| BackgroundChronic illness is reported to be the main cause of mortality worldwide,and the prevalence of chronic illness continues to rise.Meanwhile,it makes up the biggest burden of disease in either developed or developing countries.With recent global emphasis on patient engagement in chronic illness self-management,focus has been placed on patient empowerment as a way to improve the patient experience and decrease the burden of chronic illness care.The majority of published and translated Chinese versions of instruments for measuring empowerment measure empowerment outcomes,rather than empowerment process.Jerofke and Weiss developed Patient Perceptions of Patient-Empowering Nurse Behaviours Scale(PPPNBS)in 2016 for the evaluation of patient perceptions of the process of empowerment while hospitalized.There is evidence that the original English version of PPPNBS has satisfactory reliability and validity.Nevertheless,there is no reliability and validity study,as well as the application report on PPPNBS in China.And mostly,researches concerning the empowerment are theoretical elaborations and empirical interventions,lacking the exploration on the influencing factors of empowerment and the effect and mechanism of empowerment on outcome indicators.Objective1.To translate the original English version of Patient Perceptions of Patient-Empowering Nurse Behaviours Scale(PPPNBS)into Chinese,and to psychometrically test the Chinese version of PPPNBS in hospitalized patients with chronic illnesses,so as to form a suitable instrument measuring empowerment process for Chinese culture.2.To investigate the status quo and influencing factors of perceptions of empowerment process during hospitalization among hospitalized patients with chronic illnesses.3.To understand the present self-efficacy and patient activation among hospitalized patients with chronic illnesses.4.To analyze the relationship and influencing mechanism among perceptions of empowerment process,self-efficacy and patient activation among hospitalized patients with chronic illnesses.Methods1.After being authorized by the original author,the Chinese version of PPPNBS was preliminary formed through the process of translation,back-translation,expert committee review and pilot test.Then the scale was evaluated by content validity,exploratory factor analysis(EFA),confirmatory factor analysis(CFA),convergent validity,internal consistency and test-retest reliability,and finally the revised Chinese version of PPPNBS was formed.2.Using convenient sampling method,a total of 485 chronically ill inpatients from two tertiary comprehensive hospitals in Guangzhou were investigated with the demographic questionnaire,Patient Perceptions of Patient-Empowering Nurse Behaviours Scale(PPPNBS),Chronic Disease Self-Efficacy Scale(CDSES)and Patient Activation Measure(PAM)on the day of discharge.Results1.The revised Chinese version of PPPNBS contains 35 items.The content validity index of scale(S-CVI)was yielded as 0.94,and the content validity index of each item(I-CVI)ranged from 0.83-1.00.EFA identified 6 dimensions explaining 68.56%of the total variance.Each item had a high factor loading(>0.4)on one of the factors without cross-loading items.Goodness-of-fit indices in CFA met the criteria,which confirmed the newly proposed six-factor structure.The score of the revised Chinese version of PPPNBS was significantly,positively correlated with that of the Client Satisfaction Questionnaire(r=0.68,P<0.01),as was the Chronic Disease Self-Efficacy Scale score(r=0.32,P<0.01).Cronbach's alpha coefficient was 0.960 for the total scale and 0.840-0.915 for the subscales.The test-retest reliability of the scale was 0.86.2.The item mean of the revised Chinese version of PPPNBS was 5.26±1.45.Among the six dimensions,the dimension of Developing formal power systems had the highest score of 6.50±1.49.While the dimension of Resources and opportunities had the lowest score of 4.42±1.76.The multiple linear regression analysis revealed that the educational level,time since diagnosis,way of care-giving and marital status were the significant influencing factors.3.The total mean score of CDSES and PAM was 6.25±1.79 and 52.24±11.95.Perceptions of empowerment process could positively predict self-efficacy(?=0.402,P<0.01)and patient activation(?=0.169,P<0.01).Self-efficacy could also positively predict patient activation ?=0.887,P<0.01).And self-efficacy,of which the effect accounted for 67,87%of the total effect,played a partial intermediary role between perceptions of empowerment process and patient activation.Conclusions1.The study results provide evidence supporting the validity and reliability of the revised Chinese version of PPPNBS.It can be applied to hospitalized patients with chronic illnesses as a metric of the patient perceptions of empowerment process.2.Hospitalized patients with chronic illnesses reported low perceptions of empowerment process,especially in the aspect of resources and opportunities.Nurses should grasp the scientific connotation of empowerment and promote the harmonious interactions with patients.And nurses should focus on tailoring their patient-empowering behaviours to patients'specific conditions.A consequence of item reduction due to scale adjustments may be improved clinical practicability and feasibility in Chinese clinical context.3.The level of self-efficacy and activation of hospitalized patients with chronic illnesses in China still needs to be improved.Perceptions of empowerment process,self-efficacy and patient activation mutually affect and promote each other.Perceptions of empowerment process could directly affect the activation level of hospitalized patients with chronic diseases,but mostly it indirectly affected patient activation through the mediation of self-efficacy.To improve patient activation,empowerment and self-efficacy should be both emphasized and applied by the nurses,so that patients can move smoothly from a care receiver before discharge to one of self-management after discharge. |
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