RESEARCH PAPER PRE-MSC CHANGE MANAGEMENT
HOW DO HEALTHCARE PROFESSIONALS RESPOND TO
EMPOWERED PATIENTS BY THE USE OF SOCIAL MEDIA
IN RELATIONSHIP WITH THEIR PATIENTS?
Student Name: Marion Barendregt Student Number: S3231933 Course Code: EBS006A10
Course Name: Research Paper for Pre-MSc BA Specialization: Change Management
Date: 9th of June 2017
TABLE OF CONTENT Table of content ... 3 1. Introduction ... 4 2. Research Framework ... 6 2.1 Literature ... 6 2.1.1. Patient ... 6 2.1.2. Patient empowerment ... 7 2.1.3. Healthcare professional ... 8
2.1.4. Doctor – patient relationship ... 8
2.2 Research Question ... 9 3. Research Design ... 10 3.1 Research Method ... 10 3.1.1. Data collection ... 10 3.1.2. Data analysis ... 11 3.1.3. Participants ... 11 3.2 Limitations ... 12 4. Result Analysis ... 13
4.1 Patient’s empowered behavior ... 13
4.2 Effect of patient empowerment on physiotherapy ... 14
4.3 Influences on the relationship ... 15
4.4 Additional findings ... 16
5. Discussion ... 17
5.1 Limitations and Further research ... 18
6. Conclusion ... 19
7. Reference list ... 20
8. Appendices ... 23
8.1 Appendix 1 – Interview Guide ... 23
8.2 Appendix 2 – Code Book ... 25
8.2.1. Social media ... 25
8.2.2. Patient empowerment ... 26
1. INTRODUCTION
he social media makes it possible for the healthcare to respond to more demanding patient expectations (Bugshan, Hajli, Xiaolin, Featherman, & Cohen, 2013). The healthcare organizations are aware of the fact that patients are going on the internet in searching for and sharing information (Yamout, Glick, Lind, & Monson, 2011). Traditionally, healthcare professionals are the patient’s most reliable source of health-related information (De Rosis & Barsanti, 2014). Greater accessibility to the internet and the broad availability of online health-related information have provided a new source of health knowledge for people (De Rosis & Barsanti, 2014). Smailhodzic, Hooijsma, Boonstra and, Langley (2016) state that by using the social media platforms patients enhance empowerment. Patient empowerment can be defined as a process through which people gain greater control over decisions and actions affecting their health (Nutbeam, 1998). Patient empowerment increases when patients have the ability to participate in decision making and patients self-awareness of managing their own life raises (Smailhodzic et al., 2016). Patient empowerment can affect the relationship between doctor and patient.
A number of cross-sectional studies suggest an association between patient empowerment and the relationship of doctor-patient (Stanger, 2015; Johnson & Ramaprasad, 2000; Lober & Flowers, 2011; Smailhodzic, et al., 2016). Due to the upcoming use of social media by patients, patients become more empowered. Most research on social media, patient empowerment and the doctor-patient relationship is done from the perspective of the patient instead of the healthcare professional. Although some research has been carried out on the relationship between patient empowerment and the doctor-patient relationship, there has been none empirical investigation into the role of physiotherapists in particular. According the convenience sampling the participating physiotherapists are chosen on their availability and access. The emerged research gap is interesting for empirical and medical field. This denotes to the conducted research question: How do healthcare professionals respond to empowered patients by the use of social media in their relationship? The aim of this research paper is to explore the response of physiotherapists on patient empowerment by the use of social media, and the influences on their doctor-patient relationship.
The contribution of this research has two perspectives. First from the academic point of view, by investigating the research gap of the relationship between physiotherapists’ response on empowered patients, and the doctor-patient relationship. Secondly, specified view of the physiotherapists has a beneficial approach for the sector of healthcare. The results provide new insights on how to handle with empowered patients and how their relationship can contribute by patient empowerment.
