Patient participation is emphasised as an ideal in international health care policies. Yet, some studies suggest that the enactment of patient participation is not always ideal but ‘constrained. Aim: To analyse critically the concept of ‘constrained patient participation’ in health care, from the perspectives of older persons, through a systematic review of qualitative research findings. Methods: Qualitative studies on older persons’ views of participating in their health care were retrieved from four data bases (CINAHL, Pubmed, Web of Science and Scopus). Preliminary definition of ‘constrained participation’ and outlined inclusion and exclusion criteria guided the selection of studies. Then diverse attributes of constrained participation of older persons in health care were identified and contrasted with person-centred participation and analysed through a framework synthesis, drawing upon prior conceptual frameworks. Results: A total of 42 studies met the inclusion criteria for the synthesis. Constrained participation in health care from older persons’ perspectives was found to be characterised by patients experiencing less or more participation than preferred, which most often involved communication struggles between them and health-care professionals. In these instances, the latter either did not allow patients the desired kind/extent of participation or forced them into unwanted participation. Constrained patient participation manifested itself via two constructs: ‘fought-for participation’, or experiencing less participation than preferred, and ‘forced-to participation’. Those were further divided into 3-4 themes respectively. Conclusion: The results challenge earlier concept analyses of patient participation, where these constructs do not appear.

Authors:
Kristin Thorarinsdottir, University of Akureyri, Iceland
Kristján Kristjánsson, University of Birmingham, United Kingdom

About the Presenter(s)
Dr. Kristín Thórarinsdóttir is currently an Associate professor at the Faculty of Nursing, University of Akureyri, Iceland.

See this presentation on the full schedule – Saturday Schedule

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