Measuring Patient Advocacy Engagement and Identifying Possible Predictors Among Frontline Health Professionals in Acute Care Hospitals

Background. The PCORI Pilot Project, “Improving Healthcare Outcomes Through Advocacy,” validated a Patient Advocacy Engagement Scale that measures the extent social workers, nurses, and medical residents in eight acute care hospitals of different types engage in patient advocacy.  (The development and validation of this scale is discussed in another paper in this Symposium).  Other predictor scales were developed in this project, including ones that measured these healthcare professionals’ ethical commitment to engage in patient advocacy (EC), perceived job supports for advocacy (JS), extent professionals believe they have skills to engage in patient advocacy (SKILLS), the extent they are aware of a wide range of patients’ unresolved problems in their patient loads during the prior two months (AWARENESS), the extent they want to engage in greater levels of patient advocacy in the future (EAGERNESS), organizational receptivity to advocacy (OR), and the extent they believe professionals, generally, seek to empower patients in their hospitals (CONTAGION).

Methods. A sample of 100 nurses, 100 social workers, and 100 medical residents were randomly drawn from the rosters of eight acute-care hospitals in Los Angels County. To assess the relationships between the various predictor variables and the outcome of patient advocacy engagement, a series of descriptive and inferential analyses were conducted, as follows: 1) Pearson’s R on bivariate correlations between all the advocacy measures was computed.  2) Exact test on the statistical significance of the correlations was generated. 3) For each scale, descriptive statistics such as frequencies, mean scores, and standard deviations were calculated by participant groups and/or by hospital setting. 4) Comparison of the mean scores on each scale between the three professional groups was performed using one-way analysis of variance (ANOVA).  Bonferroni Adjustment was used to account for multi-comparisons between groups.  5) General linear multiple regression model was used to identify group-specific variables that are associated with the various predictor scales. A back-wise selection procedure was conducted to identify all significant covariates.  6) How the above-mentioned scales predicted the extent health professionals engage in patient advocacy was investigated using the general linear multiple regression, after controlling for the group-specific variables identified above.

Results. The sample of 300 healthcare professionals was comprised of 70% females and 46% Caucasians. Results of multiple linear regression demonstrate that EAGERNESS SKILLS, and CONTAGION were found to be significantly associated with patient advocacy engagement. No associations were found between patient advocacy engagement and AWARENESS, JS, OR, and EC.      

Conclusion. Patient advocacy engagement is predicted by personal attributes and orientations (SKILLS and EAGERNESS), as well as professionals’ perceptions of the extent peer professionals engage in advocacy (CONTAGION).  These findings suggest that system-wide advocacy training may be a useful tool for increasing health professionals’ engagement in advocacy to the extent they can be taught skills as well as motivation to engage in greater levels of advocacy.  To the extent training leads to higher levels of patient advocacy by peer professionals, specific health professionals may be more likely to engage in it as they believe their peers engage in it.