Shared decision-making in healthcare: development and assessment of the translated Finnish version of the SDM-Q-9.

AIMS: The aim of this study was to assess the cultural validity and reliability of a Finnish version of the nine-item Shared Decision-Making Questionnaire (SDM-Q-9) in a sample of patients with different sociodemographic characteristics. METHOD: The original SDM-Q-9 was translated into Finnish with the agreement of the developers of the original scale. The standardised translation procedure was followed by a pilot test of the questionnaire. The data were collected from an online questionnaire. Reliability was estimated by Cronbach's alpha. Structural validity of the questionnaire was assessed by confirmatory factor analysis. RESULTS: The pilot study assessing the cultural validity of the scale was a success, as it did not find any expressions needing to be revised. The Finnish version of the SDM-Q-9 - the SDM-Q-9-FIN - was tested in the study where a total of 736 patients responded to the questionnaire. The questionnaire yielded high reliability with a Cronbach's alpha of 0.92. Confirmatory factor analysis confirmed the unidimensional factor structure with Item 1 excluded. CONCLUSIONS: The SDM-Q-9-FIN was shown to be a reliable instrument for evaluating shared decision-making among Finnish patients. Further testing and research are recommended among a greater diversity of patient groups.

Shared decision-making endorses intention to follow through treatment or vaccination recommendations: a multi-method survey study among older adults.

BACKGROUND: Previous studies have shown that shared decision-making (SDM) between a practitioner and a patient strengthens the ideal of treatment adherence. This study employed a multi-method approach to SDM in healthcare to reinforce the theoretical and methodological grounds of this argument. As the study design, self-reported survey items and experimental vignettes were combined in one electronic questionnaire. This technique aimed to analyze the effects of previous experiences and the current preferences regarding SDM on the intentions to follow-through with the medical recommendations. METHOD: Using quantitative data collected from the members of the Finnish Pensioners' Federation (N = 1610), this study focused on the important and growing population of older adults as healthcare consumers. Illustrated vignettes were used in the evaluation of expected adherence to both vaccination and the treatment of an illness, depending on the decision-making style varying among the repeated scenarios. In a within-subjects study design, each study subject acted as their own control. RESULTS: The findings demonstrated that SDM correlates with expected adherence to a treatment and vaccination. Both the retrospective experiences and prospective aspirations of SDM in clinical encounters supported the patients' expected adherence to vaccination and treatment while decreasing the probability of pseudo-compliance. The association between SDM and expected adherence was not affected by the perceived health of the respondents. However, the associations among the expected adherence and decision-making styles were found to differ between the treatment and vaccination scenarios. CONCLUSIONS: SDM enables expected treatment adherence among older adults. Thus, the multi-method study emphasizes the importance of SDM in various healthcare encounters. The findings further imply that SDM research benefits from questionnaires combining self-report methods and experimental study designs. Further cross-validation studies using various types of written and illustrated scenarios are encouraged.

Learning from fall-related interventions for older people at home: A scoping review.

This scoping review aims to provide a better understanding about the fall-related interventions, and the conditions which stand out as effective in decreasing fall risks of older people at home. A total of 28 peer-reviewed papers were included when they reported interventions with an incidence of falls or fall-risk as a primary outcome for older people, focusing on the home environment, from 8 databases. Qualitative examination was complemented by quantitative risk ratio analysis where it was feasible. The interventions regarding incidence of falls had a mean risk rate of 0.75; moreover, interventions using multiple strategies were found relatively successful. The interventions regarding fall risk had a mean hazard rate of 0.66. A considerable number of no-effect ratios were evident. Combining education, home assessment or improvement, and use of technology with implementation by health service experts appears to be the most promising intervention strategy to reduce falls.

Technology in the Home Care of Older People: Views from Finland and Ireland.

