Developing a patient-educator program for adolescents with juvenile arthritis: exploring motivation sources, barriers, and facilitators
DOI :
https://doi.org/10.36834/cmej.80035Résumé
Background: Patients can be valuable contributors to medical education, offering nuanced perspective and guidance, based on lived experience. While numerous training programs have integrated adult patients in this manner, very few have engaged adolescent patients. Recognizing adolescent educators may be particularly helpful in teaching pediatric conditions, this study appraises the potential for including those with juvenile arthritis in pediatric rheumatology training.
Methods: Using an exploratory qualitative approach, we conducted semi-structured interviews with adolescents with juvenile arthritis receiving treatment at two tertiary-care pediatric centres in Canada about the motivations, perceptions, facilitators, and barriers that influence their engagement as patient educators. The interview transcripts were analyzed using an iterative qualitative descriptive method.
Results: Participants (n = 19, aged 13-18) identified intrinsic factors, such as learning about their condition and socializing with peers, and extrinsic factors, such as helping students learn and promoting greater disease awareness, as relevant drivers for participating as patient educators. They pointed to balancing school and medical appointments, transportation, and discomfort with sharing personal experiences in large groups as barriers. Parental support, accruing volunteer hours, and engaging health professionals in the teaching sessions were seen as facilitators that could meaningfully enhance the relevance and impact of adolescents’ contributions to medical education.
Conclusion: Adolescents with juvenile arthritis are motivated to participate as patient educators. Understanding the factors that promote their involvement supports the development of training initiatives involving adolescents that are likely to be successful and sustainable.
Téléchargements
Références
1. Rowland P, McMillan S, McGillicuddy P, Richards J. What is "the patient perspective" in patient engagement programs? Implicit logics and parallels to feminist theories. Health (London). 2017;21(1):76-92. https://doi.org/10.1177/136345931664449
2. Henriksen AH, Ringsted C. Medical students’ learning from patient-led teaching: experiential versus biomedical knowledge. Adv Health Sci Educ. 2013. https://doi.org/10.1007/s10459-013-9454-8
3. Henriksen AH, Ringsted C. Learning from patients: students’ perceptions of patient-instructors. Medl Educ. 2011;45(9):913-9. https://doi.org/10.1111/j.1365-2923.2011.04041.x
4. Gruppen LD, Branch VK, Laing TJ. The use of trained patient-educators with rheumatoid arthritis to teach medical students. Arthritis Care Res. 1996;9(4):302-8. https://doi.org/10.1002/1529-0131(199608)9:4<302::aid-anr1790090415>3.0.co;2-r
5. Haq I, Fuller J, Dacre J. The use of patient partners with back pain to teach undergraduate medical students. Rheumatol. (Oxford). 2006;45(4):430-4. https://doi.org/10.1093/rheumatology/kei167
6. Oswald AE, Bell MJ, Wiseman J, Snell L. The impact of trained patient-educators on musculoskeletal clinical skills attainment in pre-clerkship medical students. BMC Med Educ. 2011;11:65. https://doi.org/10.1186/1472-6920-11-65
7. Oswald AE, Wiseman J, Bell MJ, Snell L. Musculoskeletal examination teaching by patients versus physicians: how are they different? Neither better nor worse, but complementary. Med Teach. 2011;33(5):e227-35. https://doi.org/10.3109/0142159X.2011.557412
8. Regan de Bere S, Nunn S. Towards a pedagogy for patient and public involvement in medical education. Med Educ. 2016;50(1):79-92. https://doi.org/10.1111/medu.12880
9. Oswald A, Czupryn J, Wiseman J, Snell L. Patient-centred education: what do students think? Med Educ. 2014;48(2):170-80. https://doi.org/10.1111/medu.12287
10. van Schelven F, van Weele M, van der Meulen E, Wessels E, Boeije H. Patient and public involvement in the development of the digital tool MyBoT to support communication between young people with a chronic condition and care providers. Health Expectations. 2024;27(2):e14003. https://doi.org/10.1111/hex.14003
11. Towle A, Bainbridge L, Godolphin W, et al. Active patient involvement in the education of health professionals. Med Educ. 010;44(1):64-74. https://doi.org/10.1111/j.1365-2923.2009.03530.x
12. Balasa R, Chartrand J, Moreau K, Tousignant K, Eady K. Patients’ and parents’ perspectives of and experiences with assessing nursing students’ paediatric clinical practice. J Clin Nurs. 2021;30(1-2):217-28. https://doi.org/10.1111/jocn.15544
13. Jha V, Quinton ND, Bekker HL, Roberts TE. What educators and students really think about using patients as teachers in medical education: a qualitative study. Med Educ. 2009;43(5):449-56. https://doi.org/10.1111/j.1365-2923.2009.03355.x
14. Parsons S, Thomson W, Cresswell K, Starling B, McDonagh JE, Barbara Ansell National Network for Adolescent R. What do young people with rheumatic conditions in the UK think about research involvement? A qualitative study. Pediatr Rheumatol Online J. 2018;16(1):35. https://doi.org/10.1186/s12969-018-0251-z
15. Lee RR, Mountain D, Connelly Met al. ‘That's what makes me better’: Investigating children and adolescents' experiences of pain communication with healthcare professionals in paediatric rheumatology. Eur J Pain. 2023;27(1):111-28. https://doi.org/10.1002/ejp.2043
16. Jandial S, Myers A, Wise E, Foster HE. Doctors likely to encounter children with musculoskeletal complaints have low confidence in their clinical skills. J Pediatr. 2009;154(2):267-71. https://doi.org/10.1016/j.jpeds.2008.08.013
17. Jandial S, Rapley T, Foster H. Current teaching of paediatric musculoskeletal medicine within UK medical schools—a need for change. Rheumatol. (Oxford). 2009;48(5):587-90. https://doi.org/10.1093/rheumatology/kep038
18. Yu JC, Rashid M, Davila-Cervantes A, Hodgson CS. Difficulties with learning musculoskeletal physical examination skills: student perspectives and general lessons learned for curricular design. Teach Learn Med. 2022 Mar 15;34(2):123-34. https://doi.org/10.1080/10401334.2021.1954930
19. Towle A, Godolphin W. Patients as teachers: promoting their authentic and autonomous voices. Clin Teach. 2015;12(3):149-54. https://doi.org/10.1111/tct.12400
20. Vallerand RJ. Deci and Ryan's self-determination theory: A view from the hierarchical model of intrinsic and extrinsic motivation. Psychol inquiry. 2000 Jan 1;11(4):312-8.
