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Source Publication

Journal of Advanced Nursing

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To identify, critically appraise, and summarize instruments that measure patients’ preferences for engagement in health care.


Psychometric systematic literature review.

Data sources

PubMed, Embase, CINAHL, and PsycINFO were searched from inception to March 2019.

Review methods

Three reviewers independently evaluated the ‘methodological quality’ and the ‘measurement properties’ of the included instruments using the Consensus‐based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and Terwee's quality criteria. Each instrument was given a Grading of Recommendations Assessment, Development and Evaluation (GRADE) score. The review was registered at PROSPERO (registry number CRD42018109253).


A total of 16 studies evaluating 8 instruments measuring patients’ preferences for engagement in health care were included. All instruments were downgraded for their ‘methodological quality’ or ‘measurement properties’, or a combination of both. Common concerns were lack of theoretical basis, absence of patient input during development, incorrect usage and reporting of validity measures and absence of a priori hypotheses to test validity.


There were no identified instruments that demonstrated adequate evidence for all measurement properties. The Patient Preferences for Patient Participation Scale (4Ps) and 10‐item Decisional Engagement Scale (DES‐10) had the highest overall GRADE scores; however, each had some underlying developmental or methodological issues.


Assessing how patients prefer to engage in their care is a critical first step to truly individualize engagement interventions to meet patient expectations. Systematic reviews of measures of patient experience with engagement in health care have been undertaken but none are available on measures of patient preferences for engagement. The results highlight the need to further develop and test instruments that measure patients’ preferences for engagement in health care within a framework for consumerism. Involving the consumer in the instrument development process will ensure that engagement strategies used by healthcare providers are relevant and individualized to consumer preferences.


Accepted version. Journal of Advanced Nursing, Vol. 76, No. 8 (August 2020): 1988-2004. DOI. © 2020 Wiley. Used with permission.

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