Optimistic expectations of technology can be identified in policy documents, academic centres and businesses that aim to create and promote a variety of technologies so that older people can age at home. This article draws on recent data from Ireland and Finland, two countries at different stages of technological development, to examine the role of technology in the home care for older adults. Research participants (service providers and care recipients) agreed that technology could play an important role by improving communications, enabling social contact, and connecting the 'lone worker' and 'isolated patient' to other stakeholders in home care services. However, participants also had serious concerns around technology. Care was conceptualised as relational and participants expressed apprehension about technology replacing face-to-face contact. Service providers expressed trepidation about the digital divide and technology driving further inequalities in the future. It is important that attempts to develop technology for older adults consider the concerns identified in this study, in order for home care technology to be successfully implemented, widely adopted and meaningfully used.

Proeating disorder websites and subjective well-being: A four-country study on young people.

OBJECTIVE: Proeating disorder (pro-ED) communities online encourage harmful weight-loss and weight-control practices. This study examined the association between exposure to pro-ED content online and subjective well-being (SWB) among adolescents and young adults in four countries. METHOD: Cross-national data were collected in the US, Germany, the UK and Finland from Internet users aged 15-30 years (N = 3,557; 50.15% male). The questionnaire assessed SWB, exposure to harm-advocating websites, online activity, prior victimization, and social belonging. Ordinary least squares (OLS) regression models assessed the relationship between SWB and pro-ED exposure and adjusted for a number of confounding factors. RESULTS: Of the participants, 17% had been exposed to pro-ED content (US 20%, Germany 7%, UK 21%, Finland 22%). Exposure to pro-ED content online was negatively associated with SWB in the US, Germany, and Finland, also after adjusting for the confounding factors. Offline social belonging moderated the association between pro-ED and SWB. DISCUSSION: Participants who visited pro-ED websites reported lower SWB than others did. The potentially harmful impact of visiting these sites was buffered by the strong offline social belonging. Given the observed similarities across the countries, it is important for families, health professionals, and educators to stay abreast of online communities that have possible contra recovery influences and to be able to discuss such Internet contents in a way that increases treatment motivation. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:50-57).

Subjective Rationalities of Nonadherence to Treatment and Vaccination in Healthcare Decision-Making.

Objective: In this short report contributing to the literature on treatment and vaccination adherence, nonadherence was examined from the perspective of decision-making (DM) practice in healthcare. The objective of this study was to survey the rationalities given for treatment nonadherence and their association with DM practice. Methods: The Ottawa decision Support Framework was used as a theoretical background for the study. Multiple choice and open-text responses indicating nonadherence were drawn from vignette survey data. The results have been analyzed and reported as descriptive statistics and findings of data-driven content analysis. The number of observatory units was 1032 in the within-subject study design. Results: DM practice was predominantly associated with nonadherence to vaccination, whereas nonadherence to treatment was consistently associated with attitudinal reasons independent of DM practice. Nonadherence to vaccination was most often rationalized by prior negative experiences in simple DM scenarios. After other DM practices, nonadherence was rationalized by uncertainty and criticism about the benefits of the recommended vaccine. Mistrust toward healthcare providers stood out, first in treatment nonadherence generally and, second, in vaccination nonadherence after simple DM where the final decision was left to the patient. Conclusion: In medical DM, adherence to treatment and vaccination may be achieved through a recognition of patients' previous healthcare encounters and potential trust-related concerns, which could pose a risk for nonadherence. To be able to observe these risks, patient engagement and mutual trust should be priorities in decision support in healthcare.

Research on treatment and vaccination adherence aim at increasing knowledge about improving adherence and treatment outcomes. This study examined explanations given for not adhering to treatment and an association between the explanations and medical decision-making practices. Decision-making practices are known to impact patient­physician interaction and the patients' motivation to have an active role at the appointment. In a shared decision-making (SDM) practice, patients' participation is encouraged. SDM is built on both medical expertise of the practitioner and individual views, values and preferences of the patient. As opposed to SDM, authoritarian decision-making refers to a practice in which decisions are made solely by the physician. In guided decision-making, the physician shares information with the patient but makes the final decision. In simple decision-making, the final decision is left to the patient after consultation. This empirical study used illustrated vignette survey data from Finland. Out of the 1935 respondents, 64% were female with an average age of 68. In the study design, nonadherence was presumed to depend on a decision-making practice presented. Primary findings showed that nonadherence to treatment is most correlated with attitudinal predetermination of the patient and mistrust toward healthcare providers. Nonadherence to vaccination had a stronger association with decision-making practices. After simple decision-making, declining vaccination was most often explained by prior negative experiences and mistrust toward healthcare providers. After other decision-making practices, explanations for declining included uncertainty and criticism about the benefits of the recommended vaccine. This study underscores the pivotal role of trust in the patient-physician interaction.

