School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden.
Procome, Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden.
BMC Health Serv Res. 2021 May 20;21(1):480. doi: 10.1186/s12913-021-06455-8.
Chronic care involves multiple activities that can be performed by individuals and healthcare staff as well as by other actors and artifacts, such as eHealth services. Thus, chronic care management can be viewed as a system where the individual interacts with people and eHealth services performing activities to maintain or improve health and functioning, called co-care. Yet, the system perspective is not reflected in concepts such as person-centered care and shared decision making. This limits the understanding of individuals' global experience of chronic care management and subsequently the ability to optimize chronic care. The aim of this study was threefold: (1) to propose a theory-based operationalization of co-care for chronic care management, (2) to develop a scale to measure co-care as a distributed system of activities, and (3) to evaluate the scale's psychometric properties. With the theory of distributed cognition as a theoretical underpinning, co-care was operationalized along three dimensions: experience of activities, needs support, and goal orientation.
Informed by the literature on patient experiences and work psychology, a scale denoted Distribution of Co-Care Activities (DoCCA) was developed with the three conceptualized dimensions, the activities dimension consisting of three sub-factors: demands, unnecessary tasks, and role clarity. It was tested with 113 primary care patients with chronic conditions in Sweden at two time points.
A confirmatory factor analysis showed support for a second-order model with the three conceptualized dimensions, with activities further divided into the three sub-factors. Cronbach's alpha values indicated a good to excellent reliability of the subscales, and correlations across time points with panel data indicated satisfactory test-retest reliability. Convergent, concurrent and predictive validity of the scale were, overall, satisfactory.
The psychometric evaluation supports a model consisting of activities (demands, unnecessary tasks, and role clarity), needs support and goal orientation that can be reliably measured with the DoCCA scale. The scale provides a way to assess chronic care management as a system, considering the perspective of the individuals with the chronic condition and how they perceive the work that must be done, across situations, either by themselves or through healthcare, eHealth, or other means.
慢性护理涉及多项活动，既可以由个人和医疗保健人员完成，也可以由其他角色和人工制品（如电子健康服务）完成。因此，慢性护理管理可以被视为一个系统，其中个人与执行活动以维持或改善健康和功能的人员和电子健康服务进行交互，称为共同护理。然而，系统视角并没有反映在以患者为中心的护理和共同决策等概念中。这限制了对个人接受慢性护理管理的全面体验的理解，进而限制了优化慢性护理的能力。本研究的目的有三：（1）提出一种基于理论的共同护理操作化方案，用于慢性护理管理；（2）开发一种衡量共同护理的量表，将其作为活动的分布式系统；（3）评估量表的心理测量特性。以分布式认知理论为理论基础，共同护理沿着三个维度进行操作化：活动体验、需求支持和目标导向。
根据患者体验和工作心理学文献，开发了一个名为共同护理活动分布（DoCCA）的量表，该量表包含三个概念化维度，活动维度由三个子因素组成：需求、不必要的任务和角色明确性。该量表在瑞典的 113 名患有慢性疾病的初级保健患者中进行了两次测试。
验证性因素分析支持了一个二阶模型，包含三个概念化维度，活动维度进一步细分为三个子因素。子量表的克朗巴赫 α 值表明信度良好到优秀，面板数据的时间点间相关性表明测试重测信度令人满意。该量表的收敛、同时和预测效度总体上令人满意。
心理测量评估支持由活动（需求、不必要的任务和角色明确性）、需求支持和目标导向组成的模型，该模型可以使用 DoCCA 量表可靠地进行测量。该量表提供了一种方法来评估慢性护理管理作为一个系统，考虑到患有慢性疾病的个体的视角，以及他们如何感知必须完成的工作，无论是通过自己还是通过医疗保健、电子健康或其他方式。
