Diagnostics, activities and evaluation

The diagnostics, activities and evaluation of empowering patient education are focused on different clinical fields. Currently, the fields include cancer care, orthopaedic care, people with long-term health problems, mental health promotion of adolescents, and other clinical fields.

Empowering patient education in cancer care

Effectiveness of empowering patient education of patients with colorectal cancer

PhD candidate: Leena Tuominen, MNSc
leetuo(a)utu.fi

The aim of this study is to evaluate the effectiveness of empowering patient education on self-care activation, level of knowledge, quality of life, and risk of malnutrition among patients with colorectal cancer (CRC) during the chemotherapy treatment (CTX). The goal is to improve the quality of nursing care.

Primary research methods:

  1. A systematic review of reviews (n=9) analyzing outcomes of nursing interventions among patients with cancer
  2. Individual interviews of patients with CRC (n=15) analyzing their expectations towards nursing during the CTX
  3. Randomized control trial analyzing the effectiveness of empowering education on self-care activity among patients with CRC. Secondary outcomes are quality of life and risk of malnutrition

Publications:

Tuominen, L., Ritmala-Castrén, M., Nikander, P., Mäkelä, S., Vahlberg, T., & Leino-Kilpi, H. (2021). Empowering patient education on self-care activity among patients with colorectal cancer – a research protocol for a randomised trial. BMC nursing, 20(1), 94. https://doi.org/10.1186/s12912-021-00617-z

Tuominen, L., Leino-Kilpi, H., & Meretoja, R. (2020). Expectations of patients with colorectal cancer towards nursing care- A thematic analysis. European Journal of Oncology Nursing, 44, 101699. https://doi.org/10.1016/j.ejon.2019.101699

Tuominen, L., Stolt, M., Meretoja, R., & Leino-Kilpi, H. (2019). Effectiveness of nursing interventions among patients with cancer: An overview of systematic reviews. Journal of Clinical Nursing, 28(13-14), 2401–2419. https://doi.org/10.1111/jocn.14762

Knowledge expectations of patients with cancer during the illness trajectory

The goal of this study was to develop a model for empowering patient education praxis for adult cancer patients during their illness trajectory. The model had two parts: a self-report instrument for identifying and communicating cancer patients’ knowledge expectations during illness trajectory; and an inter-professional screening instrument for cancer patients’ education process (patients’ cognitive resources, knowledge expectations, comprehension outcomes during illness trajectory).
This study combines several datasets from both cancer patients’ and health care professionals’ points of view.

Publications:

Vaartio-Rajalin, H., Huumonen, T., Iire, L., Jekunen, A., Leino-Kilpi, H., Minn, H., Paloniemi, J., & Zabalegui, A. (2016). Development of an inter-professional screening instrument for cancer patients’ education process. Applied Nursing Research, 29, 248–253. https://doi.org/10.1016/j.apnr.2015.07.002

Quality of radiotherapy care by the development of e-feedback knowledge

Principal investigator: Mervi Siekkinen, PhD, RT
mervi.siekkinen(a)utu.fi

The aim of this three-phase study was to develop the quality of radiotherapy care by the e-Feedback knowledge of radiotherapy -intervention (e-Re-Know). In Phase I, the purpose was to describe the quality of radiotherapy care and its deficits experienced by cancer patients. Based on the deficits in patient education in Phase II, the purpose was to describe cancer patients’ e-knowledge expectations in radiotherapy. In Phase III, the purpose was to develop and evaluate the outcomes of the e-Re-Know among breast cancer patients. The ultimate aim was to develop radiotherapy care to support patients’ empowerment with patient e-education.

Publications:

Siekkinen, M. (2014). Quality of radiotherapy care by development of e-feedback knowledge (Doctoral dissertation).

