Background: Patient participation in goal setting is important to deliver client-centered care. In daily practice, however, patient involvement in goal setting is not optimal. Patient-specific instruments, such as the Patient Specific Complaints (PSC) instrument, can support the goal-setting process because patients can identify and rate their own problems. The aim of this study is to explore patients’ experiences with the feasibility of the PSC, in the physiotherapy goal setting. Method: We performed a qualitative study. Data were collected by observations of physiotherapy sessions (n=23) and through interviews with patients (n=23) with chronic conditions in physiotherapy practices. Data were analyzed using directed content analysis. Results: The PSC was used at different moments and in different ways. Two feasibility themes were analyzed. First was the perceived ambiguity with the process of administration: patients perceived a broad range of experiences, such as emotional and supportive, as well as feeling a type of uncomfortableness. The second was the perceived usefulness: patients found the PSC useful for themselves – to increase awareness and motivation and to inform the physiotherapist – as well as being useful for the physiotherapist – to determine appropriate treatment for their personal needs. Some patients did not perceive any usefulness and were not aware of any relation with their treatment. Patients with a more positive attitude toward questionnaires, patients with an active role, and health-literate patients appreciated the PSC and felt facilitated by it. Patients who lacked these attributes did not fully understand the PSC’s process or purpose and let the physiotherapist take the lead. Conclusion: The PSC is a feasible tool to support patient participation in the physiotherapy goal setting. However, in the daily use of the PSC, patients are not always fully involved and informed. Patients reported varied experiences related to their personal attributes and modes of administration. This means that the PSC cannot be used in the same way in every patient. It is perfectly suited to use in a dialogue manner, which makes it very suitable to improve goal setting within client-centered care.
DOCUMENT
In recent years, the subsidiarity principle has been underlined in Sport-for-All policies in countries such as Germany, Austria and Belgium. According to this organising principle, issues need to be handled by the lowest possible political and administrative level, and as close to the citizens as possible. The 2007 decree concerning Sport-for-All policies at the local level in Flanders (Belgium) clearly referred to this. It emphasised the decentralisation of the Sport for All policy, and highlighted the regulatory and coordinating role of local sports authorities. As a consequence, they may face conflicting roles of being coordinator, regulator and provider of mass sport at the local level. In this paper, a mixed-method approach is used to give a closer insight in the role perceptions of local sports authorities in Flanders, and their position towards private sport providers. The results show that local sports authorities consider the coordination and regulation of mass sport in their municipality as their primary task. Yet, it appears that private sport providers also perceive competition from local sports authorities. Moreover, a considerable number of the local sports authorities believe they can combine the roles of provider and coordinator. As there appears to be considerable goal ambiguity, it is necessary for local sports authorities to formulate clear goals. Referring to the principle of subsidiarity, it is argued that sports authorities should only intervene when (non-)profit sport providers are not able to achieve the desirable outcomes with regard to sport and the welfare agenda.
LINK
