequences. The game layer also consists of a reward system to encourage learning. People can play and replay the game, get rewarded from performing the right principles and penalised from failures in the game. This abstract will explain the concept of the game and how it has been used in a stakeholder participation environment.

Electoral rules, political competition and fiscal spending: regression discontinuity evidence from brazilian municipalities

We exploit a discontinuity in Brazilian municipal election rules to investigate whether political competition has a causal impact on policy choices. In municipalities with less than 200,000 voters mayors are elected with a plurality of the vote. In municipalities with more than 200,000 voters a run-off election takes place among the top two candidates if neither achieves a majority of the votes. At a first stage, we show that the possibility of runoff increases political competition. At a second stage, we use the discontinuity as a source of exogenous variation to infer causality from political competition to fiscal policy. Our second stage results suggest that political competition induces more investment and less current spending, particularly personnel expenses. Furthermore, the impact of political competition is larger when incumbents can run for reelection, suggesting incentives matter insofar as incumbents can themselves remain in office.

"Os bárbaros estão chegando": o processo de democratização do governo Richa no Paraná

O presente trabalho de pesquisa acadêmica abrange a análise da conjuntura política do processo de transição democrática no Brasil e no Paraná, ocorrida no final da década de 1970 e inícios dos anos 80. No capítulo introdutório examino os elementos teórico-metodológicos, que são as categorias de análise que utilizo no estudo da situação concreta brasileira, como contexto amplo, e da conjuntura das eleiçôes de 1982 e do governo de José Richa no Paraná. Era necessário examinar a concepçâo "ampliada" de Estado, o conceito de estrutura e de superestrutura do bloco histórico e a concepção da vertente da democracia liberal e da vertente da democracia popular, no enfoque da literatura do materialismo histórico-dialético, de autores clássicos e modernos. No segundo capítulo examino o projeto de transição democrática dos generais presidentes Geisel e Figueiredo: um plano dos militares e das elites brasileiras para salvar as elites no poder, na travessia pelo alto. O projeto não ia além da legitimação do regime e do modelo econômico pela passagem do governo militar aos civis, por um processo eleitoral duvidoso. No Paraná, objetivo principal da pesquisa, examino o projeto liberal do governo do PMDB de Richa, desde a organizaçâo partidária, a elaboraçâo das diretrizes de governo, a campanha eleitoral, a participaçâo de intelectuais de ponta na campanha, as alianças do PMDB com os setores populares da sociedade até a composição e a "direitização" do governo. "OS BÁRBAROS ESTÃO CHEGANDO", título principal da dissertação, era a denominação que a aristocracia (elite) curitibana atribuiu a José Richa, quando o mesmo ganhou as eleições ao governo do Paraná, pelo fato de ser do interior do Estado e não fazer parte do mundo civilizado da Curitiba cosmopolita. No terceiro capítulo examino a questão da democratização da escola pública do Estado pela instituição das eleições para diretor e vice-diretor da escola, pelos professores, servidores, alunos e pais de alunos. Digo que a democracia vai além do decreto governamental que estabelece as eleições. Digo ainda que o discurso na prática é outro, no caso do governo Richa e da educação. A questão básica da pesquisa é trabalhar a idéia de que a educação é um campo de disputas e confrontos de classes pela hegemonia do poder, em que a classe dominante luta para manter-se no poder como classe dirigente e as classes subalternas ora se mantém aliadas e como classes auxiliares à classe dominante, ora consentem e raras vezes rebelam-se contra a dominaçâo da classe dirigente.