2. RESEARCH FRAMEWORK 2.1 LITERATURE
ocial media is of interest for the healthcare for several reasons which will be described in this paragraph. Social media has multiple descriptions which are mostly mentioned in the description of Kaplan and Haenlein (2010). In this research social media will be referred as: “A group of interest-based applications that build on the ideological and technological foundation of Web 2.0, and that allows the creation and exchange of user generated content” (Kaplan & Haenlein, 2010). Prior research confirms that Web 2.0 is an alternative network effect. It enables large numbers of individuals to unite and collaborate around a common resource(Amol, 2006).
According to Lober & Flowers (2011) specific to the health care, patients use social media to share their experiences, reach out for information and opinions, and engage with peers and providers. Social media exists from social communication, nowadays more social communities are built so that empower patients can share their personalized health information (Bugshan et al., 2014). The success of social media is related to their ability to facilitate talking as well as listening, consuming and participating (Eytan, Benabio, Golla, Parikh, Stein, 2011). Social media turns communication into an interactive dialogue. Before mentioned are two reasons behind the rapid and extensive penetration of social media into our culture, and into health (Lober & Flowers, 2011). According to Gibbons et al. (2011) individuals who access social applications for health reasons are helped by the comfort that they experience in findings social support. This is expressed in expanding their knowledge by finding answers from other individuals, and thus feel empowered and more personally involved in the management of their health (Gibbons et al., 2011). The advancements in ICT and the emergence of Web 2.0 have empowered individuals to have social interactions and generate content on the internet (Bugshan et al., 2014). People are eager to receive informational and emotional support on social media websites (Bugshan et al., 2014).
2.1.1. PATIENT
mentioned that patients have a right to choose a doctor, and doctor and patient share the same goals since the main goal of being a patient is relief of illness. Nowadays, a growing group of patients now execute their tasks of gathering and sharing information, and making decisions about their health, using a broad range of devices capable of supporting Web interactions (Lober & Flowers, 2011).
2.1.2. PATIENT EMPOWERMENT
There are several definitions of patient empowerment. Rappaport, Swift and Hess (1984) refer to empowerment as the process by which people, organizations and communities gain control over their lives. Although, in this research patient empowerment will be denoted as follows: “The process through which people gain greater control over decisions and actions affecting their health” (Nutbeam, 1998). Patient empowerment occurs according to Lober and Flowers (2011) as follows, ways in which patients explore to gather information and make health care decisions, increasingly in the places and times of their own choosing, and increasingly going beyond the traditional health care relationships by engaging family, friends, and strangers. From the results’ perspective, patient empowerment can be seen as a outcome of the integration of information and communication technologies into health care practices: in searching for and sharing information on internet, and using social media to create new types of interactions (Yamout, Glick, Lind, Monson, & Glick, 2011).
2.1.3. HEALTHCARE PROFESSIONAL
A healthcare professional is a person associated with either a specialty or a discipline and who is qualified and allowed by regulatory bodies to provide a healthcare service to a patient (Segen's Medical Dictionary, 2012). The concerns of patient empowerment by physicians are that information on the internet can mislead patients (Diaz, Griffith, Reinert, Friedmann, & Moulton, 2002). This let them fear for aggressive patients in order to the available time for a consult. Even so, the physicians might perceive the empowered patient to be a threat to their authority, even though they still have the power to write prescriptions. Last, physicians mention the danger of self-diagnosis and subsequent self-treatment with the unbridled availability of information. In contradiction, healthcare professionals must remember that empowerment is about redistributing, or restoring, a fair balance of power (Toofany, 2006). Even so, empowerment in healthcare systems requires healthcare professionals to engage sincerely with their clients, and that clients develop new ways of thinking and behaving (World Healthcare Organization, 1997). Physicians should know what online resources are available, be a mentor for more informed or curious patients, guiding them to reliable and accurate websites, and discuss the information they find online (Diaz et al., 2005; Zablocki, 1998; Hannan & Celia, 2013). The sample of this research is concentrated on the physiotherapist. The physiotherapist helps patients in their consult to relief them of disease, bodily defects, or bodily weaknesses by providing physical remedies, massage, and special exercises (Ologies & Isms, 2008).