Development of interactive pathway of patients with breast cancer

Principal investigator: Anne Ryhänen, PhD

The ultimate goal of this study was to evaluate the effect of the Breast Cancer Patient’s
Pathway program (BCPP) on the breast cancer patient’s empowerment by using the patient pathway as a patient education tool. In phase I, a systematic literature review was carried out to chart the solutions and outcomes of Internet-based educational programs for breast cancer patients. In phase II, a Delphi study was conducted to evaluate the usability of web pages and the adequacy of their content. In phase III, the BCPP program was piloted with 10 patients, and patients were randomized to an intervention group (n=50) and a control group (n=48).

Publications:

Ryhänen, A. (2012). Internet-based breast cancer patient’s pathway as an empowering patient educational tool (Doctoral dissertation)

Master's theses

There are several master’s theses conducted in this field. See the list of publications.

Recent master’s theses:

Palmu, H. (2021). Voimavaraistumista tukeva tiedollinen tuki ja sen yhteys minäpystyvyyteen, positiiviseen mielenterveyteen ja elämänlaatuun syöpäpotilailla. University of Turku, Department of Nursing Science. Turku, Finland. (Master’s thesis)

Liljeroos, S. (2019). Internet-pohjainen potilasohjaus rintasyöpäpotilaan voimavaraistumisen tukena. University of Turku, Department of Nursing Science. Turku, Finland. (Master’s thesis)

Honkonen, A. (2017). Traumaperäinen kasvu interventioiden yhteydessä syöpäpotilailla: systemaattinen kirjallisuuskataus RCT-tutkimuksista [Posttraumatic Growth within Interventions in Cancer Patients: A Systematic Review of RCTs]. University of Turku, Department of Nursing Science. Turku, Finland. (Master’s thesis)

Empowering patient education in orthopaedic care

Patient empowerment and recovery in orthopaedic care

PhD candidate: Arja Pekonen, MNSc, RN
arja.pekonen(a)tyks.fi

Supervisors:
Helena Leino-Kilpi, Professor and nurse director, PhD, RN, Department of Nursing Science, University of Turku, and Turku University Hospital
Petri Virolainen, hospital director, Turku University Hospital.

The purpose of this follow-up study is to evaluate patients’ recovery after short-stay orthopedic surgery and recognize factors that are connected to recovery, especially how patients’ knowledge and their own action are associated with recovery. Results of this study can be used to develop short-stay orthopedic patients’ care and improve the quality of care.

Publications:

Pekonen, A., Eloranta, S., Stolt, M., Virolainen, P., & Leino-Kilpi, H. (2020). Measuring patient empowerment – A systematic review. Patient Education and Counseling, 103(4), 777–787. https://doi.org/10.1016/j.pec.2019.10.019

Empowering surgical orthopaedic patients through education

Principal investigator: Kirsi Valkeapää (ex-Johansson), Docent, PhD, RN
kirsi.valkeapaa(a)gmail.com

Research teams

The focus of the “Empowering Surgical Orthopaedic Patients through Education” project is on the education of osteoarthritis patients in the surgical context and it includes collaboration between researchers in health care and nursing science in seven European countries (Finland, Cyprus, Greece, Iceland, Lithuania, Spain and Sweden). This project aims to a) strengthen the theoretical basis of empowering patient education, b) identify and explain the differences between patient education in various countries, b) construct practice-oriented patient education models including those factors promoting best practices for orthopaedic patients in the surgical context and c) test and validate instruments used in evaluating patient education.

In this project, the theoretical basis lies in empowering patient education that emphasizes the power of patients and their self-management as a goal of patient education. In empowering patient education, it is essential to be aware of patients’ knowledge expectations and to measure the knowledge received. The basic assumption is that the closer patients’ expectations and received knowledge are, the more empowered they will be, and thus possibilities for self-management are created.

In the orthopaedic surgical context, knowledge of patients’ expectations and received care has been studied on the national level. “Empowering Surgical Orthopaedic Patients through Education” – the project is a step toward an international perspective on orthopaedic patient education. This project has already been started by a) making the research plan and establishing the international research team, b) preparing, testing and validating the instruments and c) planning the sample and data collection. Empirical data has been collected in seven participating countries. The data (N=1634) has been collected in all countries among surgical orthopaedic patients (n=172-279/country) and their significant others (n=1097) in connection with knee or hip replacement. Data collection points have been at admission, at discharge and 6-7 months after surgery. Nurses (n=317), caring for these patients, have also evaluated the quality of the education received by these patients. At this point, the data is under reporting.