Three essays on local demand for public services

Local provision of public services has the positive effect of increasing the efficiency because each locality has its idiosyncrasies that determine a particular demand for public services. This dissertation addresses different aspects of the local demand for public goods and services and their relationship with political incentives. The text is divided in three essays. The first essay aims to test the existence of yardstick competition in education spending using panel data from Brazilian municipalities. The essay estimates two-regime spatial Durbin models with time and spatial fixed effects using maximum likelihood, where the regimes represent different electoral and educational accountability institutional settings. First, it is investigated whether the lame duck incumbents tend to engage in less strategic interaction as a result of the impossibility of reelection, which lowers the incentives for them to signal their type (good or bad) to the voters by mimicking their neighbors’ expenditures. Additionally, it is evaluated whether the lack of electorate support faced by the minority governments causes the incumbents to mimic the neighbors’ spending to a greater extent to increase their odds of reelection. Next, the essay estimates the effects of the institutional change introduced by the disclosure on April 2007 of the Basic Education Development Index (known as IDEB) and its goals on the strategic interaction at the municipality level. This institutional change potentially increased the incentives for incumbents to follow the national best practices in an attempt to signal their type to voters, thus reducing the importance of local information spillover. The same model is also tested using school inputs that are believed to improve students’ performance in place of education spending. The results show evidence for yardstick competition in education spending. Spatial auto-correlation is lower among the lame ducks and higher among the incumbents with minority support (a smaller vote margin). In addition, the institutional change introduced by the IDEB reduced the spatial interaction in education spending and input-setting, thus diminishing the importance of local information spillover. The second essay investigates the role played by the geographic distance between the poor and non-poor in the local demand for income redistribution. In particular, the study provides an empirical test of the geographically limited altruism model proposed in Pauly (1973), incorporating the possibility of participation costs associated with the provision of transfers (Van de Wale, 1998). First, the discussion is motivated by allowing for an “iceberg cost” of participation in the programs for the poor individuals in Pauly’s original model. Next, using data from the 2000 Brazilian Census and a panel of municipalities based on the National Household Sample Survey (PNAD) from 2001 to 2007, all the distance-related explanatory variables indicate that an increased proximity between poor and non-poor is associated with better targeting of the programs (demand for redistribution). For instance, a 1-hour increase in the time spent commuting by the poor reduces the targeting by 3.158 percentage points. This result is similar to that of Ashworth, Heyndels and Smolders (2002) but is definitely not due to the program leakages. To empirically disentangle participation costs and spatially restricted altruism effects, an additional test is conducted using unique panel data based on the 2004 and 2006 PNAD, which assess the number of benefits and the average benefit value received by beneficiaries. The estimates suggest that both cost and altruism play important roles in targeting determination in Brazil, and thus, in the determination of the demand for redistribution. Lastly, the results indicate that ‘size matters’; i.e., the budget for redistribution has a positive impact on targeting. The third essay aims to empirically test the validity of the median voter model for the Brazilian case. Information on municipalities are obtained from the Population Census and the Brazilian Supreme Electoral Court for the year 2000. First, the median voter demand for local public services is estimated. The bundles of services offered by reelection candidates are identified as the expenditures realized during incumbents’ first term in office. The assumption of perfect information of candidates concerning the median demand is relaxed and a weaker hypothesis, of rational expectation, is imposed. Thus, incumbents make mistakes about the median demand that are referred to as misperception errors. Thus, at a given point in time, incumbents can provide a bundle (given by the amount of expenditures per capita) that differs from median voter’s demand for public services by a multiplicative error term, which is included in the residuals of the demand equation. Next, it is estimated the impact of the module of this misperception error on the electoral performance of incumbents using a selection models. The result suggests that the median voter model is valid for the case of Brazilian municipalities.

How does foreign capital participation affect brazilian companies' performance?: investigation of foreign direct investment's impact on host country

In this dissertation, we investigate the effect of foreign capital participations in Brazilians companies’ performance. To carry out this analysis, we constructed two sets of model based on EBITDA margin and return on equity. Panel data analysis is used to examine the relationship between foreign capital ownership and Brazilian firms’ performance. We construct a cross-section time-series sample of companies listed on the BOVESPA index from 2006 to 2010. Empirical results led us to validate two hypotheses. First, foreign capital participations improve companies’ performance up to a certain level of participation. Then, joint controlled or strategic partnership between a Brazilian company and a foreign investor provide high operating performance.