Patient Knowledge, Beliefs and Self Management In Nursing for Health Outcome Measure
Knowledge of or Need for Information In health Care and Nursing
Knowledge or assessment of a patient’s or family’s felt need for
information is similarly specific to a particular domain of knowledge or
information. Much has been made of the truth that knowledge is essential but
not sufficient to create a change in behavior, this assumes that behavior
change is the only valued outcome from patient education.
Much evidence shows
that patients or families value information for the perspective it provides and
almost uniformly believe they do not receive enough from the health care
system.
Redman (2003) reviews a number of knowledge instruments including
for diabetes, rheumatoid arthritis, asthma, cardiac (including stroke), cancer
(including breast and colorectal), maternal serum screening and phenylketonuria
tests, Crohn’s disease and colitis, osteoporosis, preoperative, schizophrenia ,
HIV/AIDS, and discharge learning needs.
Information needs seem to be
particularly high among persons with cancer. Misters, van den Borne, De Boer,
and Pruyn (2001) describe such a measure and test it with individuals with
breast cancer, Hodgkin’s disease, and head and neck cancer. Greater information
needs were found to relate to higher levels of state-anxiety, more depression,
and more psychological complaints. Need for information about disease and
treatment changes over the course of the illness.
Knowledge assessment instruments also must be checked regularly for
current content, for example, treatment patterns changed after the Diabetes
Control and Complications and the United Kingdom Prospective Diabetes Study.
Also important is precise definition of the domains of knowledge being tested
and assurance that each domain is adequately sampled.
Some instruments measure
knowledge specific to a particular patient education program and cannot be
considered universal. Many instruments measure knowledge essential for
self-management, infrequently there is clarity about how much knowledge (what
score level) is enough. Although patients may have the knowledge, they still
may not be able to act on it. Additional instruments to assess information
needs and knowledge levels are widely available.
Beliefs of Patient In health Care and Nursing
Beliefs are measured for two reasons:
(a) they represent a
theoretical model that explains health behavior such as the Health Belief Model.
(b) they describe a “lay” model by which people commonly understand a health
condition. Several examples from the field of pain illustrate the difference.
The Pain Stages of Change Questionnaire (PSOCQ) is derived from the
Transtheoretical Model, which holds that intentional change requires movement
through discrete motivational stages: precontemplation for considering changes,
contemplation, preparation for change, taking action to change, and maintenance
of change. PSOCQ is used to identify an individual’s readiness to self-manage
chronic pain.
Interventions are matched to the individual’s stage (Kerns,
Rosenberg, Jamison, Caudill, & Haythomthwaite, 1997). The Pain Beliefs and
Perceptions Inventory measures common beliefs about pain such as whether it
will be an enduring part of life, that pain is mysterious and poorly
understood, or that individuals are to blame for their own pain (Williams,
Robinson, & Geisser, 1994 ).
The Osteoporosis Health Belief Scale is based on the health belief
model (susceptibility to and seriousness of osteoporosis, benefits in
preventive action, and barriers to accomplishing them) and is especially
designed to assess beliefs related to exercise and calcium intake in the
elderly. Scores should predict taking of preventive actions to avoid
osteoporosis (Kim, Horan, Gendler, & Patel, 1991).
The Menopause
Representations Questionnaire (MRQ) is based on Leventhal’s self regulation
model and measures a range of cognition about menopause including identity,
consequences, time frame, and perceptions of control and cure (Hunter &
O’Dea, 2001). MRQ can be used in research of the theoretical model.
Other instruments measure patient beliefs about particular
illnesses and provide a target for efforts to change incorrect beliefs or those
that interfere with recovery. The Back Beliefs Questionnaire was developed to
identify inappropriate beliefs that foster a reluctance toward early return to
activities after back pain.
Interventions to change those beliefs have been
successful (Symonds, Burton, Tillotson, & Main, 1996). The York Angina
Beliefs Questionnaire assesses for common misconceptions and maladaptive
beliefs among those who have angina, which can then be targeted for change
(Furze, Bull, Lewin, & Thompson, 2003).
Self-management In health Care and Nursing
Advances in self-management of chronic illnesses are discussed. in
chapter 5. Here, we consider measurement instruments, most of which involve
self-report of recommended self-management behaviors. For example, the
Self-Care of Heart Failure Questionnaire asks how frequently patients carry out
the behaviors, how worrisome certain symptoms would be, and if patients had
them, what they did about them.
More experienced patients reported limiting
their sodium intake and increasing their diuretic dose with a sudden weight
gain, as would be expected (Carlson, Riegel, & Moser, 2001). The Epilepsy
Self-Management Scale also asks patients to report how frequently they carry
out particular self-management activities including safety measures such as not
going swimming alone (Dilorio & Henry, 1995).
Other instruments measure skills such as ability to solve problems
in self-management. The Diabetes Problem Solving Measure for Adolescents
provides critical incidents that patients are asked to solve in an interview
format. Adolescence is frequently a time of deteriorating glycemic control
(Cook, Aikens, Berry, & McNabb, 2001).
Finally, the Diabetes
Self-Management Profile attempts to assess (again, through self-report) what
parts of the complex regimen of exercise, management of hypoglycemia, diet,
glucose testing and insulin administration, and dose adjustment individuals
with type 1 diabetes are carrying out (Harris et al., 2000).
Other Measures In health Care and Nursing
A cluster of measures focuses on the decision process including
conflict experienced while the decision is being made and regret afterwards.
They are reviewed in Redman (2003).
Lack of culturally competent instruments for measuring relevant
predictors, as well as study outcomes for groups such as Mexican American
populations, is a barrier to addressing health disparities in
non English speaking individuals. The work is complicated by low literacy rates
in this community.
The norm of developing instruments in English for
middle-class populations means the instruments need not only to be translated
but also to be made relevant to the local culture significant investment in
time and skill ( Brown, Becker, Garcia, Barton, & Hanis, 2002).
Others have described adapting objective structured clinical exams
from professional education to lay caregivers. Using simulated patients,
stations are set up to assess competencies and rated by faculty.
For example,
care for a tunneled line includes stations assessing dressing change skill,
identification from photos of moisture under dressings and infected line. skill
in flushing the line on a chest model, and cap change and contamination to be
identified from a video. At each station, learners receive immediate feedback.
This is a more realistic method than many reviewed above to assess when family
members are adequately prepared to assume caregiving responsibilities or
patients to do self-care (Heermann, Eilers, & Carney, 2001).
Rapid expansion of the number of measurement instruments available
in-patient education is helpful. Many are in very early stages of development
psychometrically, and there is little evidence that those that meet
psychometric standards are being used routinely in clinical practice.
This
means that evaluation is based entirely on clinical judgment, without evidence
of the predictive validity of those judgments. Setting of outcome standards
(which has not yet been accomplished) would require evidence of meeting them
and would perhaps force inclusion of objective measurements in addition to
clinical judgment.