The ultimate goal of these international analyses and comparisons is to construct the best educational practices internationally for supporting patients’ self-management in the orthopaedic surgical context.

This project has scientific, societal, clinical and educational outcomes.

Publications

Empowering patient education in surgical care of patients with spinal stenosis

Principal investigator: Jukka Kesänen, PhD
jpkesa(a)utu.fi

The purpose of the present study was A) to describe the use of knowledge tests in patient education, and B) to assess the impact of a specific patient education intervention on the empowerment of patients undergoing surgery for lumbar spinal stenosis. The aim was to improve the quality of patient education in this patient group.

Publications:

Kesänen, J., Leino-Kilpi, H., Lund, T., Montin, L., Puukka, P., & Valkeapää, K. (2019). Spinal Stenosis Patients’ Visual and Verbal Description of the Comprehension of Their Surgery. Orthopedic Nursing, 38(4), 253–261. https://doi.org/10.1097/NOR.0000000000000572

Kesänen, J. (2018). Empowering education in surgical care of patients with spinal stenosis (Doctoral dissertation).

Kesänen, J., Leino-Kilpi, H., Lund, T., Montin, L., Puukka, P., & Valkeapää, K. (2017). Increased preoperative knowledge reduces surgery-related anxiety: a randomised clinical trial in 100 spinal stenosis patients. European Spine Journal, 26(10), 2520–2528. https://doi.org/10.1007/s00586-017-4963-4

Kesänen, J., Leino-Kilpi, H., Lund, T., Montin, L., Puukka, P., & Valkeapää, K. (2016). The Knowledge Test Feedback Intervention (KTFI) increases knowledge level of spinal stenosis patients before operation-A randomized controlled follow-up trial. Patient Education and Counseling, 99(12), 1984–1991. https://doi.org/10.1016/j.pec.2016.07.025

Kesänen, J., Leino-Kilpi, H., Arifulla, D., Siekkinen, M., & Valkeapää, K. (2014). Knowledge tests in patient education: a systematic review. Nursing & Health Sciences, 16(2), 262–273. https://doi.org/10.1111/nhs.12097

Empowering patient education in an ambulatory orthopaedic nursing internet-based intervention

Principal investigator: Katja Heikkinen, PhD

The aim of this study was to create and evaluate an Internet-based patient education programme aiming to cognitively empower ambulatory orthopaedic surgery patients. The research process was divided into two phases. In Phase I, the purpose was to create the content for cognitively empowering Internet-based patient education for ambulatory orthopaedic surgery patient care. In Phase II, the purposes were: to evaluate cognitively empowering Internet-based patient education (experiment group) user acceptance and the outcomes of this education and to compare the outcomes of cognitively empowering Internet-based patient education to the outcomes of cognitively empowering face-to-face education (control group). The ultimate goal of this study was to create a new type of cognitively empowering patient education intervention which offers an individualized and engaging method that is free of time and place for patients having ambulatory orthopaedic surgery operations.

Publications:

Heikkinen, K. (2011). Cognitively Empowering Internet-Based Patient Education for Ambulatory Orthopaedic Surgery Patients (Doctoral dissertation).

Master's theses

There are several master’s theses conducted in this field. See the list of publications.

Recent master’s theses:

Sibakov, P. (2018). Ohjausmateriaalin hyödynnettävyys ortopedisen leikkauspotilaan kokemana [Orthopedic patients’ experiences of the usefulness of education material]. University of Turku, Department of Nursing Science. Turku, Finland. (Master’s thesis)

Empowering patient education of people with long-term and other health problems

Patient education of people with chronic kidney disease

Research team:
Helena Leino-Kilpi, Professor, Nurse director, PhD, MEd, RN, FAAN, FEANS, MAE,
Department Nursing Science, University of Turku
Turku University Hospital
helena.leino-kilpi(a)utu.fi