2.1.4. DOCTOR – PATIENT RELATIONSHIP
2.2 RESEARCH QUESTION
3. RESEARCH DESIGN 3.1 RESEARCH METHOD
he research has a qualitative approach, the researcher performs a case study to explore the relationship between the response of healthcare professionals on patient empowerment and the influences on their doctor-patient relationship. Qualitative data help researchers to get beyond initial conceptions and to generate or revise conceptual frameworks (Miles & Huberman, 1994). A major advantage of the case study approach is that it investigates ‘how’ and ‘why’ questions, and is suitable for developing new theories and ideas. This is suitable for the research. The case study need five interviews, according to the convenience sample held with physiotherapists. Before the interviews where set, there were some criteria the physiotherapists practice had to take into account. The first criteria, the amount of working people in the practice needs to be at least three physiotherapists. Second, the minimum number of participant in the practice needs to be two. Last, the participants need to have experience with the influences of social media usage by patients.
3.1.1. DATA COLLECTION
The data collection is done by interviews. The semi-structured approach was chosen because it will help to uncover the story behind a participant’s experiences (Miles & Huberman, 1994). The interview guide in appendix one shows the questions which are conducted for the interviews. Beforehand the interview guide is made based on three different topics to structure the interviews. The topics and questions are partly based on the information collected by literature review. The literature review is done by the following sources: peer viewed papers, journals and medical magazines. Since the interview is semi-structured there is place for closed- and open questions. The researcher conducted twenty-two questions from where five of them are closed. The three topics to divide the questions are: social media use by patients, response on empowered behavior of patients, and last the relationship between patients and doctor.
First in the process of data collection, the participants were informed about the general topic of the investigation. As another conformation that they agree to participate they signed the informed consent provided by the RUG. The data was collected anonymous from five physiotherapists. The data were recorded on a digital audio recorder and transcribed by the interviewer. The interviews
were done on four different days, namely Wednesday the 17th of May, Friday the 19th of May, Monday the 22th of May, and Wednesday 24th of May. Three interviews went through Facetime since there was limited time to make an appointment in person, or they had walk-in hours. The other two interviews were held in person. The interviews last on average thirty-nine minutes. The first interview last longest, namely 47 minutes.
3.1.2. DATA ANALYSIS
By analyzing the results of the semi-structured interview, the participant will make an extension on the existing theory. As part of the data analysis the interviews are transcribed. The interviewees have the possibility to read the transcript and adjust or modify the results. The physiotherapists will be referred to by “Interviewee …, 2017”, the number is added based on the order of interviews. Prior to analyzing the interview data, the transcripts were checked for the experience with the use of social media by patients, effects of behaviors of empowered patients mentioned by the physiotherapists, and the influences which empowered patients have on the doctor-patient relationship. The results were conducted in the code book, since coding offered the researcher a formal system to organize the data obtained (Bradley, Curry & Devers, 2007). The codebook is visible in appendix two. The results can help healthcare professionals to respond correctly on the patient empowerment. Even so, it will exhibit insights in the contribution to their relationship.
3.1.3. PARTICIPANTS
service is somewhat different from the regular physiotherapists, based on mostly chronical illness of patients.
3.2 LIMITATIONS
4. RESULT ANALYSIS
he first set of questions aimed to answer the specializations of the physiotherapists and their experience on their job and in training. The experience as physiotherapists is close to five years for four out of the five participants. One is working in the field for twenty-seven years.
4.1 PATIENT’S EMPOWERED BEHAVIOR
The theme of patient empowerment recurred throughout the dataset. All participants agree upon the fact that empowered patients are better informed by the use of social media. Even though, three out of ten patients are making actively use of social media. Since a couple of years ago this difference is visible. Especially the intention for the consult of the patient, based on getting confirmation on their assumptions and expectations. This view was echoed by one participant: “Patients ask questions about their findings, instead of the physiotherapist who has to ask questions to pick up the underlying problem” (Interviewee three, 2017). This result assumes that patients move to more equal communication in the consult. From a positive perspective on empowered patients, the participants were unanimous in the view that educated patients mostly have a positive influence on the outcome of the consults. Especially, patients are in most situations better to guide through (alternative) treatments since they already read about those treatments on the internet.
