1. Introduction
The realization of people-centered care (PCC) is said to be an essential element for achieving universal health coverage, and it is one of the concepts that have been attracting attention worldwide [1]. Several initiatives based on the PCC have been reported. For example, in response to the problem of high maternal mortality, the government of El Salvador has worked with various national and international partners since 2006 to implement a people-centered approach to improve maternal and neonatal health [2]. The importance of patient and public involvement in the development of medical practice guidelines is also widely recognized internationally. The Guidelines International Network (G-I-N) Public Working Group has published its ideas in the G-I-N Public Toolkit, which provides practical advice to guideline developers and others on involving patients and the public in guideline activities [3]. The National Health Service in England also emphasizes the importance of patient and public participation [4]. There are many similar terms, such as patient-centered care, person-centered care, population-centered care, and integrated people-centered health services. However, their meanings and usage are unclear. The authors decided to re-examine the concept of PCC in light of recent global efforts and social conditions and see if it can be used as a concept that serves as a basis for practicing problem solving in the health care field. Therefore, this study clarifies the attributes, antecedents, and consequences of the concept of PCC.
2. Method
2.1. Data Collection
The references were obtained from PubMed, EBSCO (CINAHL Plus with Full Text), Medline, EMBASE, PsycINFO, Japan Medical Abstracts Society (JAMAS), and Citation Information by the National Institute of Informatics (CiNii). The search terms were “people-centered care” or “people-centered.” Furthermore, there were no restrictions on language or the year of publication. The search dates were from the oldest searchable year in each database to June 6, 2021. The titles and abstracts were checked to avoid duplication, and those that did not focus on PCC were excluded. As for the types of articles, original articles, research reports, practical reports, and commentaries were included, while published conference proceedings, including abstracts of research presented at conferences, were excluded. A manual search was performed to identify articles and various types of reports. In the selection of literature, two nursing researchers worked independently and discussed before making decisions when there were differences.
2.2. Data Analytics
Rogers and Knafl’s evolutionary method [5] was used to analyze the concept of PCC. The analyzed literature was read carefully, and “Attributes,” which indicate the characteristics of PCC, “Antecedents,” which indicate the changes and contexts in which PCC occurs, and “Consequences,” which are the events that occur consequently, were extracted on the coding sheet. The extracted contents of each of the “Attributes,” “Antecedent,” and “Consequences” from the created coding sheets were summarized as codes, and similar codes were categorized. To improve the validity of the analysis, the authors received supervision from a researcher who had been conducting research and practice on PCC.
3. Result
The initial search yielded 392 articles. The titles and abstracts of the 392 articles were checked to avoid duplication, and those that did not focus on PCC were excluded. Four articles were identified through a manual search. Finally, 33 studies were included in the analysis; the outline of the effort and country of the included studies (selected) is listed in Table 1. The final 33 included studies used in the analysis identified four attributes, four antecedents, and three consequences.
3.1. Attributes
Four attributes were extracted from this concept of PCC: the subject is people, approaches to improving and enhancing health issues, relationships as a basis for partnership building, and behavioral attitudes for building partnerships. []indicates the attributes and [ ] indicates the subcategory. Table 2 presents the attributes of the PCC along with the literature from which they were extracted.
[The subject is people] In PCC, the priority is [people are respected as subjects of health]. This approach is [based on partnerships between people and healthcare providers], and [access to health information that meets people’s needs] is an essential element in various approaches. Various forms of [collaboration with communities] also occurred. Respecting people’s autonomy means keeping the [presence of people from all social, economic, and cultural backgrounds] in mind.
[Approaches to improving and enhancing health issues] Approaches to improving and enhancing health issues included [approaches to improving and enhancing health issues for individuals], [approaches to improving and enhancing health issues for the community], and [approaches to improving the health system].
[Relationships as a basis for partnership building] To build a partnership, the first step is [mutual understanding]. To continue working together, it is necessary to have [mutual trust]. The relationship between trust and trust continues based on [mutual understanding]. [Mutual respect] is also essential for building partnerships in activities.
[Behavioral attitudes toward building partnerships] As the activities continue, both people and healthcare providers are [taking on each other’s roles] that are appropriate to their positions and situations. While fulfilling their roles, they are [growing together]. People come into various decision-making situations, and each has the right and duty to participate in decision-making and [shared decision-making]. It is also important to [use each other’s strengths] as equals, share the current situation and issues, think together, and [overcome problems] together.
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Table 1. Outlines of efforts of included studies (selected).
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Table 2. Attributes of the concept of people-centered care.
3.2. Antecedent
Four antecedents were extracted from PCC: changes in social conditions; increasing people’s ownership of their health; health issues in modern society; and care in a variety of settings indicates the antecedent and indicates the category. Table 3 presents the antecedents of PCC along with the literature from which they were extracted.
