title: [Patients' perspectives on behavioral and cognitive changes after hospitalization: a 3-month follow-up cohort study using qualitative and quantitative research methods].
abstract: OBJECTIVE
  To describe patients' subjective perspectives on hospitalization at time of admission, to prospectively investigate patients' views on changes actually achieved after discharge, and to identify predictors of subjective changes 3 months after hospitalization.
  
  
  METHODS
  We conducted a 3-month follow-up cohort study using qualitative and quantitative research methods. Consecutive adult inpatients of an internal medicine ward and a ward integrating internal and psychosomatic medicine were included. They answered open-ended questions concerning their motivation for change at the time of admission (N = 639) using self-report questionnaires and 3 months post hospitalization via a telephone interview (N = 389). Qualitative content analysis was performed. Predictors of subjective change 3 months after hospitalization were identified using multivariate logistic regression analyses.
  
  
  RESULTS
  At admission, more psychosomatic patients than internal-medicine ward patients wanted to achieve change (58% vs. 44 %). Patients expressed desires that were assigned to three main categories: to pay more attention to one's physical health (40 %), to change one's perceptions (32 %), and to change one's way of life (16 %). Three months after discharge, 52 % of patients had experienced cognitive and behavioral changes they attributed to their hospitalization. 31 % of the patients reported continuing to implement changes that had begun during hospitalization. Predictors of subjective change 3 months after hospitalization included high educational level (OR = 2.04, 95 %-CI 1.27-3.26), young age (OR = 0.98, 95 %-CI 0.97-1.00), and length of hospitalization (OR = 1.03, 95 %-CI 1.00-1.05).
  
  
  CONCLUSIONS
  There is considerable motivation for behavioral and cognitive change among inpatients following admission; this deserves the attention of healthcare professionals. An integrated psychosomatic setting would appear to support cognitive and behavioral changes more effectively than a classical internal medicine ward.
authors.affiliation: Klinik für Allgemeine Innere Medizin und Psychosomatik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg. arne.zastrow@med.uni-heidelberg.de
authors.forename: Arne
authors.initials: A
authors.lastname: Zastrow
authors.forename: Franziska
authors.initials: F
authors.lastname: Seyboth
authors.forename: Verena
authors.initials: V
authors.lastname: Faude
authors.forename: Dorothea
authors.initials: D
authors.lastname: Niehoff
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herzog
authors.forename: Bernd
authors.initials: B
authors.lastname: Löwe
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006748:Hospital Departments; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011446:Prospective Studies; D011575:Psychoanalytic Therapy; D011602:Psychophysiologic Disorders / Q000523:psychology* / Q000628:therapy*; D012648:Self Care / Q000523:psychology; D012803:Sick Role