Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
BMC Geriatrics
Published in: BMC Geriatrics 1/2017

Open Access 01-12-2017 | Research Article

Assessing the predictive power of psychological empowerment and health literacy for older patients’ participation in health care: a cross-sectional population-based study

Authors: Gabriele Sak, Fabia Rothenfluh, Peter J. Schulz

Published in: BMC Geriatrics | Issue 1/2017

Login to get access

Abstract

Background

Research has confirmed a positive link between patient involvement in decision-making and improvements in health outcomes. The objective of this study was to examine the roles of psychological empowerment and health literacy on the elderly’s willingness to engage in treatment decisions.

Methods

A self-administered questionnaire was completed by a randomly selected sample of Swiss adults aged 65–80 years old (N = 826). Multivariate logistic regression was applied to determine the contribution of health literacy, psychological empowerment, and trust in physician on participants’ preference to be active, collaborative or passive in decision-making.

Results

Most of the survey respondents preferred some participation in dealing with health related decisions (collaborative: 51%, and active: 35.6%). More than two-thirds of the sample was satisfied with their current involvement in medical decision-making (72.7%). Roughly one-fifth (18.8%) wished to attain a more active engagement than currently experienced, and the remainder of the sample preferred the opposite (8.5%). Due to higher reported levels of psychological empowerment and health literacy, Swiss-German seniors significantly preferred and assumed higher participation in medical decisions than Swiss-Italians. Psychological empowerment correlated with older adults’ preferred and perceived involvement in medical decision-making. However, health literacy only predicted actual involvement in the last treatment decision that had to be made, differentiating only the active from the passive involvement group. Additionally, this research showed that health literacy mediated the relationship between psychological empowerment and the actual involvement in the last treatment decision that had to be made by the participant. Trust in physician and age appeared to be barriers to involvement, whereas education served as a facilitator.

