How do I make my patients part of the solution (co-creation)?
Knowledge database Organisation Leadership & Culture Human Patient-centred approach B.2: Hospital in Motion - Preventing complications through activity monitoring in hospitalLack of exercise among patients in hospitals is a common problem - and this is precisely where an innovative solution comes in: A wearable-based activity monitoring system that records patients' movement and visualises it for both the HCP and the patients themselves.
Problem description, research question and relevance
At the first International Conference on Health Promotion in Ottawa in 1986, health promotion was defined as a process to enable all people to achieve a higher degree of self-determination over their health and thus empower them to strengthen their health (Ottawa Charter on Health Promotion, 1986). Since then, people who receive healthcare services have become increasingly actively involved in the planning of public health activities and healthcare provision, making them co-producers of their own health (Weidinger et al., 2021).
The concept of co-creation is built on this foundation. It is a participatory method. In the healthcare system, the users of healthcare services, such as patients, and the providers, such as doctors or carers, are seen as equal partners. They work together on the development and further development of products or services in order to incorporate the needs of all parties involved and thereby create added value (Spencer et al., 2013; Kuipers et al., 2019).
The healthcare system is constantly changing. A hospital visit is different today than it was ten years ago. Thanks to the wide range of options for providing information to patients, they can also be more actively involved and are therefore more motivated to adhere to the jointly developed treatment pathway. When helping to shape the treatment pathway for patients, it is particularly important and crucial that individual circumstances and possibilities are taken into account (Prahalad et al., 2004).
The promotion of patient self-determination and satisfaction through the co-creation concept should not be underestimated and can also be applied to the issue of promoting physical activity in hospitals. Above all, patients often lack an understanding of the immense importance of exercise, especially if they are bedridden for long periods of time. Exercise plays a key role in maintaining physical and mental health and has a decisive effect on recovery.
This lack of understanding often makes it difficult to motivate patients to become active and exercise. For this reason, it would be particularly useful to actively involve patients in the development of an individualised exercise concept. This would not only allow the background and benefits of exercise to be communicated in an understandable and comprehensible way, but would also allow the specific needs and possibilities of individual patients to be taken into account. Such a participatory approach would not only raise awareness of the relevance of exercise, but also promote intrinsic motivation. Patients could identify better with the concept and perceive it as a personalised tool for their recovery. Ultimately, this approach can make a decisive contribution to sustainably increasing the acceptance of and willingness to exercise.
This knowledge article presents a possible concept and various suggestions on how the concept of co-creation could be implemented in hospitals to promote physical activity and make patients part of the solution.
Methods and procedures in the project
Promoting physical activity among patients in acute hospitals should be a key priority. Motivating people to be physically active is a fundamental interest of doctors in all specialities (Löllgen et al., 2024).
In order to better address the exact needs of patients, it would be useful for them, their relatives and health care professionals (HCPs) to contribute their perspectives in order to jointly develop creative solutions for promoting physical activity.
Sub-project B.2 is developing a possible concept for promoting activity in hospitals. The aim here is to promote physical activity among acute inpatients by wearing an activity sensor and visualising the recorded movement data. The co-creation approach is of particular importance in this context, as the monitoring of patient activity and mobility aims to encourage patients to be more active. To support this goal, the participating patients were continuously surveyed in the validation and integration study about how they felt about wearing and handling the activity sensors in order to incorporate their feedback into the further development process. In addition, a follow-up project is planned to develop an application to visualise the activity data with the help of the patients' feedback in order to present the data in such a way that they can be motivated to move more.
The following points show a possible approach to how the co-creation approach can be integrated into various steps in everyday hospital life to promote physical activity:
Results and findings
1. Education and sensitisation with regard to the topic of physical activity in hospital: Patients and relatives should be sensitised to the topic and the positive effects of exercise in order to promote understanding of the topic and thus motivation to exercise.
- In B.2 , patients were informed in writing, using the patient information leaflet and verbally in order to give them an understanding of the background to the project and to sensitise them to the topic.
- In the future, patients and their relatives could be sensitised by means of posters, flyers and educational talks with doctors in order to promote acceptance and normality in dealing with physical activity in hospital.
2. Creation of a movement-orientated atmosphere by means of:
- Use of activity sensors and an application that encourages patients to be more physically active.
- Setting small and achievable activity goals.
3. Promoting self-efficacy and self-motivation: A key aspect of promoting physical activity is to actively involve patients in their recovery. This can be achieved by giving patients the opportunity to exercise independently and by encouraging them to take responsibility for their own activity:
- Recording and taking into account feedback from patients.
- Setting activity goals for the HCP together with the patients.
Recommendations for practice
The following recommendations for practice can be derived from the above topic:
- Patients should be actively involved in the planning of projects/projects: the patient advisory board can be used as a representative body here.
- Create individualised exercise goals and plans: HCPs and patients should work together to set personalised exercise goals that are adapted to individual interests, abilities and clinical condition.
- Create motivating exercise programmes: together with the patient advisory board, exercise stations, playful programmes or small challenges can be created to encourage patients to be more active and at the same time promote enjoyment of exercise.
- Evaluation of feedback: Questionnaires and feedback can be used to gather ideas and suggestions for improvement regarding the promotion of physical activity. Apps for promoting physical activity can be used here, in which simple feedback options are integrated in order to actively involve patients and track progress.
- Encourage community activity: Group walks or exercise programmes offer the opportunity for social interaction and increase motivation to exercise.
Literature and other sources
for Europe, W. R. (1986). Ottawa Charter for Health Promotion, 1986 (No. WHO/EURO: 1986-4044-43803-61669). World Health Organisation. Regional Office for Europe.
Kuipers, S.J., Cramm, J.M. & Nieboer, A.P. The importance of patient-centred care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting. BMC Health Serv Res 19, 13 (2019). doi.org/10.1186/s12913-018-3818-y Prahalad, C.K. et al. (2004). Journal of Interactive Marketing 18(3): 5-14. DOI: doi.org/10.1002/dir.20015
Löllgen, H., Bachl, N., Pitsiladis, Y., Pigozzi, F., & Casasco, M. (2024). The magical power of physical activity: the ten-pillar model. The Cardiology, 18(1), 74-84.
Schneider, I. T. (2019). Physical activity of older people in hospital: a phenomenological-hermeneutic study (Doctoral dissertation, Dissertation, Halle (Saale), Martin Luther University Halle-Wittenberg, 2019).
Spencer, M. et al (2013). Co-producing services - Co-creating health. Available at: www.1000livesplus.wales.nhs.uk/sitesplus/documents/1011/T4I%20(8)%20Co-production.pdf [18.01.2021}
Weidinger, L., Löffler, K., & Goldgruber, J. (2021). Co-Creation: Shaping health together: Patients and users are actively involved in development. ProCare, 26, 46-49.
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