Exploring Study On The Willingness, Status And Social Demographic Influencing Factors Of Patient Participation In Healthcare——based On The Inpatients In Shanghai

Purpose:In order to explore patients’ experience and status of engagement in clinical settings, the study based on the view from patient perspective and focus on the progress that patients participate in healthcare during their hospitalization. By looking for the different requirements of various patients in multiple clinical encounters, theoretical basis for clinical practice according with "Patient Centered Care " and targeted strategies were expected to be found, which will contribute to improve Patient safety and satisfaction.Method:1、The qualitative study on patients’experience and status of engagement in healthcare during their hospitalization: On principle of phenomenological method, patients’ gender, age, profession, registered residence, health insurance and other Demographic factors were taken into the consideration to conduct the sampling.74 patients of observation and 11 patients to be interviewed were drawned from 4 internal medicine and surgical departments in 2 hospitals by comprehensive application of convenience sampling and purposive sampling. The data was collected by participatory observation and semi-structured interview, and was analyzed by the thematic analysis developed by Colaizzi in virtue of Qualitative Analysis Software Nvivo 10.0.2、The development of Questionnaire for the willingness and status of inpatients’ engagement in healthcare:Literature review and qualitative study were conducted initially to form the prototype of the questionnaire, which was followed by a panel meeting with 9 experts. And after the revision of structural dimensions and items, the questionnaire was used to conduct a preliminary test of 50 patients, which was in order to revise the questionnaire by item analysis and testing the reliability and validity.3、The cross-sectional survey of patient engagement in healthcare in Shanghai during their hospitalization: On the basis of convenience sampling, a cross-sectional survey of 408 inpatients was conducted in 8 secondary and tertiary general hospitals distributed throughout Shanghai. The data was collected by the questionnaire developed before and was analyzed by SPSS Statistical Analysis Software(18.0) to explore patients’ willingness to be engaged in healthcare and their actual engagement in multiple clinical encounter.Results:1、There themes and several subthemes were extracted by analyzing the data from the qualitative study:(1)the content of patient engagement presented abundant, including the engagement in:① information interaction; ② making decisions; ③ health caring; ④ appealing; (2)the forms of patient engagement diversified, such as:① active engagement and passive engagement coexisted; ② forms of engagement in decision-making differed; ③ the subjects of engagement diversified, manifesting as engagement in varying degrees; ④ the initiative of engagement Varied from patients different perceptions meaning of the activities.(3) the engagement was influenced by many factors;2、The Cronbach alpha coefficient of the developed questionnaire and its dimensions various from 0.770 to 0.968, and the CVI was 0.96.3、The results of the cross-sectional survey indicates that:(1) the patients willingness to be engaged in healthcare: ① patients’general willingness to be engaged in healthcare was relatively high (4.23±0.58); ② patients willingness to be engaged in different dimensions ranked from high to low by the scores: information interaction related participation (4.42±0.52)、decision making related participation (4.20±0.75)、caring related participation (4.18±0.62) and complaint related participation (3.94±0.85);③ the top score occured "when I’m satisfied with the healthcare professionals or the Institution I will express my appreciation to them", and the though score presented to "Before the treatment or caring, I will ask my healthcare professionals that’Have you washed your hands’?"; ④ patients’willingness to be engaged in healthcare differ variously among patients from different hospitals, departments, residence and with different age, educational background, insurance, history of hospitalization, history of surgery and times of adverse events or medical disputes.(2) the patients’actual engagement in healthcare:① patients’actual participation levels showed a general performance (3.98±0.60);② patients actual engagement in different dimensions ranked from high to low by the scores:information interaction related participation (4.40±0.54)、caring related participation (4.01±0.63)、decision making related participation (3.86±0.82)、and complaint related participation (3.59± 0.89); ③ the top score occured "when I’m satisfied with the healthcare professionals or the Institution I will express my appreciation to them", and the though score presented to "Before the treatment or caring, I will ask my healthcare professionals that’Have you washed your hands’?";④ patients’ actual engagement in healthcare differ variously among patients from different hospitals, departments, residence and with different age, educational background, insurance, history of hospitalization, history of surgery and times of adverse events or medical disputes.(3) Difference comparison of patients willingness and their actual engagement in healthcare:① Patients’ actual engagement level was inferior to their willingness to be engaged in healthcare and Significant differences were found for the total score and all dimensions between them; ② Significant differences were found for the 49 items between Patients’ actual engagement level and their willingness to be engaged in, except the item 28"I often adjust the drug dose or infusion speed based on my experience by myself".Conclusions:1、The content of patient engagement presented abundant, the forms of patient engagement diversified and the process of engagement was influenced by many factors.2、The self-developed questionnaire in the study was proved to be good reliability and validity.3、① Patients were willing to be engaged in healthcare while it emerged discrepancy of preference when it comes to different contents:And information interaction was proved to be the primary demand among four dimensions; ② Patients actual participation level was inferior to their willingness to be engaged in healthcare, which indicates that the ③patient engagement in healthcare was influenced by various factors, such as the grades of hospitals, the different departments, the assurance,the education background and so on.