Conclusions

As older adults’ health literacy plays a role in individuals’ willingness to attain an active role in health care decision-making, public health efforts should aim at developing programs and appropriate information that facilitate this process, especially for individuals with moderate or lower levels of health literacy. The current investigation showed that adequate health literacy levels are essential (but not sufficient) in order to reach higher rates of participation in the healthcare context. This research complements past evidence by adding knowledge on the psychosocial antecedents, and their combined effects on patients’ involvement in healthcare.
Literature
1.
2.
Ballard-Reisch DS. A model of participative decision making for physician-patient interaction. Health Commun. 1990;2(2):91–104.CrossRef
3.
Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44(5):681–92.CrossRefPubMed
4.
Frosch DL, Kaplan RM. Shared decision making in clinical medicine: past research and future directions. Am J Prev Med. 1999;17(4):285–94.CrossRefPubMed
5.
Xie B. Older adults’ health information wants in the internet age: implications for patient–provider relationships. J Health Commun. 2009;14(6):510–24.CrossRefPubMed
6.
Schulman BA. Active patient orientation and outcomes in hypertensive treatment. Med Care. 1979;17:267–80.CrossRefPubMed
7.
Greenfield S, Kaplan S, Ware JE. Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med. 1985;102(4):520–8.CrossRefPubMed
8.
Golin CE, DiMatteo MR, Gelberg L. The role of patient participation in the doctor visit. Implications for adherence to diabetes care. Diabetes Care. 1996;19(10):1153–64.CrossRefPubMed
9.
Belcher VN, Fried TR, Agostini JV, Tinetti ME. Views of older adults on patient participation in medication-related decision making. J Gen Intern Med. 2006;21(4):298–303.CrossRefPubMedPubMedCentral
10.
Chewning B, Bylund CL, Shah B, Arora NK, Gueguen JA, Makoul G. Patient preferences for shared decisions: a systematic review. Patient Educ Couns. 2012;86(1):9–18.CrossRefPubMed
11.
Degner LF, Kristjanson LJ, Bowman D, Sloan JA, Carriere KC, O’Neil J, Mueller B. Information needs and decisional preferences in women with breast cancer. J Am Med Assoc. 1997;277(18):1485–92.CrossRef
12.
Sutherland HJ, Llewellyn-Thomas HA, Lockwood GA, Tritchler DL, Till JE. Cancer patients: their desire for information and participation in treatment decisions. J R Soc Med. 1989;82(5):260–3.PubMedPubMedCentral
13.
Arora NK, McHorney CA. Patient preferences for medical decision making: who really wants to participate? Med Care. 2000;38(3):335–41.CrossRefPubMed
14.
15.
16.
Davison BJ, Gleave ME, Goldenberg SL, Degner LF, Hoffart D, Berkowitz J. Assessing information and decision preferences of men with prostate cancer and their partners. Cancer Nurs. 2002;25(1):42–9.CrossRefPubMed
17.
Rees C, Bath PA. Information seeking behaviour of women with breast cancer. Oncol Nurs Forum. 2001;28(5):899–907.PubMed
18.
Cassileth BR, Zupkis RV, Sutton-Smith K, March V. Information and participation preferences among cancer patients. Ann Intern Med. 1980;92(6):832–6.CrossRefPubMed
19.
Strull WM, Lo B, Charles G. Do patients want to participate in medical decision making? JAMA. 1984;252(21):2990–4.CrossRefPubMed
20.
Pinquart M, Duberstein PR. Information needs and decision-making processes in older cancer patients. Crit Rev Oncol Hematol. 2004;51(1):69–80.CrossRefPubMed
21.
22.
23.
Deber RB, Kraetschmer N, Irvine J. What role do patients wish to play in treatment decision making? Arch Intern Med. 1996;156(13):1414.CrossRefPubMed
24.
Degner LF, Sloan JA. Decision making during serious illness: what role do patients really want to play? J Clin Epidemiol. 1992;45(9):941–50.CrossRefPubMed
25.
Ende J, Kazis L, Ash A, Moskowitz MA. Measuring patients’ desire for autonomy: decision making and information-seeking preferences among medical patients. J Gen Intern Med. 1989;4(1):23.CrossRefPubMed
26.
Hill SA, Laugharne R. Decision making and information seeking preferences among psychiatric patients. J Ment Health. 2006;15(1):75–84.CrossRef
27.
Braman AC, Gomez RG. Patient personality predicts preference for relationships with doctors. Personal Individ Differ. 2004;37(4):815–26.CrossRef
28.
Flynn KE, Smith MA. Personality and health care decision-making style. J Gerontol Ser B Psychol Sci Soc Sci. 2007;62(5):261–7.CrossRef
29.
Ankem K. Factors influencing information needs among cancer patients: a meta-analysis. Libr Inform Sci Res. 2006;28(1):7–23.CrossRef
30.
Petrisek AC, Laliberte LL, Allen SM, Mor V. The treatment decision-making process: age differences in a sample of women recently diagnosed with nonrecurrent, early-stage breast cancer. Gerontologist. 1997;37(5):598–608.CrossRefPubMed
31.
Gaston CM, Mitchell G. Information giving and decision-making in patients with advanced cancer: a systematic review. Soc Sci Med. 2005;61(10):2252–64.CrossRefPubMed
32.