Changes in social conditions and medical conditions] have been intense, and non-communicable diseases are on the rise worldwide, resulting in a significant increase in the burden of disease. [Changes in population structure] are also advancing.
[Increasing people’s ownership of their health] and [Diversification of subjective health views] are also advancing as advances in medical technology have made it possible to diversify options to maintain and improve health while living with a disease. There are also [changes in the way people interact with healthcare] in this diversification. However, there is a [gap between people and health care providers]. Consequently, there are [communication challenges between people and healthcare providers].
3.3. Consequences
Three consequences were extracted from the concept of PCC: achieving goals set by the people themselves, self-transformation of both people and healthcare providers, and social transformations. [] indicates the consequence and [] indicates the category. Table 4 presents the consequences of PCC along with the literature from which they were extracted.
[Achieving goals set by the people themselves] PCC enables [access to healthcare with respect to autonomy]. Achieving this goal also ensures that [people can take the actions they want to realize].
[Self-transformations of both people and healthcare providers] [Changing people’s mindset] enables them to take a more proactive view of their health and make decisions that are important to them in a way that makes sense to them. [Improving people’s competence] includes improving health literacy, health knowledge, self-efficacy, and changes in health behaviors. People are not the only people whose competence is enhanced. To deliver care that meets people’s needs is [improve the competence of healthcare providers]. It also means improved patient safety and satisfaction, and enhanced satisfaction for healthcare providers.
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Table 3. Antecedent of the concept of people-centered care.
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Table 4. Consequence of the concept of people-centered care.
[Social transformations] The transformation of the individual comes [community empowerment]. As the community accumulates activities, they expand and develop. The increase and expansion of social capital for health leads to the [transformation of the social system]. The development of health policies at the national level based on PCC can be reorganized to meet people’s needs. These social transformations benefit people and the health system.
4. Discussion
Based on the analysis results, PCC was defined as “an initiative in which people step forward and partner with health care providers to improve and enhance health issues in individuals and communities.” In various social and individual changes, the realization of PCC is expected to result in the achievement of goals set by the people themselves together with healthcare providers, as well as the transformation of individuals and society. This definition does not deviate from the conceptual diagram of PCC constructed by Takahashi et al. [39] and is thought to be captured in reports from overseas published after 2017, without significant differences in the central idea.
Patient-centered care is a concept associated with PCC. The most distinguishing feature of PCC from patient-centered care is that it does not limit its target to the patient. The focus is on the whole person, not just the person with the disease [2], and the target group includes not only the patient but also their family, friends, and community [22] [27]. The emphasis is on respecting the wishes of these people [8].
The need for a broader view of the target population is also influenced by the diversification of health problems due to changes in social conditions [12] [35]. Even with the development of medicine, many health problems remain [12] [28] [29] [30], and new needs of people regarding health and healthcare [2] [16] [20] [21] [23] [24] [29]. In response to these, the expansion of the role of healthcare professionals [13] [14] [15] [16] [25] [37] and diversification of activity sites [8] [9] [10] [11] [13] [14] [15] [16] [25] [37] are advancing based on the concept of PCC. In some cases, PCC has been introduced into healthcare systems through a top-down process as a national policy; in others, it has been introduced as a small demonstration project and subsequently spread to other parts of the country [2]. Integrating PCC into existing healthcare systems is important through diverse approaches. Such a trend would lead to improved patient safety and satisfaction.
In this analysis, the authors emphasized the inclusion of the subcategory [presence of people from all social, economic, and cultural backgrounds] in the attributes. This content could have been included in the subcategory [people are respected as subjects of health]. However, it is categorized as an independent subcategory because the authors believe that, due to the diversification of the population, consideration of social, economic, and cultural backgrounds is becoming more important. Through PCC-based practices, people receive care that meets their needs and enables them to achieve goals based on their will. Personal change occurs for citizens and healthcare providers, leading to social change toward improving community empowerment and health issues [37].
This study was peer reviewed to ensure that the validity of the results was supported. However, researchers’ conceptual biases and rigor are limited. This concept is dynamic and does not provide a permanent definition [5].
While the concept of PCC is especially important in terms of people’s ownership of their health, it is presumed that ownership of health is also highly influenced by healthcare circumstances and cultural background. The significance of the concept of PCC has been noted for many years [30], and it is expected that it will continue to be used in healthcare initiatives. It is important to validate this concept through PCC-based care.
5. Conclusion
The concept of PCC was analyzed using Rogers and Knafl’s evolutionary method [5]. This concept was defined as “an initiative in which people step forward and partner with health care providers to improve and enhance health issues in individuals and communities.” The realization of PCC is expected to achieve the goals set by the people themselves, together with healthcare providers, and to transform individuals and society.
Acknowledgements
We would like to thank Dr. Keiko Takahashi, who belongs to Saitama Prefectural University, for valuable advice regarding the analysis.