Märit Löfgren

Empowering patients to participate in health care decisions

The thesis evaluates an intervention with supervised study circles intended to increase patient participation in care and rehabilitation. The target group is primary care patients of working age who lost role functioning and control of life because of chronic illness.

The thesis evaluates an intervention with supervised study circles intended to increase patient participation in care and rehabilitation. The target group is primary care patients of working age who lost role functioning and control of life because of chronic illness.

Chronic disease and loss of working capacity implies great personal suffering and large community costs. Co-morbidity and psychosocial consequences from disease contribute to complex symptomatology and rehabilitation barriers. Both sense of coherence (SOC) and the ability to absorb health-related information (health literacy) affect individual problem solving and hence the prerequisites for contributing to the health care process, something that is known to have a positive impact on health outcomes.

The main purpose of the thesis is to evaluate whether there is a causal relationship between the intervention to be studied and the participants’ activity level, sense of coherence, health literacy, autonomy, and quality of life. In addition, the thesis aims to analyze whether the intervention is cost-effective, to evaluate patients’ experience of participating in the intervention and to systematically review the research area of ​​patient education and the impact on activity level, independence, sense of coherence and health literacy for patients with reduced activity level due to chronic illness in comparison with Treatment as Usual.

The thesis will consist of a pragmatic cluster randomized controlled trial with follow-up at baseline and after three, six, and twelve months comparing the intervention with Treatment as Usual. In addition the thesis will include a cost efficiency study aiming at comparing the difference in cost with the difference in quality adjusted life years (QALY). Furthermore the thesis will include a qualitative study with patient focus groups to explore patient experience form participating in the intervention as well as a systematic review.

The study is expected to show whether the intervention with patient education aiming at increasing health literacy and sense of coherence has an effect on sick leave and inactive sick leave in patients with complex symptomatology and rehabilitation barriers.


School of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg

Supervisor:Dominique Hange, Assistant Professor in General Practice