Langsigtet udbytte af patientuddannelse

Abstract

Resumé Baggrund Antallet af personer, der lever med en kronisk sygdom, er stigende i Danmark. 70-80 % af sundhedsvæsenets ressourcer anvendes på personer med kroniske sygdomme. Patientuddannelse udgør én type forebyggelses- indsats, der er rettet mod håndtering af kroniske sygdomme. Imidlertid mangler der viden om virkningen af patientuddannelse på lang sigt. Da kronisk sygdom i reglen er livslang, er det paradoksalt, at betydningen af patientuddannelse kun er undersøgt på relativt kort sigt. Formål Formålet med specialet er at undersøge hvilket langvarigt udbytte tidligere deltagere på patientuddannelse oplever i deres hverdag. Endvidere undersøges med afsæt tidligere deltageres forandringsforslag, hvordan det langsigtede udbytte af patientuddannelse kan fastholdes. Endeligt undersøges hvordan hverdagslivsteori kan bidrage til at forstå udbyttet af patientuddannelsen og understøtte forandringspotentialet. Metode Via systematisk litteraturstudie afdækkes kvalitative studiers rapportering af langsigtet udbytte af patientud- dannelse. Gennem fænomenologisk interviewundersøgelse undersøges oplevelse af udbytte efter deltagelse i patientuddannelse to-tre år tilbage blandt otte tidligere deltagere. Endelig foretages en teoretisk analyse af deltagernes oplevede udbytte og de foreslåede forandringspotentialer med afsæt i Birte Bech Jørgensens hverdagslivsteori. Resultat Litteraturstudiet peger på deltagere på patientuddannelse stadig efter et år oplever øget kontrol, øget evne til at passe på sig selv, øget fysisk aktivitet og socialt udbytte i hverdagen. Interviewundersøgelsen viser at informanterne primært oplever udbytte i relation til fysisk aktivitet og kost. Endvidere oplever flere infor- manter et socialt og mentalt udbytte, og særligt deltagere med KOL oplever betydningsfuldt mentalt udbytte. I forhold til forandringsperspektivet viser den empiriske undersøgelse at deltagerne generelt efterspørger en fortsættelse af det eksisterende træningstilbud og efterspørger mere praktisk undervisning i madlavning. Resultatet af den teoretiske analyse viser at det langvarigt udbytte af patientuddannelse kan forstås som et resultat af sygdomsrelateret forandring i hverdagen. Patientuddannelse kan i den forbindelse betragtes som et meningsgivende tilbud om sygdomshåndtering. Gennem intenderet håndtering og justering af daglige va- ner, har informanterne tilpasset deres hverdag til livet med sygdom. Da disse håndteringer og justeringer blev oplevet som meningsfulde blev de fastholdt. Konklusion På baggrund af specialets resultater kan der konstateres en klar tendens til at deltagere på patientuddannelse oplever et langvarigt udbytte i relation til motion, kost, sociale og mentale områder. Der kan peges på, at fortsættelse af et træningstilbud i lighed med uddannelsens formentlig vil bidrage til fastholdelse deltagernes udbytte på længere sigt. Specialets teoretiske analyse peger på at udbyttet kan forstås som et resultat af informanternes intenderede og upåagtede håndteringer af kronisk sygdom og hverdagens vaner som betin- gelse og at patientuddannelse formentlig har langsigtet virkning, fordi den opleves som meningsgivende.

Abstract Background The number of people living with a chronic disease in Denmark is increasing. Furthermore, it is estimated that 70-80% of the resources spent on health-care are related to people with chronic diseases. Patient-di- rected prevention through patient education represents one type of approach aimed at managing chronic diseases. However, there is a lack of knowledge about the long-term effects of patient education. The impact of patient education has only been studied in a relatively short term which is a paradox given the often life- long consequences of chronic disease. Objective The main aim of this thesis is to investigate whether participants in patient education experience long-term benefits in their everyday lives. Furthermore, the aim is to investigate the participants’ propositions in regard to sustaining the long-term benefits of the patient education in order to modify the existing program. Finally, examine how everyday life theory may help to understand the benefits of patient education and support changing potential. Methods Through a systematic review of the literature national and international research, covering long-term bene- fits of patient education were identified. Furthermore, an empirical study consisting of eight semi-structured interviews was conducted. All informants took part in patient education during 2012 or 2013. Finally, a theoretical analysis of the informants’ perceived benefits and the proposed change initiatives was conducted based on Birte Bech-Joergensen's theory of everyday life. Results The review of the literature indicate that the participants in patient education after a year still experiences enhanced control, enhanced ability to take care of oneself , increased physical activity and social benefits in their everyday life. The qualitative interview shows that the informants primarily experiences benefits related to physical activity and diet. Furthermore several informants experiences social benefits, while especially participants diagnosed with COPD also experiences mental benefits of the patient education. In relation to the further development of the patient education, the interview shows that the participants primarily are asking for more practical cooking lessons and an expansion of the existing exercise program. The result of theoretical analysis shows that the long-term benefits of patient education can be seen as a result of the changes in everyday life caused by the chronic disease. Patient education can in relation to this be seen as a meaningful way of managing the disease. Through intentional management and modification of daily habits, the informants adjust their everyday to the life with chronic disease. Conclusion The results of the thesis shows a clear tendency toward participants in patient education experiencing long- term benefits in relation to e.g. physical activity, diet and different mental aspects. The continuation of an exercise program similar to the current would probably contribute to the retention of the long-term benefits of the participants. The theoretical analysis of the thesis shows that the long-term benefits of patient education can largely be interpreted as a result of the informants' intentional and unrec- ognized handling of chronic disease and everyday habits as a condition. In continuation hereof patient edu- cation presumably have long-term benefits because participants experiences the education as meaningful.

A master thesis from Aalborg University

Langsigtet udbytte af patientuddannelse - i et brugerperspektiv

[Long-term Benefits of Patient Education - in a Patient Perspective]