Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Institute of Psychology, University of Bern, Bern, Switzerland.
Swiss Med Wkly. 2024 Oct 1;154:3385. doi: 10.57187/s.3385.
Low mobility of patients during hospitalisation is associated with adverse outcomes. To successfully change behaviours related to mobility of older hospitalised patients, we need to better understand the mechanisms underlying patient and healthcare professional behaviours. In this study, we thus assessed patient- and healthcare professional-reported intentions and behaviours related to mobility of older patients hospitalised on an acute medical ward, based on a theoretical framework - the Health Action Process Approach (HAPA) model - and on additional barriers and facilitators to mobility.
We conducted a cross-sectional survey in April 2022 among patients aged ≥60 years recently hospitalised on an an acute medical ward of one of three hospitals of different language/cultural regions of Switzerland, and healthcare professionals (physicians, nurses/nursing assistants, physiotherapists) working on those wards. The survey assessed the HAPA model and additional barriers and facilitators to patient mobility at hospital, as previously identified in the literature. The target behaviour studied was "to move as much as possible during hospitalisation" for patients and "to ensure my patients move as much as possible during hospitalisation" for healthcare professionals. We conducted hierarchical linear regressions to determine factors associated with the self-reported intention to perform the behaviour and with the self-reported behaviour itself.
A total of 142 healthcare professionals (61 physicians, 59 nurses, 22 physiotherapists) and 200 patients (mean age 74 years) completed the survey. Patients with higher intention to move as much as possible during hospitalisation scored significantly higher on factual knowledge, outcome expectancies and risk perception. Healthcare professionals with higher intention to ensure that their patients move as much as possible during hospitalisation scored higher on action knowledge, outcome expectancies and risk perception. The more the patients reported that they moved as much as possible during hospitalisation, the higher their action knowledge and action control. The more healthcare professionals reported that they ensure that patients move as much as possible during hospitalisation, the higher they scored on factual knowledge, role perception, planning and action control.
factual and action knowledge, self-efficacy, outcome expectancies, risk perception, planning and action control were identified as important drivers of patient- and healthcare professional-reported intentions and behaviours related to inpatient mobility. These parameters can be addressed through behaviour-change interventions and should be considered in future interventions to successfully implement practice changes, with the goal of improving mobility of older patients during hospitalisation, and thus the outcomes of this particularly vulnerable population.
患者在住院期间活动能力低与不良结局有关。为了成功改变与老年住院患者活动能力相关的行为，我们需要更好地理解患者和医疗保健专业人员行为背后的机制。因此，在这项研究中，我们根据理论框架——健康行动过程方法（HAPA）模型，并基于移动性的额外障碍和促进因素，评估了老年患者在急性内科病房住院期间的患者和医疗保健专业人员报告的与移动性相关的意图和行为。
我们于 2022 年 4 月在瑞士三个不同语言/文化地区的三家医院之一的急性内科病房最近住院的年龄≥60 岁的患者和在这些病房工作的医疗保健专业人员（医生、护士/护理助理、物理治疗师）中进行了横断面调查。该调查评估了 HAPA 模型以及文献中先前确定的患者在医院移动的额外障碍和促进因素。研究的目标行为是“在住院期间尽可能多地移动”，对于患者，“确保我的患者在住院期间尽可能多地移动”，对于医疗保健专业人员。我们进行了分层线性回归，以确定与自我报告的行为意向和自我报告的行为本身相关的因素。
共有 142 名医疗保健专业人员（61 名医生、59 名护士、22 名物理治疗师）和 200 名患者（平均年龄 74 岁）完成了调查。移动意愿越高的患者在事实知识、结果预期和风险感知方面得分越高。移动意愿越高的医疗保健专业人员在行动知识、结果预期和风险感知方面得分越高。移动意愿越高的患者在住院期间移动的次数越多，他们的行动知识和行动控制就越高。移动意愿越高的医疗保健专业人员报告他们确保患者在住院期间尽可能多地移动，他们在事实知识、角色感知、计划和行动控制方面的得分就越高。
事实和行动知识、自我效能、结果预期、风险感知、计划和行动控制被确定为与住院患者移动性相关的患者和医疗保健专业人员报告的意图和行为的重要驱动因素。可以通过行为改变干预措施来解决这些参数，并应在未来的干预措施中考虑这些参数，以成功实施实践变革，目标是改善老年患者在住院期间的活动能力，从而改善这一特别脆弱人群的结局。