In contradiction, there are some negative responses on empowered patients. The physiotherapists experienced that their expertise is doubted by some patients. In addition, patients’ own social media findings are prominent throughout the treatment. Two out of five participants mentioned: “Patients are hard to guide since they are convinced about their findings on a particular treatment, they are stuck in their findings” (Interviewee four, 2017). If patients’ expectations are not similar with outcome of the consult, patients can behave disappointed towards the physiotherapist. This behavior implies a negative response on the use of social media for making decisions according the treatment. To illustrate a contradiction, three out of five participants mentioned the experience that patients in most cases are still passive and rely on the expertise of the physiotherapist. This contradiction can be nuanced by the number of experiences with empowered patients in consults. Another effect encountered by the participants, some patients show the disability to judge their findings on the internet in relation to their own situation. Echoed by one participant: “Through misleading word choices or wrong information via social media, patients are not able to judge if the treatment fits
their situation” (Interviewee two, 2017). In addition, this results in the fact that patients often expect the worst case scenario. Namely, one participant state: “Her own view about her complaint is not clear to her, but still she stays at her own conclusion about having arthrosis. Even after the scans excluded her conclusion, she still comes to consults with research and treatments based on arthrosis” (Interviewee five, 2017). These results indicate that patient’s ability to criticize their findings is a negative response on patient empowerment.
New insights came to light when three out of five participants’ mentioned that social media can lack to provide useful information. This can negatively affect the dialogue with the physiotherapist. One participant argues on the behavior of patients, “Since patients found alternative treatments on the internet, the needed regular physiotherapy will not be their first choice, even though this will contribute to their complaints” (Interviewee five, 2017). This is argued by other participants, since this possess a minimum number of patients. These findings presume that patients can be misguided by the internet.
4.2 EFFECT OF PATIENT EMPOWERMENT ON PHYSIOTHERAPY
4.3 INFLUENCES ON THE RELATIONSHIP
4.4 ADDITIONAL FINDINGS
5. DISCUSSION
his review provides an insight into the current body of knowledge on the response of healthcare professionals on patient empowerment, based on the use of social media for health related information, and the effects on the patient-physiotherapist relationship. The results are conducted from the profession of physiotherapists. The findings of the investigation demonstrate an overall positive response to changed patient behavior. The key findings about the changed patient behavior are that patients are more educated, move towards equal communication and are in most cases capable of making own healthcare decisions. In the negative occurrences, patients rely less on the physiotherapists expertise, however more on the internet. This causes problems, namely that patients are disable to judge their findings on their own situation, mostly patients rely on worst situational findings. This can affect the decisions making according treatments. In order to the doctor-patient relationship, positive findings on the social media causes extremely positive behaviors and outcomes. Even so, the physiotherapists’ ability to manage patients’ expectations will cause a good relationship with the patient. Whereby negative findings can lead to extreme negative behaviors and outcomes. Even so, patients will switch from physiotherapist. The researcher identified that the role of physiotherapist changes to an advisory role, and more often hands-off therapy. To respond to this change, physiotherapists are obligated to keep learning and practicing to still provide hands-on therapy.
The results from this investigation demonstrate that physiotherapists indicate that patients show educated behavior, equal communication and power in the decision-making. According to the literature social media used by patients for health related reasons can lead to patients who may increasingly interact with their healthcare professional and get more involved in the decision making process (Colineau and Paris, 2010). This effect refers to patients feeling more confident in their relationship with the healthcare professional (Smailhodzic et al., 2016). The researcher of this investigation positively supports the findings about patient’s equal communication and the power in decision making also can be applied to physiotherapists relationship with the patient.
