Patient Involvement – A Service Perspective

........................................................................................................................................................... iii Sammanfattning ............................................................................................................................................ v Acknowledgements .................................................................................................................................... vii List of appended papers ............................................................................................................................ ix List of tables .................................................................................................................................................... x List of figures ................................................................................................................................................. xi 1 Introduction ............................................................................................................................................ 1 1.1 Patient involvement ............................................................................................................................................... 2 1.2 A service perspective on healthcare ............................................................................................................... 3 1.3 Purpose and research questions ...................................................................................................................... 4 1.4 Outline of this thesis .............................................................................................................................................. 5 2 Patient involvement .............................................................................................................................. 7 2.1 Patient involvement as a key concept in quality improvement .......................................................... 7 2.2 Patient involvement research ........................................................................................................................... 8 2.2.1 Patient-­‐centered care ............................................................................................................................ 8 2.2.2 Patient empowerment .......................................................................................................................... 9 2.2.3 Self-­‐management .................................................................................................................................. 10 2.2.4 Shared decision-­‐making .................................................................................................................... 10 2.3 Challenges with patient involvement .......................................................................................................... 11 2.3.1 Attitudes towards patient involvement ..................................................................................... 11 2.3.2 Preparation for involvement ........................................................................................................... 12 2.4 Gaps in healthcare research of patient involvement ........................................................................... 12 3 Theoretical framework ..................................................................................................................... 15 3.1 A service perspective .......................................................................................................................................... 15 3.1.1 Value creation ........................................................................................................................................ 17 3.2 Customer involvement ....................................................................................................................................... 20 3.2.1 A rationale for customer involvement ........................................................................................ 21 3.2.2 Methods for customer involvement ............................................................................................. 21 3.2.3 Degree of involvement ....................................................................................................................... 22 3.2.4 What customers to involve? ............................................................................................................ 23 3.3 Applying a service perspective on patient involvement ...................................................................... 23 4 Research approach ............................................................................................................................. 27 4.1 Background ............................................................................................................................................................ 27 4.2 Methodological considerations ..................................................................................................................... 27 4.3 Research process .................................................................................................................................................. 28 4.4 Reflections on the research process ............................................................................................................. 29 4.4.1 Reliability ................................................................................................................................................. 29 4.4.2 Validity ...................................................................................................................................................... 30 4.4.3 Methodological considerations: Paper A ................................................................................... 30 4.4.4 Methodological considerations: Paper B and C ....................................................................... 30 4.4.5 Ethical considerations ........................................................................................................................ 31 5 Overview of appended papers ........................................................................................................ 33 5.1 Paper A: The antecedents and consequences of patient involvement: A systematic review and thematic analysis. ................................................................................................................................................... 33 5.1.1 Background ............................................................................................................................................. 33 5.1.2 Result and contributions ................................................................................................................... 34