Saija Inkeroinen, MHSc, BHSc, PHN, RN, Department of Nursing Science, University of Turku
Jenni Koskinen, MNSc student, BHSc, RN, Department of Nursing Science, University of Turku and Turku University Hospital
Vanesa Numanovic, MNSc, Helsinki University Hospital
Pauli Puukka, MSocSc, Department of Nursing Science, University of Turku
Riitta Tuominen, MNSc, Turku University Hospital
Heli Virtanen, PhD, RN, Department of Nursing Science, University of Turku

Partners in Turku University Hospital:
Mia Karlsson, RN
Senni Kiukainen, RN
Johanna Laulaja, RN

Partners in Turku City Welfare, City of Turku:
Taina Kilpi, RN

Partners in Helsinki University Hospital:
Ros-Marie Taponen, BSc

Research on patient education of patients with chronic kidney disease focuses on the usefulness and sufficiency of patient education. Research is done in collaboration with Turku University Hospital and Helsinki University Hospital.

Publications:

Inkeroinen, S., Koskinen, J., Karlsson, M., Kilpi, T., Leino-Kilpi, H., Puukka, P., Taponen, RM., Tuominen, R., & Virtanen, H. (2021). Sufficiency of Knowledge Processed in Patient Education in Dialysis Care. Patient Preference and Adherence, 15, 1165-1175. https://doi.org/10.2147/PPA.S304530

Inkeroinen, S., Numanovic, V., Karlsson, M., Kiukainen, S., Koskinen, J., Leino-Kilpi, H., Puukka, P., Taponen, R. M., Tuominen, R., & Virtanen, H. (2021). Voimavaraistumista tukevassa potilasohjauksessa välitetyn tiedon hyödyllisyys: Pre- ja kotidialyysihoidossa olevien potilaiden näkökulma. In: Eskolin S. E., Inkeroinen, S., Riuttaskorpi, M., & Virtanen, H. (eds.) Terveyttä edistävä ohjaus. University of Turku, Department of Nursing Science, Research reports, A: 84/2021. Turku, Finland: University of Turku, 32–45.

Inkeroinen, S., Leino-Kilpi, H., Tuominen, R., & Virtanen, H. (2021). Munuaissairautta sairastavat kokevat tietonsa riittäväksi ja hyödylliseksi. Elinehto, 50(3), 31.

Inkeroinen, S., Virtanen, H., Kilpi, T., Laulaja, J., Puukka, P., Tuominen, R., & Leino-Kilpi, H. (2020). Relationship between sufficiency and usefulness of patient education: A cross-sectional study of patients with chronic kidney disease. Nursing & Health Sciences, 22(4), 846–853. https://doi.org/10.1111/nhs.12770

Virtanen, H., Tuominen, R., Kiukainen, S., Koskinen, J., Koskenniemi, J., Laulaja, J., Numanovic, V., & Leino-Kilpi, H. (2019). Experiences of safety among patients receiving home dialysis therapies. Journal of Renal Care, 45(4), 223–231. https://doi.org/10.1111/jorc.12298

The application of theory of planned behavior in self-management of people with type 2 diabetes

Principal investigator: FangFang Zhao, PhD

In this research regarding people with diabetes, the theory of planned behavior is used to analyze the connection of self-care activities to patients’ feelings and patient education in China.

Publications:

Zhao, F. F., Suhonen, R., Katajisto, J., Stolt, M., & Leino-Kilpi, H. (2020). Association between diabetes-related self-care activities and positive health: a cross-sectional study. BMJ Open, 9(7), e023878. https://doi.org/10.1136/bmjopen-2018-023878

Zhao, FF. (2019). The diabetes-related self-care activities of people with type 2 diabetes: their level and associated factors (Doctoral dissertation).