Another important aspect to be mentioned in the discussion is empowerment of patients. According to Nutbeam (1998), empowerment determines the motivation and ability of people to gain access to information, and to understand and critically use this information in ways which promote and maintain good health. The research argues on patients’ understanding and critical use of information,
results show disabilities by patients in their judgement. Nutbeam (1988) add that by use in a critical way, healthcare professionals can facilitate success and the process of empowerment. This conclusion is supported by the researcher since it can contribute to the doctor-patient relationship.
Findings in the article of De Rosis and Barsanti (2011) shows how healthcare professionals should manage patient empowerment. According to the article “The virtuous circle of appropriate empowerment through the internet requires healthcare professionals to play an active role, they should know what online resources are available, be a mentor for more informed or curious patients, guide them, and discuss the information they find online” (Diaz et al., 2005; Zablocki, 1998; Hannan, Celia, 2013; De Rosis, & Barsanti, 2012). In case of physiotherapists, they have to support the virtuous circle to manage the expectations of patients.
5.1 LIMITATIONS AND FURTHER RESEARCH
In this investigation there are sources of error which suggest further research. One of the main errors indicate that the sample is limited, namely five interviewees. Based on the available time and accessibility of the physiotherapists, this amount is chosen. The sample has several limitations, namely there is a narrow focus on physiotherapists instead of the healthcare professionals. Consequently, the results of this paper might not be generalizable for the healthcare professionals. Another limitation of the sample is that the practices are in and around the city of Groningen, whereby possibly only a minor amount of the Dutch physiotherapist practices can be represented. Due to limited time, it was not possible to investigate the significant relationships of patient empowerment and the patient-physiotherapist relationship further.
6. CONCLUSION
rom the researcher’s point of view the physiotherapists named the positive attitude towards empowered patients. Most patients are able to have equal communication and make decision according their health. Unfortunately, this view is not decisively for the response of physiotherapists. The social media findings are sometimes prominent to the patients. They show disability to judge their findings and changed their behavior negatively towards a critical attitude. This can cause negative effects on the outcome of the relationship with physiotherapists.
The use of social media causes expectations by the patients who are divided into right or wrong. The profession of physiotherapists is challenged to manage these expectations of patients. The virtuous circle needs to be applied which will contribute to success of the treatment and processed empowerment.
7. REFERENCE LIST
-
Amol, D., (2006). Web 2.0: Could it help move the health system into the 21st century? Journal of Men’s Health and Gender 3, pp. 332–336.-
Aral, S., Dellarocas, C., Godes, D. (2013). Introduction to the Special Issue—Social Media and Business Transformation: A Framework for Research. Information Systems Research 24, 3-13.-
Andreassen, H.K., Bujnowska-Fedak, M.M., Chronaki, C.E., Dumitru, R.C., Pudule, I., Santana, S., Voss, H., Wynn, R. (2007). European citizens’ use of E-health services: a study of seven countries. BMC Public Health 7, 53.-
Batifoulier, P. Domin, J., Gadreau, M., (2011). Market empowerment of the patient: French experience. Review of social economy 22, 2.-
Bowes, P., Stevenson, F., Ahluwalia, S., Murray, E. (2012). I need her to be a doctor: patient’s experiences of presenting health information from the internet in GP consultations. British Journal of General Practice, 732–738.-
Bugshan, H.N., Hajli, M., Xiaolin, L., Featherman, M.C.I., Cohen, I. (2014). Social media for developing health services. Qualitative Market Research: An International Journal 17, 283 – 296.-
Colineau N, Paris C. (2010). Talking about your health to strangers: understanding the use of online social networks by patients. New Rev Hypermed Multimed 16, 141–60.-
