Consensual norms regarding patient involvement.

A stratified sample of 72 nurses, physicians and members of the general public met together in small tripartite dialogue groups each month for 20 months, in order to mutually identify health care behaviors that effectively involve patients in their own health care. Content analysis of 200 hours of verbatim transcripts from the dialogue sessions yielded 1245 patient involvement behaviors. These behaviors were rated by all subjects for their degree of importance within the normative health care relationship through use of a Likert-type inventory. Analysis of the 656 behaviors from the inventory which were classified as essential for effective patient involvement produced 44 clusters, with inter-item correlations ranging from 0.80 to 0.95. Further reduction of the 44 clusters indicated six core clusters, suggesting key norms that existed regarding effective involvement of patients in their own care. Salient norms centered on overt contracts in health relationships, egalitarian communication between patient and professional, patient access to broad-based information, tailoring of treatment programs, self-care and lifestyle modification. The lack of congruence between these norms and the realities of health care is discussed.