21. Ryan RM, Deci EL. Self-determination theory: Basic psychological needs in motivation, development, and wellness: Guilford publications; 2017. https://doi.org/10.1521/978.14625/28806
22. Caelli K, Ray L, Mill J. ‘Clear as mud’: toward greater clarity in generic qualitative research. Intern J Qual Meth. 2003;2(2):1-13. https://doi.org/10.1177/160940690300200201
23. Ellis JL, Hart DL. strengthening the choice for a generic qualitative research design. Qual Rep 2023;28(6):1759-68. https://doi.org/10.46743/2160-3715/2023.5474
24. Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;23(4):334-40. https://doi.org/10.1002/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G
25. Sandelowski M. What's in a name? Qualitative description revisited. Res Nurs Health. 2010;33(1):77-84. https://doi.org/10.1002/nur.20362
26. Turale S. A brief introduction to qualitative description: A research design worth using. Pacific Rim Intern J Nurs Res. 2020;24(3):289-91.
27. Patton MQ. Qualitative research & evaluation methods. sage; 2002.
28. Bergman E, de Feijter J, Frambach J, et al. AM last page: a guide to research paradigms relevant to medical education. Acad Med. 2012;87(4):545. https://doi.org/10.1097/ACM.0b013e31824fbc8a
29. Petty RE, Southwood TR, Manners P, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31(2):390-2.
30. Magnusson E, Marecek J. Doing interview-based qualitative research: A learner's guide. Cambridge University Press; 2015.
31. Elo S, Kyngas H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107-15.
32. Kelle U. Computer-assisted analysis of qualitative data. Paper prepared for the Discussion paper series of the LSE Methodology Institute. 2004.
33. Thierry S, Fautrel B, Lemelle I, Guillemin F. Prevalence and incidence of juvenile idiopathic arthritis:a systematic review. Joint Bone Spine. 2014;81(2):112-7. https://doi.org/10.1016/j.jbspin.2013.09.003
34. Martini A, Lovell DJ, Albani S, et al. Juvenile idiopathic arthritis. Nat Rev Dis Primers. 2022 Jan 27;8(1):5. https://doi.org/10.1038/s41572-021-00332-8.