De Rosis, S., & Barsanti, S. (2014). Patient satisfaction, e-health and the evolution of the patient-general practitioner relationship: evidence from an Italian survey. Elsevier: Health policy 120, 1279–1292.-
Diaz, J.A., Griffith, R.A., Ng, J.J., Reinert, S.E., Friedmann, P.D., Moulton, A.W. (2002). Patient’s use of the internet for medical information. Journal of the society General Internal Medicine 17, 180-185.-
Eytan T, Benabio J, Golla V, Parikh, R., Stein, S. (2011). Social Media and the Health System. The Permanente Journal 15, 71-74.-
Gibbons, M.C., Fleisher, L., Slamon, R.E., Bass, S., Kandadai, V. & Beck, J.R. (2011), Exploring the potential of Web 2.0 to address health disparities, Journal of Health Communication 16, 77-89.-
Hannan, T.J., & Celia C. (2013). Are doctors the structural weakness in the e- health building? Internal Medicine Journal 43, 1155–1164.-
Johnson, G.L., & Ramaprasad, A., (2000). Patient-physician relationships in the information age. Marketing health services, 21 – 24.-
Kaplan, A.M., & Haenlein, M. (2010). Users of the world, unite! The challenges and opportunities of Social Media. Business Horizons 53, 59-68.-
Lenert, L. (2009). Transforming healthcare through patient empowerment. Information Knowledge Systems Management 8, 159-175.-
Lober, W.B., & Flowers, J.L., (2011). Consumer empowerment in health care amid the internet and social media. Seminars in Oncology Nursing 27, 169-182.-
Meisel, Z.F. (2011, January 19th). Googling symptom: how it can help patients and doctors. Available at: http:// http://content.time.com/time/health/article/0,8599,2043125,00.html.-
Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis: An expandedsourcebook. San Diego: Sage Publications Inc.
-
Murray, E., Lo, B., Pollack, L., Donelan, K., Catania, J., Lee, K., Zapert, K., Turner, R. (2003). The Impact of Health Information on the Internet on Health Care and the Physician-Patient Relationship: National U.S. Survey among 1.050 U.S. Physicians. Journal of Medical Internet Research 5, 17-
Nutbeam, D. (1998). Health Promotion Glossary. WHO/HPR/HEP/98.1. Geneva: World Health Organisation.-
Normann Andersen, K., Medaglia, R., Zinner Henriksen, H. (2012). Social media in public health care: impact domain propositions. Government Information Quarterly 29, 462–469.-
Rappaport, J., Swift, C., Hess, R. (1984). Studies in empowerment: steps towardsunderstanding and action. New York: Hawthorn Press.
-
Smailhodzic, E. Hooijsma, W., Boonstra, A., Langley, D.J. (2016). Social media use in healthcare: A systematic review of effects on patients and on their relationship with healthcare professionals. BMC Health Services Research 16, 442.-
Stanger, J. (2015). Why your employees may be their own best care managers. Benefits magazine 52, 14-19.-
Stewart, M. (2001). Towards a global definition of patient centred care. British Medical Journal 322, 444-445.-
Tomes, N. (2006). Patients or health-care consumers? Why the history of contested terms matters. In: History and health policy in the United States. Putting the past back in (pp. 83-110). New Brunswick, NJ: Rutgers University Press.-
Toofany, S. (2006). Patient empowerment: Myth of reality? Nursing management 13.-
Ulrike, F., Lisa, G., Astrid, M. (2009). Shaping the future e-patient. The citizen-patient inpublic discourse on e-health. Science Studies 22, 24–43.
-
Wade, J.C. (1995). The Patient/Physician Relationship: One Doctor's View. Health Affairs 14, 209-212.-
Wald, H.S., Dube, C.E., Anthony, D.C. (2007). Untangling the Web—the impact of Internet use on health care and the physician-patient relationship. Patient Education and Counseling 68, 218–24.-
World Health Organization (1985). Health for All: Policy framework for the WHO European region. Geneva: World Health Organization.-
Yamout, S.Z., Glick, Z.A., Lind, D.S., Monson, R.A.Z., & Glick, P.L. (2011). Using social media to enhance surgeon and patient education and communication. Bulletin of the American College of Surgeons 96, 7–15.8. APPENDICES
8.1 APPENDIX 1 – INTERVIEW GUIDE First appendix describes the interview guide.
Interviewer: Marion Barendregt
Interviewee: … Function: Fysiotherapeut Date: … mei 2017 Time: …… Control:
-
Respondent’s commitment for recording.-
Recorder works,First, I want to thank you for the participation on this investigation. I’m Marion Barendregt, student of the pre-master program Change Management on the faculty of Economics and Business Administration at the Rijks University Groningen.
