More Informed, More Involved: The Roles of Psychological Empowerment and Health Literacy for Older Patients’ Participation in Health Care.

Older adults are a growing number of patients who have experienced a socio-political change in patient-provider relationships. This change requires patients to be more actively involved and autonomous. Two types of active involvement are taken into account, namely health information-seeking and participation in medical decision-making. Previous research indicates that older patients tend to prefer being less involved with a relatively large variation between older patients. Whereas older adults desire a lot of information, only to a lesser degree do they want to participate in decision making. However, patient involvement has been associated with higher treatment satisfaction and adherence. Further, in the context of doctor-patient interactions, older adults are less likely to ask questions and get involved without being explicitly instructed to do so. A better understanding of what motivates involvement can help to promote involvement and thereby treatment satisfaction. The majority of previous research has focused on describing associations between socio-demographic variables and involvement preferences. The current research project extends previous research by investigating psychological antecedents of patients’ involvement preferences and by investigating potential mechanisms. More specifically, the project aims at better understanding the impact of psychological empowerment and health literacy on involvement. Psychological empowerment refers to feelings of power, control, and self-esteem that lead the patient to value autonomy and thus interest in and desire to participate in healthcare decisions. Health literacy can be defined as an individuals’ ability to obtain, process, and understand basic health information. The proposed project employs a multi-methodological approach comprising a survey and two experiments. The goals of the proposed research project are threefold. First, the research project aims at investigating the role of patient empowerment and health literacy for older adults’ participation preferences in a large survey study (Study 1). Further, the survey data will inform about the type of Swiss older adults’ involvement in their healthcare and the channels they use to seek health information. Second, the proposed research project aims at studying the impact of the facilitation of patients’ participation on patient satisfaction in an experimental setting (Study 2). This study extends previous research in that it experimentally manipulates the degree of health care provider’s encouragement to participate and controls for other situation-specific influences. It allows to test whether the willingness to engage can be influenced through patient-role manipulation and results in increased patient satisfaction. This experiment can contribute to a better understanding of contextual changes in the patient-provider interaction that could foster patient empowerment. Third, the proposed research project aims at studying the process of older patients’ information seeking and potential emergence of patient empowerment (decision self-efficacy) and the willingness to shared decision-making ( Study 3). The goal of this experiment is to contribute to a better understanding of the function information seeking has to older patients. More specifically, it will test whether decision self-efficacy increases as a function of information search. Additionally, the experiment allows insight into the type of information older patients prefer. Overall, the proposed project helps to better understand when older patients want to engage in shared medical decision making and which function information seeking may have in this respect. The relevance of the proposed project stems on the one hand from its’ contribution to the understanding of antecedents and processes in patient involvement and on the other hand from its’ applied meaning, given that involving patients can help to improve the quality of health care.