Robinson A, Thomson R. Variability in patient preferences for participating in medical decision making: implication for the use of decision support tools. Qual Health Care. 2001;10:34–8.CrossRef
33.
Morgen S, Bookman A. Rethinking women and politics: an introductory essay. Women and the politics of empowerment. In: Bookman A, Morgen S, editors. Women and the politics of empowerment. Philadelphia: Temple University Press; 1988.
34.
Rissel C. Empowerment: the holy grail of health promotion? Health Promot Int. 1994;9(1):39–47.CrossRef
35.
Wallerstein N. Powerlessness, empowerment, and health: implications for health promotion programs. Am J Health Promot. 1992;6(3):197–205.CrossRefPubMed
36.
Lachman ME, Firth KM. The adaptive value of feeling in control during midlife. In: Brim OG, Ryff CD, Kessler R, editors. How healthy are we? A national survey of well-being at midlife. Chicago: University of Chicago Press; 2004. p. 320–49.
37.
Mirowsky J, Ross CE. Life course trajectories of perceived control and their relationship to education1. Am J Sociol. 2007;112(5):1339–82.CrossRef
38.
U.S. Department of Health and Human Services. Healthy people 2010: understanding and improving health. In: Department of Health and Human Services W, DC. 2nd ed. Washington, DC: U.S. Government Printing Office; 2000.
39.
40.
Schulz PJ, Nakamoto K. Emerging themes in health literacy. Studies Commun Sci. 2005;5(2):1–10.
41.
Wilson PM. A policy analysis of the expert patient in the United Kingdom: self-care as an expression of pastoral power? Health Soc Care Commun. 2001;9(3):134–42.CrossRef
42.
43.
Renner B, Schwarzer R. Risk and health behaviors: documentation of the Scales of the Research Project “Risk Appraisal Consequences in Korea” (RACK). 2nd edition. Germany: International University Bremen & Freie Universität Berlin; 2005. 1–55.
44.
Spreitzer GM. Psychological empowerment in the workplace: dimensions, measurement, and validation. Acad Manag J. 1995;38(5):1442–65.CrossRef
45.
46.
Bandura A. Social cognitive theory. In: Barnouw E, editor. International encyclopedia of communications, vol. 4. New York: Oxford University Press; 1989. p. 92–6.
47.
Schwarzer R, Jerusalem M. Generalized self-efficacy scale. In: Weinman J, Wright S, Johnston M, editors. Measures in health psychology: a user’s portfolio. Causal and control beliefs. Windsor: NFER-NELSON; 1995. p. 35–7.
48.
Scholz U, Gutiérrez-Doña B, Sud S, Schwarzer R. Is general self-efficacy a universal construct? Psychometric findings from 25 countries. Eur J Psychol Assess. 2002;18(3):242–51.CrossRef
49.
50.
51.
52.
53.
Iacobucci D. Mediation analysis and categorical variables: the final frontier. J Consum Psychol. 2012;22:582–94.CrossRef
54.
Vogel BA, Helmes AW, Hasenburg A. Concordance between patients’ desired and actual decision making roles in breast cancer care. Psychooncology. 2008;17:182–9.CrossRefPubMed
55.
Liu G, Franssen E, Fitch MI, Warner E. Patient preferences for oral versus intravenous palliative chemotherapy. J Clin Oncol. 1997;15(1):110–5.PubMed
56.
Crooks DL. Older women with breast cancer: new understandings through grounded theory research. Health Care Woman Int. 2001;22(1–2):99–114.CrossRef
57.
Liang W, Burnett CB, Rowland JH, Meropol NJ, Eggert L, Hwang Y, Mandelblatt JS. Communication between physicians and older women with localized breast cancer: Implications for treatment and patient satisfaction. J Clin Oncol. 2002;20(4):1008–16.CrossRefPubMed
58.
Petersen S, Heesacker M, Schwartz RC, Marsh RD. Predictors of decision-making style among cancer patients: an empirical test of theory. Psychol Health. 2000;15(5):663–75.CrossRef
59.
60.
Malloy-Weir LJ, Charles C, Gafni A, Entwistle VA. Empirical relationships between health literacy and treatment decision making: a scoping review of the literature. Patient Educ Couns. 2015;98(3):296–309.CrossRefPubMed
61.
62.
Paasche-Orlow MK, Wolf MS. The causal pathways linking health literacy to health outcomes. Am J Health Behav. 2007;31(1):S19–26.CrossRefPubMed
63.
64.
Von Wagner C, Semmler C, Good A, Wardle J. Health literacy and self-efficacy for participating in colorectal cancer screening: the role of information processing. Patient Educ Couns. 2009;75:352–7.CrossRef
65.
Kraetschmer N, Sharpe N, Urowitz S, Deber RB. How does trust affect patient preferences for participation in decision-making? Health Expect. 2004;7:317–26.CrossRefPubMedPubMedCentral
66.
Keating NL, Green DC, Kao A, Gazmararian JA, Wu VY, Cleary PD. How are patients’ specific ambulatory care experiences related to trust, satisfaction, and considering changing physicians? J Gen Intern Med. 2002;17:29–39.CrossRefPubMedPubMedCentral
67.
Englehardt H. The foundations of bioethics. 2nd ed. New York: Oxford University Press; 1996.
68.
Bayertz K. Sanctity of life and human dignity. Boston: Kluwer Academic Press; 1996.CrossRef
69.
Keyes W. Life, death, and the Law: a sourcebook on autonomy and responsibility in medical ethics. Springfield: Thomas; 1995. p. 1995.
70.
