PUB - Publikationen an der Universität Bielefeld

__Introduction:__ Research has shown that patient participation is associated with improved health outcomes. This is in particular relevant for patients with chronic diseases, as they experience problems with regard to receiving targeted healthcare and face challenges in their social lives. In the context of chronic diseases, strong primary healthcare (PHC) is crucial for supporting patient participation. It is regarded as a means of providing continuous, lowthreshold care. PHC nurses are often responsible for accompanying patients with chronic diseases. Research on how PHC nurses support patient participation in the context of chronic diseases and the factors that facilitate or hinder their attempts to do so remains scarce.

__Study objective:__ This dissertation aims to analyse the approaches used by PHC nurses to strengthen patient participation in the context of chronic diseases and to investigate the barriers and enablers that PHC nurses face in their efforts to support patient participation.

__Material and Methods:__ This dissertation involves three methodological approaches: (1) an integrative review; (2) a cross-country qualitative study conducted in Brazil, Germany, and Spain based on semi-structured interviews with a total of n = 57 participants who included both key informants (n = 23) and practicing PHC nurses (n = 34); and (3) an in-depth qualitative study in Spain investigating how PHC nurses adapted their approach to support patient participation during the coronavirus disease 2019 (COVID-19) pandemic. The latter comprised qualitative interviews with n = 13 practicing PHC nurses. All interview data were analysed using thematic coding following the approach suggested by Flick.

__Results:__ The integrative review resulted in a conceptual framework that highlighted areas in which PHC nurses support patient participation. The cross-country qualitative study revealed two interpretive and practice patterns reflecting PHC nurses’ understanding of patient participation: "giving clients orientation in dealing with chronic diseases" and "supporting the integration of illness in clients’ everyday lives." Four categories were identified that provide information on enablers and barriers for PHC nurses’ ability to promote the participation of patients with chronic diseases: “establishing bonds with patients”; “cooperation with relatives and families”; “communication and cooperation within PHC teams”; and the “PHC working environment." The in-depth qualitative study offered insights into the ways in which PHC nurses adapted their approaches to support patient participation in reaction to challenges that emerged during the COVID-19 pandemic.

__Conclusion:__ Strengthening patient participation must be recognised as an area of responsibility for PHC nurses. This goal requires structures that allow these nurses to establish trusting relationships with patients. In addition, research must be conducted to investigate the differences between PHC nurses and patients in terms of their understandings of patient participation and the ways in which it can be supported.