Results Summary
PCORI funded the Pilot Projects to explore how to conduct and use patient-centered outcomes research in ways that can better serve patients and the healthcare community. Learn more.
Background
Because healthcare professionals such as hospital social workers, nurses, and doctors work with patients every day, these professionals know about problems that patients face in getting health care. Healthcare professionals can play an important role with policy makers by speaking up to develop policies that benefit patients. But there is little research on what might make a healthcare professional likely to advocate for new policies in a hospital or in local, state, or national government.
Project Purpose
Researchers wanted to create a questionnaire to measure how much healthcare professionals push for policies that help patients.
The team wanted to use the survey to understand what makes some healthcare workers more involved in patient advocacy than others.
Methods
The research team developed a survey called the Policy Advocacy Engagement Scale. The survey included questions about how involved healthcare workers are in advocating for patients in seven topic areas, such as quality of care and access to mental health care. It also included questions about healthcare workers’ personal qualities, such as their ethical beliefs and their eagerness to be advocates for patients. Finally, it included questions about workers’ hospital environment. For example, researchers asked on the survey whether healthcare workers thought their hospital supported healthcare workers who pushed for patient-friendly policies, whether they believed their coworkers would act as patient advocates, and whether they thought their hospital staff supported patients in speaking up for themselves.
Altogether, 94 social workers, 97 nurses, and 104 doctors in training from eight hospitals in Los Angeles, California, completed the survey. The research team ran statistical tests to determine whether the survey measured the seven topic areas as intended.
The research team also gave participants an existing survey called the Patient Advocacy Engagement Scale to measure their involvement in advocacy. Researchers compared the survey results to see which of the seven topic areas, if any, from the Policy Advocacy Engagement Scale predicted whether healthcare workers would engage in patient advocacy.
Findings
The statistical tests showed that the questions in the Policy Advocacy Engagement Scale accurately measured all seven topic areas.
Three topic areas in the Patient Advocacy Engagement Scale predicted whether healthcare workers were likely to be patient advocates their willingness to serve as a spokesperson for patients, their skills in advocating for patients, and their belief that the hospital was committed to encouraging patients to speak up about their needs.
Younger healthcare workers were more engaged in patient advocacy than older participants. Social workers did more patient advocacy than nurses.
Limitations
All of the healthcare workers were from Los Angeles. Results might have been different if participants in other parts of the country answered the survey questions.
Conclusions
The Policy Advocacy Engagement Scale can measure the extent to which healthcare workers are involved in advocating for better patient care policies. Researchers can also use it to identify barriers that healthcare workers may face in advocating for policies that benefit their patients.
Professional Abstract
PCORI funded the Pilot Projects to explore how to conduct and use patient-centered outcomes research in ways that can better serve patients and the healthcare community. Learn more.
Background
Although literature documents the need for hospital social workers, nurses, and medical residents to engage in patient advocacy, little information exists about what predicts the extent that they do so, and no instrument exists to measure their level of engagement in policy advocacy.
Project Purpose
This study had two aims. The first was to develop and validate the Policy Advocacy Engagement Scale to measure frontline healthcare professionals’ engagement in policy advocacy, and the second was to use that validated scale to identify predictors of health professionals’ patient advocacy engagement with respect to a broad range of patient problems.
Study Design
A cross-sectional research design was used.
Patients, Interventions, Settings, and Outcomes
The study sample included 94 social workers, 97 nurses, and 104 medical residents (N = 295) recruited from eight hospitals in Los Angeles.
Data Analysis
Bivariate correlations explored whether seven scales (Patient Advocacy Eagerness, Ethical Commitment, Skills, Tangible Support, Organizational Receptivity, Belief Other Professionals Engage, and Belief the Hospital Empowers Patients) were associated with patient advocacy engagement, measured by the validated Patient Advocacy Engagement Scale. Regression analysis examined whether these scales, when controlling for sociodemographic and setting variables, predicted patient advocacy engagement.
Findings
For the first aim, results supported the validity of the concept and the instrument. In confirmatory factor analysis, seven items loaded onto one component with indices indicating adequate model fit. A Pearson correlation coefficient of .36 supported the scale’s test-retest stability. Cronbach’s α of .93 indicated strong internal consistency. For the second aim, all seven predictor scales were significantly associated with patient advocacy engagement in correlational analyses, but only Eagerness, Skills, and Belief the Hospital Empowers Patients predicted patient advocacy engagement in regression analyses. Additionally, younger professionals engaged in higher levels of patient advocacy than older professionals, and social workers engaged in greater patient advocacy than nurses.
Limitations
Limitations include a low response rate and limited geographic scope.
Conclusions
The Policy Advocacy Engagement Scale appears to be the first validated scale to measure frontline healthcare professionals’ engagement in policy advocacy. With it, researchers can analyze variations in professionals’ levels of policy advocacy engagement, understand what factors are associated with it, and remedy barriers that might exist to their provision of it.