Experiences of Decision Making and Attitudes Toward Digital Health Services Among Older Adults in Finland.

Shared decision making (SDM) is based on the clinical expertise of healthcare professionals and patients' preferences and values. Digital health services may offer new possibilities for patient-generated data e.g. in SDM. This study aimed to assess older adults' experiences of decision making in healthcare and attitudes toward digital health and social services. Data were collected via an online survey of 629 respondents. Results showed that digital services are considered beneficial, yet half of respondents needed guidance in their use. Many factors affect SDM and the perceived benefits of digital services. Based on our findings digital services are expected to provide guidance and individualised user experience. More research is needed to provide services with equitable access for people with special needs.

Uncertainties about accepting care robots.

In the midst of the anticipation of care robots renewing elderly care, care workers are expected to orient themselves in this future, however uncertain. To examine how uncertainty over the appropriateness of care-robot use associates with robot acceptance, different scenarios of robot assistance were presented to a sample of care professionals in two waves 2016-2020. The views of usefulness of robot assistance yielded underlying structures of plausible and implausible care-robot use. The perceived appropriateness of utilizing robots in care was stronger in the plausible robot scenarios. The uncertainty about robots having an appropriate role in care work correlated negatively with the perceived usefulness of robot assistance, but was even highlighted among the scenarios of implausible tasks. Findings further show how uncertainties about care-robot use have been reduced across four years between data collections. In robotizing care work processes, it may be more beneficial to attempt to convince the care workers who are undecided about robot acceptance than to push care-robot orientation to those who strongly oppose care-robot use.

Positive Turn in Elder-Care Workers' Views Toward Telecare Robots.

Robots have been slowly but steadily introduced to welfare sectors. Our previous observations based on a large-scale survey study on Finnish elder-care workers in 2016 showed that while robots were perceived to be useful in certain telecare tasks, using robots may also prove to be incompatible with the care workers' personal values. The current study presents the second wave of the survey data from 2020, with the same respondents (N = 190), and shows how these views have changed for the positive, including higher expectations of telecare robotization and decreased concerns over care robots' compatibility with personal values. In a longitudinal analysis (Phase 1), the positive change in views toward telecare robots was found to be influenced by the care robots' higher value compatibility. In an additional cross-sectional analysis (Phase 2), focusing on the factors underlying personal values, care robots' value compatibility was associated with social norms toward care robots, the threat of technological unemployment, and COVID-19 stress. The significance of social norms in robot acceptance came down to more universal ethical standards of care work rather than shared norms in the workplace. COVID-19 stress did not explain the temporal changes in views about robot use in care but had a role in assessments of the compatibility between personal values and care robot use. In conclusion, for care workers to see potential in care robots, the new technology must support ethical standards of care work, such as respectfulness, compassion, and trustworthiness of the nurse-patient interaction. In robotizing care work, personal values are significant predictors of the task values.

Finnish healthcare professionals' attitudes towards robots: Reflections on a population sample.

AIM: To answer the question: 'How prepared healthcare professionals are to take robots as their assistants in terms of experience and acceptance?' BACKGROUND: The ageing population, increasing care needs and shortage of healthcare professionals pose major challenges in Western societies. Special service robots designed for care tasks have been introduced as one solution to these problems. DESIGN: A correlative design. METHODS: Eurobarometer data (N = 969) and survey data of nurses and other healthcare professionals (N = 3800) were used to assess the relationship between robot acceptance and experiences with robots while controlling for the respondents' age, gender, occupational status and managerial experience. RESULTS: Healthcare professionals had less experience with robots and more negative attitudes towards them than the general population. However, in healthcare, robot assistance was welcomed for certain tasks. These regarded, for example, heavy lifting and logistics. Previous experiences with robots were consistently correlated with robot acceptance.