[Patients' perspectives on behavioral and cognitive changes after hospitalization: a 3-month follow-up cohort study using qualitative and quantitative research methods]

Abstract

Objectives: To describe patients' subjective perspectives on hospitalization at time of admission, to prospectively investigate patients' views on changes actually achieved after discharge, and to identify predictors of subjective changes 3 months after hospitalization.

Methods: We conducted a 3-month follow-up cohort study using qualitative and quantitative research methods. Consecutive adult inpatients of an internal medicine ward and a ward integrating internal and psychosomatic medicine were included. They answered open-ended questions concerning their motivation for change at the time of admission (N = 639) using self-report questionnaires and 3 months post hospitalization via a telephone interview (N = 389). Qualitative content analysis was performed. Predictors of subjective change 3 months after hospitalization were identified using multivariate logistic regression analyses.

Results: At admission, more psychosomatic patients than internal-medicine ward patients wanted to achieve change (58% vs. 44 %). Patients expressed desires that were assigned to three main categories: to pay more attention to one's physical health (40 %), to change one's perceptions (32 %), and to change one's way of life (16 %). Three months after discharge, 52 % of patients had experienced cognitive and behavioral changes they attributed to their hospitalization. 31 % of the patients reported continuing to implement changes that had begun during hospitalization. Predictors of subjective change 3 months after hospitalization included high educational level (OR = 2.04, 95 %-CI 1.27-3.26), young age (OR = 0.98, 95 %-CI 0.97-1.00), and length of hospitalization (OR = 1.03, 95 %-CI 1.00-1.05).

Conclusions: There is considerable motivation for behavioral and cognitive change among inpatients following admission; this deserves the attention of healthcare professionals. An integrated psychosomatic setting would appear to support cognitive and behavioral changes more effectively than a classical internal medicine ward.