title: The development and initial validation of a clinical tool for patients' preferences on patient participation--The 4Ps.
abstract: OBJECTIVE
  To report on the development and initial testing of a clinical tool, The Patient Preferences for Patient Participation tool (The 4Ps), which will allow patients to depict, prioritize, and evaluate their participation in health care.
  
  
  BACKGROUND
  While patient participation is vital for high quality health care, a common definition incorporating all stakeholders' experience is pending. In order to support participation in health care, a tool for determining patients' preferences on participation is proposed, including opportunities to evaluate participation while considering patient preferences.
  
  
  METHODS
  Exploratory mixed methods studies informed the development of the tool, and descriptive design guided its initial testing. The 4Ps tool was tested with 21 Swedish researcher experts (REs) and patient experts (PEs) with experience of patient participation. Individual Think Aloud interviews were employed to capture experiences of content, response process, and acceptability.
  
  
  RESULTS
  'The 4Ps' included three sections for the patient to depict, prioritize, and evaluate participation using 12 items corresponding to 'Having Dialogue', 'Sharing Knowledge', 'Planning', and 'Managing Self-care'. The REs and PEs considered 'The 4Ps' comprehensible, and that all items corresponded to the concept of patient participation. The tool was perceived to facilitate patient participation whilst requiring amendments to content and layout.
  
  
  CONCLUSIONS
  A tool like The 4Ps provides opportunities for patients to depict participation, and thus supports communication and collaboration. Further patient evaluation is needed to understand the conditions for patient participation. While The 4Ps is promising, revision and testing in clinical practice is required.
authors.affiliation: Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.|School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
authors.forename: Ann Catrine
authors.initials: AC
authors.lastname: Eldh
authors.affiliation: School of Health and Medical Sciences, Örebro University, Örebro, Sweden.|Family Medicine Research Centre, Örebro County Council, Örebro, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Luhr
authors.affiliation: School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Ehnfors
mesh_terms: D003142:Communication; D032882:Comprehension; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010358:Patient Participation / Q000523:psychology*; D057240:Patient Preference; D036301:Qualitative Research; D012648:Self Care / Q000523:psychology*; D011795:Surveys and Questionnaires; D013548:Sweden
keywords: clinical tool; content validity; instrument development; patient participation; qualitative analysis