Most health care focuses on patients' risk factors, diseases, and deficits. Identifying, amplifying, and applying patients' strengths is a potentially transformative strategy for motivating positive change and expanding resources for chronic disease management and prevention. However, there has been little research on effective methods for discovering patient strengths, bringing them into health care encounters in which they might be helpful, or assessing their impact on patient-oriented outcomes.
Identify patient-identified personal strengths relevant to chronic illness management. 1. Develop a strengths-focused, computer-supported interactive, tailored patient assessment tool. 2. Engage patients, caregivers, and primary care clinicians in identifying mechanisms by which leveraging patient strengths in different ways may improve processes and patient-oriented outcomes of care. 3. Quantitatively simulate the effect of alternate, strengths-based approaches in practice on patient-oriented outcomes and provider resources as compared with that of usual deficit/disease-focused care.
The study was conducted in 2 phases by researchers from Case Western Reserve University, the University of North Carolina, the University of Oslo, and Cleveland, Ohio; primary care physicians; nurse practitioners; nurses; social workers; and patients with multiple chronic illnesses. In phase 1, we conducted focus groups and individual interviews of 76 patients from safety net practices. In phase 2, we invited particularly insightful participants to join a Design Team of patients, caregivers, and health care professionals, and purposively expanded the group to include diverse perspectives relevant to understanding how to incorporate patient strengths in primary health care, for a total of 19 participants. The Design Team had ten 2-hour meetings and conducted small pilot studies to refine a list of strengths and a new computer tool for assessing them. The Design Team also identified clinical situations in which patient strengths would be particularly helpful, developed design criteria, and attempted to model patient-oriented outcomes of a strengths-based approach in health care.
Patients from disadvantaged backgrounds found it difficult to articulate their strengths. However, interviews that started with positive life experiences, or that introduced participants to a newly developed computerized Strengths Collector tool that began with video stories, helped patients identify their strengths relevant to improving chronic disease management and prevention. Relevant patient strengths were related to personal attributes, interpersonal relationships, and community resources. Participants identified 6 scenarios in which a strengths-based approach might be particularly helpful: diabetes management, high use of health care, chronic pain management, group health care visits, when patients feel a need to get “unstuck,” and when clinicians sense that focusing on strengths would be a useful way to reframe care. Design criteria for implementing a strengths-based approach related to overcoming an external context focused on delivering commodities of disease care; organizational factors affecting relationship development; professional skills, roles, and philosophies; and the ease of implementing the strengths-based intervention. Because of limited published data on outcomes from a strengths-based approach, we were unable to quantitatively model outcomes.
Through stories and examples, patients from disadvantaged backgrounds can identify strengths relevant to improving their health. A strengths-based approach may be particularly helpful in uncovering previously hidden motivations and resources in health care situations that require ongoing behavior change.