35. Doucet S, Lauckner H, Wells S. Patients’ messages as educators in an interprofessional health education program. J Res Interprof Pract Educ. 2013 Mar 27;3(1):98. https://doi.org/10.22230/jripe.2013v3n1a98
36. Aoust L, Rossi-Semerano L, Kone-Paut I, Dusser P. Time to diagnosis in juvenile idiopathic arthritis: a French perspective. Orphanet J Rare Dis. 2017;12(1):43. https://doi.org/10.1186/s13023-017-0586-4
37. Adam HL, Giroux CM, Eady K, Moreau KA. A qualitative study of patients’ and caregivers’ perspectives on educating healthcare providers. Can Med Educ J. 2021;12(4):7-16. https://doi.org/10.36834/cmej.71541
38. Lauckner H, Doucet S, Wells S. Patients as educators: the challenges and benefits of sharing experiences with students. Med Educ. 2012;46(10):992-1000. https://doi.org/10.22230/jripe.2013v3n1a98
39. Morgan A, Jones D. Perceptions of service user and carer involvement in healthcare education and impact on students’ knowledge and practice: a literature review. Med Teach. 2009;31(2):82-95. https://doi.org/10.1080/01421590802526946
40. Eccles JS. Who I am and what am I going to do in my life? Personal and collective identities as motivators of action. Educ Psychol. 2009;44(2):78-89. https://doi.org/10.1080/00461520902832368
41. Malanchuk O, Messersmith EE, Eccles JS. The ontogeny of career identities in adolescence. New Dir Child Adolesc Dev. 2010;2010(130):97-110. https://doi.org/10.1002/cd.284
42. Andrew M, Eggerling-Boeck J, Sandefur G, Smith D. The “inner side” of the transition to adulthood: How young adults see the process of becoming an adult. Adv Life Course Res. 2006;11:225-51. https://doi.org/10.1016/S1040-2608(06)11009-6
43. Eccles JS, Barber BL, Stone M, Hunt J. Extracurricular activities and adolescent development. J Soc Issues. 2003;59(4):865-89. https://doi.org/10.1046/j.0022-4537.2003.00095.x
44. Hanghoj S, Pappot H, Hjalgrim LL et al. Helping others: reasons for participation in service user involvement initiatives from the perspective of adolescents and young adults with cancer. J Adolesc Young Adult Oncol. 2019. https://doi.org/10.1089/jayao.2019.0014
45. Cheng PTM, Towle A. How patient educators help students to learn: an exploratory study. Med Teach. 2017;39(3):308-14. https://doi.org/10.1080/0142159X.2017.1270426
46. Thompson DM, Booth L, Moore D, Mathers J. Peer support for people with chronic conditions: a systematic review of reviews. BMC Health Serv Res. 2022;22(1):427. https://doi.org/10.1186/s12913-022-07816-7
47. Cavallo S, Majnemer A, Duffy CM, Feldman DE. Participation in leisure activities by children and adolescents with juvenile idiopathic arthritis. J Rheumatol. 2015;42(9):1708-15. https://doi.org/10.3899/jrheum.140844
48. Cavallo S, Majnemer A, Mazer B, Chilingaryan G, Ehrmann Feldman D. Participation in leisure activities among Canadian children with arthritis: results from a national representative sample. J Rheumatol. 2015;42(6):1002-10. https://doi.org/10.3899/jrheum.131377
49. Pandya NK. Disparities in youth sports and barriers to participation. Curr Rev Musculoskelet Med. 2021;14(6):441-6. https://doi.org/10.1007/s12178-021-09716-5
50. Roebotham T, Hawthornthwaite L, Lee L, Lingard LA. Beyond catharsis: the nuanced emotion of patient storytellers in an educational role. Med Educ. 2018;52(5):526-35. https://doi.org/10.1111/medu.13510
51. Hawthornthwaite L, Roebotham T, Lee L, O’Dowda M, Lingard L. Three sides to every story: preparing patient and family storytellers, facilitators, and audiences. Perm J. 2018;22. https://doi.org/10.7812/TPP/17-119
52. Metersky K, Rahman R, Boyle J. Patient-partners as educators: vulnerability related to sharing of lived experience. J Patient Exp. 2023 Jun 20;10:23743735231183677. https://doi.org/10.1177/23743735231183677.
53. Moreau KA, Eady K. The benefits and challenges of involving adolescents in medical education: a qualitative study. Acad Ped. 2019;19(1):97-102. https://doi.org/10.1016/j.acap.2018.05.007
54. Towle A, Bainbridge L, Godolphin W, et al. Active patient involvement in the education of health professionals. Med Educ. 2010;44(1):64-74. https://doi.org/10.1111/j.1365-2923.2009.03530.x
55. Fawcett L, Garton A, Dandy J. Role of motivation, self-efficacy and parent support in adolescent structured leisure activity participation. Austrl J Psychol. 2009;61(3):175-82. https://doi.org/10.1080/00049530802326792
Téléchargements
Publié-e
Comment citer
Numéro
Rubrique
Licence
© Marie-Paule Morin, Aimun Qadeer Shah, Maria Mylopoulos, Marie-Pascale Pomey, François Bowen, Lawrence Grierson, Claude Julie Bourque 2025

Cette œuvre est sous licence Creative Commons Attribution - Pas d'Utilisation Commerciale - Pas de Modification 4.0 International.
La soumission d’un manuscrit original à la revue constitue une indication qu’il s’agit d’un travail original, qu’il n’a jamais été publié et qu’il n’est pas envisagé pour publication dans une autre revue. S’il est accepté, il sera publié en ligne et ne pourra l’être ailleurs sous la même forme, à des fins commerciales, dans quelque langue que ce soit, sans l’accord de l’éditeur.
La publication d’une recherche scientifique a pour but la diffusion de connaissances et, sous un régime sans but lucratif, ne profite financièrement ni à l’éditeur ni à l’auteur.
Les auteurs qui publient dans la Revue canadienne d’éducation médicale acceptent de publier leurs articles sous la licence Creative Commons Paternité - Pas d’utilisation commerciale, Pas de modification 4.0 Canada. Cette licence permet à quiconque de télécharger et de partager l’article à des fins non commerciales, à condition d’en attribuer le crédit aux auteurs. Pour plus de détails sur les droits que les auteurs accordent aux utilisateurs de leur travail, veuillez consulter le résumé de la licence et la licence complète.