Zhao, F., Suhonen, R., Katajisto, J., & Leino-Kilpi, H. (2019). Factors associated with subsequent diabetes-related self-care activities: The role of social support and optimism. Nursing Open, 7(1), 195–205. https://doi.org/10.1002/nop2.379

Zhao, F. F., Suhonen, R., Katajisto, J., & Leino-Kilpi, H. (2018). The association of diabetes-related self-care activities with perceived stress, anxiety, and fatigue: a cross-sectional study. Patient Preference and Adherence, 12, 1677–1686. https://doi.org/10.2147/PPA.S169826

Zhao, F. F., Suhonen, R., Koskinen, S., & Leino-Kilpi, H. (2017). Theory-based self-management educational interventions on patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Journal of Advanced Nursing, 73(4), 812–833. https://doi.org/10.1111/jan.13163

Supporting patients oral self-care through empowering patient education

Principal investigator: Mirkka Järvinen, PhD, MNSc, RDH

Supervisors:
Marja Pöllänen, DDS, PhD, Specialist in Periodontology
Kirsi Valkeapää, Adjunct Professor, PhD, RN

The purpose of this study was to develop and test empowering patient education program for adults with periodontitis. Design is a randomized control trial. The ultimate goal is to develop dental patient education to become more empowering so that individuals have the competence to take care of themselves.

Publications:

Järvinen, M. (2020). Support of oral self-care, especially among patients with periodontitis – The role of dental hygienists and dental nurses. Annales Universitatis Turkuensis. Series Medica-Odontologica D 1482. University of Turku, Turku. (Doctoral dissertation)

Järvinen, M., Stolt, M., Honkala, E., Leino-Kilpi, H., & Pöllänen, M. (2018). Behavioural interventions that have the potential to improve self-care in adults with periodontitis: a systematic review. Acta odontologica Scandinavica, 76(8), 612–620. https://doi.org/10.1080/00016357.2018.1490964

Nurse-led interpersonal counselling for depressive symptoms in patients with myocardial infarction

Principal investigator: Olli Oranta, PhD

The broad interest of this intervention study is in two worldwide remarkable diseases, myocardial infarction and depression. The purpose of the 18-month follow-up study was to evaluate the outcomes of interpersonal counselling implemented by a psychiatric nurse and to examine the recovery experienced by the patients after myocardial infarction.

Publications:

Oranta, O. (2011). Nurse-led interpersonal counselling for depressive symptoms in patients with myocardial infarction (Doctoral dissertation).

Counselling on limited preoperative fasting in paediatric ambulatory tonsillectomy

Principal investigator: Seija Klemetti, PhD

The purpose of this study was to examine preoperative nutritional face-to-face counselling of
the parents by nurses on limited preoperative fasting and active preoperative nutrition: how the parents adopt the knowledge, and whether postoperative recovery of the paediatric ambulatory tonsillectomy patients is safely promoted.

Publications:

Klemetti, S. (2010). Counselling on limited preoperative fasting in paediatric ambulatory tonsillectomy (Doctoral dissertation).

Empowerment of older people with a memory disorder

PhD candidate: Marta Garcia-Pascual

A study about patients with a memory disorder is carried out in Catalonia, Spain. The Expected Knowledge of Hospital Patients (EKhp) instrument is used to assess older patients’ knowledge for the improvement of patients’ and their relatives’ empowerment.

Master's theses

There are several master’s theses conducted in this field. See the list of publications.

Recent master’s theses:

Kivelä, S. (2021). Aikuisten voimavaraistumista tukevat painonhallintainterventiot hoitajien toteuttamama – systemaattinen kirjallisuuskatsaus. University of Turku, Department of Nursing Science. Turku, Finland. (Master’s thesis)

Eskolin, S.-E. (2020). Voimavaraistumista tukevan ohjauskeskustelun toteutuminen ja tunteista keskustelu ohjauksessa. University of Turku, Department of Nursing Science. Turku, Finland. (Master’s thesis)

Hellen, M. (2019). Alopecia areataa sairastavien kokemukset ja odotukset elämänlaatua tukevasta potilasohjauksesta. University of Turku, Department of Nursing Science. Turku, Finland. (Master’s thesis)

Samola, T. (2018). Asiakkaan terveydenlukutaito suunterveydenhuollossa [Health literacy of oral health care clients in Finland]. University of Turku, Department of Nursing Science. Turku, Finland. (Master’s thesis)

