Discharge Education to Promote Patient Self-Efficacy In the study, one of the ways recommended to improve patient adherence and self-efficacy is to improve patient-healthcare provider support, as social support had been determined as one of the key drivers that determine an individual's ability to cope and take action about his/her health condition (338).
Care and concern for the patient's health and well-being after being discharged from the hospital or clinic does not end for healthcare providers. Particularly for chronically ill patients, post-discharge care is more critical to ensure that in the course of the patient's daily routine and activities, all medical requirements are adhered to and all medications needed are complied with. This is why more often than not, patients receive discharge education as the healthcare provider's continuing effort to ensure that the patient and his/her family members or caregivers will be well-capacitated to continue care and treatment at home.
However, the above-mentioned scenario is the ideal rather than the actual. In real life, healthcare providers are often fraught with the dilemma of patients who are constantly hospitalized or have witnessed the worsening of their patient's condition as a result of non-compliance to their medications and other medical requirements. As studies in the past have shown, discharge education and other patient education programs are given to patients, but it is "unclear" whether these education programs translates to adherence and compliance or not (Barnason et. al., 2011 and Baker et. al., 2011).
This paper discusses the different dimensions concerning the issue of effectiveness of discharge education programs in promoting patients' compliance and general self-efficacy in managing their medication and general health and well-being. This paper will look at the concept of self-efficacy, and how this concept contributes to the effectiveness of a patient discharge education program. Further into the discussion, the paper will also review intervention programs that have been developed to promote compliance and patient self-efficacy in health management, identifying which of these interventions have been proven to be effective and more feasible for patients.
The discussion is ordered in a manner that introduces important concepts at every section, culminating in an integrative discussion that responds to the research questions: (i) what are the factors that promote self-efficacy of health management in patients (or individuals in general); and (ii) what patient discharge education programs have been proven to be effective and feasible for patients?
II. General Self-Efficacy
Self-efficacy, as a concept, is not confined to health management alone. It can be applied to specific fields or areas in a person's life. Generally speaking, general self-efficacy is defined as the "more frequent use of active, problem-focused coping strategies" (Luszczynska, 2005:442). Generally, and as applied to health management, self-efficacy looks at one's ability to develop and implement activities that aim to "cope" or adjust to the current situation or condition the individual finds himself or herself in. In the case of this study, general self-efficacy is applied in the area of health management, well-being, and health behaviors.
General self-efficacy is determined not just by one measure alone. In studying this concept, attitude statements and specific behaviors were developed, descriptors that confirms or disconfirms a person's self-efficacy. In Luszczynska et. al.'s (2005) study that tested a quantitative instrument measuring general self-efficacy, results of their multi-country study (in Germany, Korea, and Poland) showed that when tested in patients in the countries mentioned, the general self-efficacy tool showed high correlation scores on the following items: intention to train (0.62), self-regulation (0.42), and implementation in intention (0.40) (446). However, the tool, on the overall, yielded weak correlation scores between self-efficacy and health behaviors and well-being. One of the attributed reasons for this is that the instrument was not specific enough in describing and measuring self-reported self-efficacies, hence, the lower overall correlation score.
Another study that sought to understand the nature and determined the presence of self-efficacy in individual in the medical health setting is Krueger et. al.'s comprehensive review of medication adherence and persistence among patients with coronary heart disease (2005). In this study, Krueger et. al. found out, in studying the barriers and drivers to patient adherence, that they must look into specific factors found under broader categories of measures, specifically, behavioral, biochemical, and clinical adherence (321). Among these categories of measures, self-efficacy grouped under behavioral factors, and testing for this, findings showed how a patient's circumstances or profile results to low self-efficacy, which, in effect, results to low patient adherence to medication and health management (337). Patients who belong to lower income families, have low literacy or educational...