In the context of my graduation I’m going to investigate the impact of social media on health care. Whereby my focus of the investigation will be on the response of general practitioners on patient empowerment. And the possible influence which the response of general practitioners will have on the relationship between general practitioner and patient. You agreed to the fact that I can record the interview. The records will be used to transcript the interview. Naturally the results will only be used for this investigation. The interview is confidential and your statements will be changed so it is not traceable. The interview takes as maximum 45 minutes of your time.
The interview is divided in four parts, first some general questions about your profession and the practice. Followed by questions about the use of social media inside the practice. Next to that the patient empowerment, how this is visible inside the practice and how this possibly affect your profession. Last about the relationship between you as a general practitioner and the patient.
First, the general questions.
1. What is your specialization in physiotherapy?
2. How many years do you have experience as being a physiotherapist? 3. How many years are you here for in this practice?
Specific questions about social media use.
1. In what way does the practice use social media?
2. What is your own experience with social media for work?
3. Which conversations do you have with colleagues about social media in health care? 4. How is social media a topic of the future according to education or training?
Specific questions about social media experience.
5. What is your experience with patient who make use of social media?
6. Have you experienced a change in the behaviours of patient because they use social media? And how is this change visible?
7. How do you expect in the future the behaviours of patients will change by using more social media?
Specific questions about patient empowerment. Patient empowerment can be descibed on several ways, the most comprohensive way is how patients on several ways can discover to collect information and how those information is used to make decision according their care.
-
Which behaviors of patient empowerment do you notice by patients?-
In your opinion, how is the decision making power of educated people changed in the last years?-
How does the financial situation influence the decision making power of patients?-
Which changes do you expect for the future?-
To your opinion, how can the job of physiotherapist be changed due to patient empowerment? Specific questions about the relationship physiotherapists – patient.-
How is the relationship changed since they make use of social media and are more educated?-
Which expectations do you have about the future over the use of social media and empoweredpatient?
8.2 APPENDIX 2 – CODE BOOK
8.2.1. SOCIAL MEDIA
Code Description Example one Example two
Social media:
Use by physiotherapy practices.
SM/PP
Social media medium used inside
physiotherapy practices are the website of the practice and Facebook page to reach customers and to inform them about services.
“We make use of the website on which we advertise, sell articles and provide the possibility to plan appointments. Next to that we use Facebook to promote our services or when there are new researches on interesting fields which are useful for patients to know” (Interviewee one, 2017).
“Inside the practice we use Facebook to inform patients about new treatments, or information according to the
insurance. Next to that we use a website” (Interviewee three, 2017) Social media: Change of function physiotherapist. SM/CFP The function of physiotherapist is changed due to the use of social media by patients, physiotherapists have to prove their expertise.
“Patients are not directly convinced about the opinion of the physiotherapist. If the patient feels the physiotherapist is not doing well, they will search and confront the physiotherapist with it. Patients became more critical” (Interviewee three, 2017).
“On the other hand it is annoying, one the moment that patients are convinced to receive a specific treatment which I’m not sure about, patients challenge your expertise” (Interviewee 4, 2017).
Social media:
Patients exercises.
SM/PEX
Social media contributes to the exercises or keeping rest since already read about them on internet, and
“When social media shows that they need to take rest for example, patients come back to those findings when we advise them rest, ‘I
“People who search on the internet by their self, are mostly more active in
doing exercises. This
physiotherapist confirms those exercises.
already read this on the internet’. Patients are more seeing the purpose of rest after reading it on beforehand”
(Interviewee one, 2017).
recovery” (Interview four, 2017).