Numanovic, V. (2017). Äitiys- ja neuvolaterveydenhoitajien tieto raskaana olevan naisen ja neuvolaikäisen lapsen suun terveydestä [Finnish maternity clinic and child welfare clinic nurses’ knowledge about oral health during pregnancy and children under school age]. University of Turku, Department of Nursing Science. Turku, Finland. (Master’s thesis)

Nurminen, M. (2017). Suun terveyden merkitys nuorille [Meaning of oral health to adolescents]. University of Turku, Department of Nursing Science. Turku, Finland. (Master’s thesis)

 

Mental health promotion of adolescents

Adolescents' mental health needs assessment in the community

Principal investigator: Evanthia Sakellari, post-doc researcher, PhD, MSc, RHV
evasak(a)utu.fi

​Members of the research team:
Helena Leino-Kilpi, PhD, RN, Professor, University of Turku, Department of Nursing Science
Andre Sourander, MD, PhD, Professor, University of Turku, Faculty of Medicine, Research Centre for Child Psychiatry
Christina Athanasopoulou, PhD Candidate, MAed, BScOT, University of Turku, Department of Nursing Science
Pinja Kokkonen, MNSc, RN, University of Turku, Department of Nursing Science
Jouko Katajisto, Statistician, University of Turku, Faculty of Mathematics and Natural Sciences

Adolescents are the future adults and their mental health is important for promoting community health and healthy societies. In order to meet the adolescents’ needs and develop mental health promotion programmes, adolescents must be heard. Empowerment is a key tool and a core concept for mental health promotion programmes.

The aim of the study is to assess the adolescents’ mental health needs, determine the factors that are connected with those needs and further, identify the resources they use in order to address those needs. The ultimate goal is to assist health professionals to promote mental health among adolescents in different European countries. Thus, the study will provide a framework to gain a better understanding of the mental health needs among adolescents. The findings of this study will have a scientific as well as the societal impact on community health for adolescents.

The results from this study will be used to develop a model for mental health promotion among adolescents within the community including school-based intervention strategies which can be used by health professionals, policymakers and stakeholders. This model will focus on the factors related to mental health needs and more importantly on the resources the adolescents depend on to address their own mental health needs as well as activities and actions for supporting/improving their mental health.

The study is taking place in Finland and Greece, enabling cross-cultural comparisons. The Greek collaborating organisation is the Department of Public and Community Health at the University of West Attica (Athens, Greece), where the post-doctoral researcher is an Assistant Professor.

The research team has conducted a systematic literature review which is published here. Data has been collected in Finland among secondary school pupils and in Greece among adolescent service users, while it is planned to conduct the study in the general population too. The study has resulted in the validation of the Youth Efficacy / Empowerment Scale-Mental Health (YES-MH) scale in both Finnish and Greek.

Publications by Evanthia Sakellari et al.

Kokkonen, P., Athanasopoulou, C., Leino-Kilpi, H., & Sakellari, E. (2021). Secondary School Pupils’ Mental Wellbeing Is Associated with Belonging to a Perceived Minority and Experiencing Discrimination. Children (Basel, Switzerland), 8(2), 71. https://doi.org/10.3390/children8020071

Sakellari, E., Athanasopoulou, C., Kokkonen, P., & Leino-Kilpi, H. (2020). Mental Health Needs of Adolescents Assessed During the Years of Global Financial Crisis: a Systematic Review. Medical Archives, 74(4), 298–304. https://doi.org/10.5455/medarh.2020.74.298-304

Sakellari, E., Athanasopoulou, C., Kokkonen, P., Sourander, A., & Leino-Kilpi, H. (2019). Validation of the Youth Efficacy/Empowerment Scale – Mental Health Finnish version. Psychiatriki, 30(3), 235–244. https://doi.org/10.22365/jpsych.2019.303.235

Sakellari, E. (2014). Exploring the Impact of Mental Health Education on Adolescents’ Perceptions About Mental Health and Mental Illness. Improving community health (Doctoral dissertation).

Master's theses