Study On Influence Factors And Mechanism Of Patient Engagement In Healthcare

Objective: In recent years,it is increasingly recognized that patients' rational and meaningful engagement in healthcare could make important contributions to their health care and safety management.However,recent evidence indicated that patients' actual roles in healthcare didn't match their desired roles,and many patients reported a less active role than desired,which suggested that patient engagement in healthcare may be influenced by various factors.Consequently,this study aimed to analyze influencing factors on patient engagement and explore the influence mechanism,which will be expected to contribute to the strategy development of patient engagement in healthcare.Methods: On the basic of analyzing the literature and theory study,the research framework was developed.And then three small researches were followed accordingly.1.The introduction and revision of the influencing factors related scale: By extensive literature review,we introduced two related scales for measuring patient engagement influencing factors: All Aspects of Health Literacy Scale(AAHLS)and Facilitation of Patient Involvement Scale(FPI).The scales were translated into Chinese using a standard procedure of double-back translation and cross-cultural adaption.The reliability and validity of the Chinese version scales were tested in over 600 Chinese patients.2.The revision of the behavior and willness of patient engagement in healthcare questionnaire:Based on the literature review and previous research by our team,the prototype of questionnaire was formed.Questionnaire structure dimensions and the items had been consulted and revised by a panel meeting with 7 experts and pilot survey with a sample of 364 patients..3.The cross-sectional survey and analysis of influencing factors on patient engagement in healthcare:According to the research framework,a cross-sectional survey was employed using the behavior and willness of patient engagement in healthcare questionnaire,Chinese version AAHLS and FPI,and other influencing factor related scales.A convenience sample of 514 patients was recruited from 8 general hospitals in Shanghai,Jiangsu Province and Zhejiang Province.Results: 1.(1)The Chinese version of AAHLS consisted of 11 items.Three factors were extracted by factor analysis which could explain 61.275%of the total variance.Confirmatory factor analysis confirmed a 11-item,three-factor model that well fitted the data from the Chinese version AAHLS.The content validity index was 0.943,the Cronbach's ?coefficient was 0.811,and the test-retest reliability coefficient was 0.853.(2)The Chinese version of FPI consisted of 9 items.Exploratory factor analysis revealed a single factor structural model,which could explain 52.896%of the total variance.The content validity index was 0.931,the Cronbach's? for internal consistency was 0.885,and the test-retest reliability coefficient was 0.877.2.The behavior and willness of patient engagement in healthcare questionnaire consisted of 33 items.Exploratory factor analysis revealed a six factor structural model,which could explain 67.155% of the total variance.The content validity index was 0.935,the Cronbach's? for internal consistency was 0.928,0.943,and the test-retest reliability coefficient was 0.882,0.962.3.The results of the cross-sectional survey indicated that:(1)the mean score for the patient engagement behavior was(4.146±0.496),and the mean score for the willingness was(4.387±0.459).The level of patient engagement behavior was inferior to their willingness to be involved in healthcare(t=14.928,P<0.01).Significant differences were found among all dimensions of patient engagement behavior and its willingness(?2=804.675,P<0.01;?2=689.407,P<0.01).(2)The regression analysis showed that patient engagement behavior was influenced by the willingness of engagement,patients' trust in physicians,patients' perception of physician facilitation of patient engagement.The patients' willingness of engagement was influenced by patient attitude toward engagement,patients' perception of physician facilitation,health literacy,the rank of hospital and social support.(3)The influencing mechanism model of patient engagement in healthcare was constructed by the path analysis.The path analysis revealed that patient attitude toward engagement,patients' perception of physician facilitation of patient engagement and health literacy played direct prediction on the patients' willingness of engagement,and standard estimated values of path coefficient were 0.341,0.199,0.291,respectively.Patients' trust in physician and the willingness of engagement played direct prediction on the patient engagement,and standard estimated values of path coefficient were 0.211,0.641,respectively.Patient attitude toward engagement,patients' perception of physician facilitation and health literacy played indirect prediction on patient engagement,and standard estimated values of path coefficient were 0.219,0.128,0.187,respectively.Conclusions:(1)The Chinese version of AAHLS and FPI have good reliability and validity.They can be used for measuring health literacy of patients and patients' perception of physician facilitation of patient engagement.(2)The behavior and willness of patient engagement in healthcare questionnaire proved to be good reliability and validity.(3)Patients were willing to be involved in healthcare while it emerged discrepancy of preference when it comes to different contents.The influencing mechanism model of patient engagement in healthcare was constructed.Patient attitude toward engagement,patients' perception of physician facilitation of engagement and health literacy posed indirect positive influence on patient engagement through the patients' willingness of engagement.Patients' trust in physician and the willingness of engagement had direct positive influence on the patient engagement.Patient attitude toward engagement,patients' perception of physician facilitation of engagement and health literacy were the factors influencing the patients' willingness of engagement.The results of this study provided valuable evidence on guiding the development of strategies for promoting patient rational and meaningful engagement in healthcare.