Connor M, Mantwill S, Schulz PJ. Functional health literacy in Switzerland–validation of a German, Italian, and French health literacy test. Patient Educ Couns. 2013;90:12–7.CrossRefPubMed
71.
MacDonald SWS, Stawsky RS. Methodological considerations for the study of adult development and agenig. In: Schaie KW, Willis S, editors. Handbook of the psychology of aging. 8°th ed. London: Elsevier Academic Press; 2016.
72.
Nilsson LG, Sternäng O, Rönnlund M, Nyberg L. Challenging the notion of an early-onset of cognitive decline. Neurobiol Aging. 2009;30(4):521–4.CrossRefPubMed
73.
Deber RB. Physicians in health care management: 8. The patient-physician partnership: decision making, problem solving and the desire to participate. Can Med Assoc J. 1994;151(4):423–7.
74.
Butow PN, Maclean M, Dunn SM, Tattersall MHN, Boyer MJ. The dynamics of change: cancer patients’ preferences for information, involvement and support. Ann Oncol. 1997;8(9):857–63.CrossRefPubMed
75.
Tariman JD, Berry DL, Cochrane B, Doorenbos A, Schepp K. Preferred and actual participation roles during health care decision making in persons with cancer: a systematic review. Ann Oncol. 2010;21(6):1145–51. doi:10.​1093/​annonc/​mdp534.CrossRefPubMed
76.
Gattellari M, Butow PN, Tattersall MH. Sharing decisions in cancer care. Soc Sci Med. 2001;52(12):1865–78.CrossRefPubMed
77.
Davison BJ, Degner LF. Feasibility of using a computer-assisted intervention to enhance the way women with breast cancer communicate with their physicians. J Cancer Nurs. 2002;25:417–24.CrossRef
78.
Janz NK, Wren PA, Copeland LA, Lowery JC, Goldfarb SL, Wilkins EG. Patient-physician concordance: preferences, perceptions, and factors influencing the breast cancer surgical decision. J Clin Oncol. 2004;22(15):3091–8.CrossRefPubMed
79.
Hack TF, Pickles T, Bultz BD, Ruether JD, Wier LM, Degner LF, Mackey JR. Impact of providing audiotapes of primary treatment consultations to men with prostate cancer: a multi-site, randomized, controlled trial. Psycho-Oncology. 2007;16:543–52.CrossRefPubMed
80.
Hack TF, Degner LF, Watson P, Sinha L. Do patients benefit from participating in medical decision making? Longitudinal follow-up of women with breast cancer. Psycho-Oncology. 2006;15:9–19.CrossRefPubMed
81.
82.
Kryworuchko J, Stacey D, Bennett C, Graham ID. Appraisal of primary outcome measures used in trials of patient decision support. Patient Educ Couns. 2008;73:497–503.CrossRefPubMed
83.
84.
UST (Ufficio di Statistica del Canton Ticino), (2014a). Rilevazione Strutturale (RS), 2014.
85.
UST (Ufficio di Statistica del Canton Ticino), (2014b). Statistica della popolazione e delle economie domestiche (STATPOP). 2014.
86.
Degner LF, Sloan JA, Venkatesh P. The control preference scale. Can J Nurs Resour. 1997;29(3):21–43.
87.
Roter DL, Hall JA. Doctors talking with patients/patients talking with doctors: Improving communication in medical visits. 2nd ed. Westport: Praeger; 2006.
88.
Berkman ND, Dewalt DA, Pignone MP, Sheridan SL, Lohr KN, Lux L, Sutton SF, Swinson T, Bonito AJ. Literacy and health outcomes: summary. In: AHRQ evidence report summaries. Rockville: Agency for Healthcare Research and Quality (US); 2004. 1998–2005. Retrieved August 15 2016, from: http://​www.​ncbi.​nlm.​nih.​gov/​books/​NBK11942/​.
89.
90.
91.
Institute of Medicine. Health literacy: a prescription to end confusion. Washington, DC: National Academies Press; 2004.
92.
Metadata
Title
Assessing the predictive power of psychological empowerment and health literacy for older patients’ participation in health care: a cross-sectional population-based study
Authors
Gabriele Sak
Fabia Rothenfluh
Peter J. Schulz
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2017
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-017-0448-x

Other articles of this Issue 1/2017

BMC Geriatrics 1/2017 Go to the issue

Study protocol

Making the Most of Mealtimes (M3): protocol of a multi-centre cross-sectional study of food intake and its determinants in older adults living in long term care homes

Research Article

Dementia and cognitive disorder identified at a forensic psychiatric examination - a study from Sweden

Study protocol

Study protocol: pragmatic randomized control trial of an internet-based intervention (My tools 4 care) for family carers

Research article

Olfactory testing in consecutive patients referred with suspected dementia

Research Article

Vitamin D deficiency as a risk factor for dementia: a systematic review and meta-analysis

Research Article

Cohort study on living arrangements of older men and women and risk for basic activities of daily living disability: findings from the AGES project

ACC 2024 Congress Coverage

Cardiology Video

Highlights from the ACC 2024 Congress

Watch now

Watch official videos from the ACC congress summarizing key highlights from the last year in heart failure, cardiomyopathies, valvular disease, pulmonary vascular disease, and pediatric cardiology.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits