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The development and initial validation of an observational tool for measuring patient participation in clinical consultations

Helle Poulsen, Else Dalsgaard Iversen, Jette Ammentorp



Objective: The aim of this study was to further develop and test The Activity Barometer (TAB) as a tool for measuring patient participation in clinical consultations.


Methods: The tool was further developed and tested by double coding 18 audio recordings from consultations between nurses and patients and by qualitative discussions between 3 raters. The raters discussed the face and content validity of the tool and the inter-rater reliability was calculated. To assess the construct validity, it was hypothesised that the tool could be used to expose a difference in the patients’ participation before and after the nurses had participated in communication skills training. This was assessed based on 31 audio recordings.


Results: All of the 3 raters found the items relevant for measuring patient participation. However, to get reliable ratings, an extended guide for coding was necessary. According to the content validity, we found that by taking a treatment-oriented perspective, core components of patient participation were not included in the tool. To capture the whole concept, the coding should be done from a holistic perspective, including the patients’ everyday life. The inter-rater reliability for the total score (0.85), the questions (0.92) and the preferences/concerns (0.6) were all above acceptable thresholds. The construct validation showed that the tool could expose differences in the patients’ participation before and after the nurses had participated in the communication skills training.


Conclusion: TAB is a promising tool for measuring patient participation. However, further validation of the tool in a larger sample is recommended prior to its use in research settings.






Patient participation, Communication skills training, Measurement tool, Psychometrics, Validity, Reliability.

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