Both studies covered self-efficacy in the context of healthcare management, specifically in the patient's ability to manage his/her health and well-being. From these studies, self-efficacy is a variable or factor best measured in specific contexts and in addition to other factors, such as the individual or patient's demographic profile and medical and clinical profile (medication regimen). This indicates that self-efficacy is a concept best understood in context to a specific situation -- that is, self-efficacy could be measured differently if applied in the context of education or personal well-being. Applied in the context of medical care and health management, though, self-efficacy is highly dependent on pre-existing factors relevant to the individual's health circumstances, specifically, attitude towards health in general, health behaviors and practices, and history of one's illness or condition. Combining all these factors, one can determine a meaningful assessment of general self-efficacy.
However, as also gleaned from these studies, determining the association or significance of self-efficacy in health management is also dependent on specific factors: sample size and the nature of the tool that measures and quantifies the concept of self-efficacy. As reflected in Luszczynska's (2005) study, self-efficacy can only be significantly measured if the instrument developed is specific enough to yield strong associations with the patient's profile and health behaviors. Further, from a statistical standpoint, measures of self-efficacy will only become statistically significant and meaningful to the researcher if results are generated from a robust sample.
III. Self-Efficacy in relation to Patient Well-being and Medical Adherence/Compliance
In the previous section, self-efficacy had been inevitably linked with healthcare management and patient adherence to their medication regimen. Indeed, self-efficacy is oftentimes determined and tested in the context of healthcare management, primarily because of its importance in determining the likelihood that a patient will comply or adhere to the doctor's instruction even after being discharged from the hospital or clinic. Self-efficacy is the springboard that compels the individual to develop the intention and take action in ensuring that his/her health condition is managed well and in adherence to the doctor's advice or recommendation.
Self-efficacy is only one of the many factors that medical researchers look into when understanding patient compliance, particularly patients with chronic illness. Van der Wal et. al. (2005) conducted a meta-analysis of studies on patient compliance over a period of fifteen years (1988-2003). The study found that patients with heart failure depend their compliance on, primarily, lifestyle factors. By "lifestyle factors," the medical researchers meant that patients were analyzed based on their demographic profile and lifestyle activities, attitudes and behaviors (10). Discussion of the results of the study qualified compliance as "the extent to which a person's behavior…coincides with the 'clinical prescription'" (6). Among the lifestyle factors that promote or hinder patient compliance, it was compliance to recommendations on activity and rest and positive treatment seeking behavior that significantly determined one predisposition to comply or adhere to medical recommendations of the doctor (10).
Another study, by Jovicic et. al. (2006), went further into understanding the patient's profile and lifestyle, including also a relevant and highly important factor, quality of life, into the equation. By including quality of life in the analysis of patient compliance, the researchers also took another step by dimensionalizing self-efficacy in the concept of "self-management." Specifically, the study looked into the effectiveness of self-management interventions on hospital readmission rates, mortality and quality of life (QOL) program.
While the meta-analysis conducted on 642 research studies yielded a non-significant relationship between self-management interventions with quality of life program, the study helped establish the link between self-efficacy and self-management, and consequently, self-management with quality of life. From both medical and pragmatic standpoints, self-efficacy is critical in developing good self-management skills and attitudes in patients, as self-management interventions have proven to be not only cost-effective (versus standard care given by a hospital or clinic), but it is also a good (albeit nonsignificant) indicator of the patient's quality of life (QOL) (5). However, the researchers also cautioned on taking this relationship between self-efficacy, self-management and QOL further than the scope of the study, as they have not looked into these measures and analyzed them with socio-demographic characteristics of the patients. These factors alone, the researchers clarified, could result to a different and significant relationship than the one established by their study.
IV. Discharge Education and Interventions that Promote Patient Self-Efficacy
In the study, one of the ways recommended to improve patient adherence and self-efficacy is to improve patient-healthcare provider support, as social support had been determined as one of the key drivers that determine an individual's ability to cope and take action about his/her health condition (338).
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