Social media:
Future of e-consults
SC/FEC
The future of social media in the physiotherapy is e-consults, the possibility for patients to have an appointment through the internet. This will be payable but less accurate in designating the problem.
“Personally I think that it will be easier to reach a bigger audience and to be more affordable when the e-consults come up. This will be good for the future” (Interviewee four, 2017)
“I really think that e-consults can be more affordable but I’m scared for the consequence that valuable information will be missed” (Interviewee five, 2017).
8.2.2. PATIENT EMPOWERMENT
Code Description Example one Example two
Patient Empowerment:
Expectation management.
PE/EM
The best way to control the patient in patient empowerment is to guide them through expectation management.
“On the moment that patients searched on the internet, and made themselves some assumptions and expectations, you have to start with guiding them through expectations management”
(Interviewee two, 2017).
“Patients who search on the internet is a good thing in the sense that they create expectations since its good informed. Hereby you only have to guide them through the treatment” (Interviewee four, 2017). Patient empowerment: Negative influence of disability of judgement. PE/NID Patient empowerment gives patients an educated feeling based on social media findings, whereby patients show
“Through misleading word choices or wrong information via social media, patients are not able to judge if the
disability in judging the findings.
treatment fits their situation” (Interviewee two, 2017).
Every complaint is linked to cancer” (Interviewee five, 2017). Patient empowerment: Negative influence on relation patient-physiotherapist PE/NRPP Patient empowerment in the dialogue causes the negative influence on the relation of patient-physiotherapist due to the persistence of the patient.
“Her own view about her complaint is not clear to her, but still she stays at her own
conclusion about having arthrosis. Even after the scans excluded her conclusion, she still comes to consults with research and treatments based on arthrosis” (Interviewee five, 2017).
“On the moment that patients read negative stories, they offer more resistance and are more critical towards the treatment. They ask there selves if they are on the right place for their recovery” (Interviewee two, 2017).
Patient empowerment:
Future perspective.
PE/FP
The future will be that patients search on the internet and come to the consult with their treatment preferences based on their
complaints. Whereby the patient will more
influence their power in decisions.
“I expect the patient to come to the consult whereby they give information about the treatments based on their complaints. In the future the patient will get more power to make the decisions about the treatments” (Interviewee five, 2017).
“As physiotherapist you have to keep learning and practicing, otherwise you will lose customers and are not able to keep up with the competitors. Nevertheless, it won’t be possible to keep stand up towards social media usage” (Interviewee one, 2017).
Patient empowerment:
Insurance coverage.
PE/IC
The insurance coverage really is an important new insight from this research, patient’s insurance covers a X number of consults, when those coverages are over, patients stop with following the treatment.
“If patients’ insurance covers nine consults, then they expect to have a consult once in the two weeks and their problem to be solved after nine times. They expect an effective treatment” (Interviewee three, 2017).
8.2.3. DOCTOR-PATIENT RELATIONSHIP
Code Description Example one Example two
Doctor-patient relationship:
Hands-off therapy.
DPR/HOF
The relationship between patient and
physiotherapist is in some cases changed due to use of social media, whereby the role of physiotherapist is more hands-off.
“Nowadays,
physiotherapy is hands-off whereby two to six consults give
information and guide patients through treatments. The hands-off approach will still change since internet plays an important role in the information provision. If you look at it that way, in ten years we will be unemployed.” (Interviewee one, 2017). Doctor-patient relationship: More equal communication. DPR/EC
The consult with the physiotherapist consists of a dialogue whereby the patient nowadays tells the findings on the internet as input, whereby the
physiotherapist rates the useful information. This consists more equal communication in the doctor-patient relationship.
“Most patients come to the counter and know which person they want to have the treatment with. And most of them come to get extra information. They ask for confirmation on special complaints or diagnosis and alternative treatments if suitable for them” (Interviewee one, 2017)
“The patients come to the consult with expectations, they want to have
confirmation or discussion about their findings. They continuously ask
