Anthony JS. Self-advocacy in health care decision-making among elderly African Americans. J Cult Divers. 2007; 14:(2)88-95

Belcher VN, Fried TR, Agostini JV, Tinetti ME. Views of older adults on patient participation in medication-related decision making. J Gen Intern Med. 2006; 21:(4)298-303

Bosworth HB. Improving patient treatment adherence. A clinician's guide.New York (NY): Springer; 2010

Brashers DE, Haas SM, Neidig JL, Rintamaki LS. Social activism, self-advocacy, and coping with HIV illness. J Soc Pers Relat. 2002; 19:(1)113-133

Chae SY, Chae MH, Isaacson N, James TS. The patient medication list: can we get patients more involved in their medical care?. J Am Board Fam Med. 2009; 22:(6)677-685

Cho E, Lee NJ, Kim EY Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: a cross-sectional study. Int J Nurs Stud.. 2016; 60:263-271

Davis M. A comparison of reported self-determination levels by members of self-advocacy groups versus matched non members. Journal of Intellectual Disability Research. 2004; 48:(4–5)

de Wit L, Fenenga C, Giammarchi C Community-based initiatives improving critical health literacy: a systematic review and meta-synthesis of qualitative evidence. BMC Public Health. 2018; 18:(1)

Elder NC, Regan SL, Pallerla H, Levin L, Post D, Cegela DJ. Development of an instrument to measure seniors' patient safety health beliefs: The Seniors Empowerment and Advocacy in Patient Safety (SEAPS) survey. Patient Educ Couns.. 2007; 69:(69–1)100-107

Elder NC, Regan SL, Pallerla H, Levin L, Post DM, Cegala DJ. Educating seniors to be patient safety self-advocates in primary care. J Patient Saf.. 2008; 4:(2)106-112

Elder KT, Wiltshire JC, McRoy L, Campbell D, Gary LC, Safford M. Men and differences by racial/ethnic group in self advocacy during the medical encounter. J Men's Health. 2010; 7:(2)135-144

Ghasemi S, Keshavarz Mohammadi N, Mohammadi Shahboulaghi F, Ramezankhani A. A critical review of studies on health needs assessment of elderly in the world. Elderly Health J.. 2017; 3:(1)1-9

Groves PS, Bunch JL. Priming patient safety: a middle-range theory of safety goal priming via safety culture communication. Nurs Inq.. 2018; 25:(4)

Hagan TL, Donovan HS. Self-advocacy and cancer: a concept analysis. J Adv Nurs. 2013a; 69:(10)2348-2359

Hagan TL, Donovan HS. Ovarian cancer survivors' experiences of self-advocacy: a focus group study. Oncol Nursing Forum.. 2013b; 40:(2)140-147

Hagan TL, Rosenzweig MQ, Zorn KK, van Londen GJ, Donovan HS. Perspectives on self-advocacy: comparing perceived uses, benefits, and drawbacks among survivors and providers. Oncol Nurs Forum. 2017; 44:(1)52-59

Hanks RG. The medical-surgical nurse perspective of advocate role. Nurs Forum. 2010; 45:(2)97-107

Jonikas JA, Grey DD, Copeland ME Improving propensity for patient self-advocacy through wellness recovery action planning: results of a randomized controlled trial. Community Ment Health J.. 2013; 49:(3)260-269

Juniper EF, Guyatt GH, Streiner DL, King DR. Clinical impact versus factor analysis for quality of life questionnaire construction. J Clin Epidemiol.. 1997; 50:(3)233-238

Kahana E, Kahana B, Kelley-Moore J Toward advocacy in cancer care for older adults: survivors have cautious personal actions but bold advice for others. J Am Geriatr Soc.. 2009; 57:s269-s271

Kamran A, Sadeghieh Ahari S, Biria M, Malepour A, Heydari H. Determinants of patient's adherence to hypertension medications: application of health belief model among rural patients. Ann Med Health Sci Res.. 2014; 4:(6)922-927

Lacasse Y, Godbout C, Sériès F. Health-related quality of life in obstructive sleep apnoea. Eur Respir J.. 2002; 19:(3)499-503

Le Pogam MA, Burnand B, Quantin C Development of elderly patient safety indicators using Swiss and French administrative linked data. Eur J Public Health. 2015; 25:176-111

Levinson W, Kao A, Kuby A, Thisted RA. Not all patients want to participate in decision making. J Gen Intern Med. 2005; 20:(6)531-535

Liu Y, Avant KC, Aungsuroch Y, Zhang XY, Jiang P. Patient outcomes in the field of nursing: a concept analysis. Int J Nurs Sci.. 2014; 1:(1)69-74

Mahdizadeh M, Solhi M. Relationship between self-care behaviors and health literacy among elderly women in Iran, 2015. Electron Physician. 2018; 10:(3)6462-6469

Naumann PL, Vessey JA. Teaching patients self-advocacy—speaking out about speaking up. Am J Nurs. 2002; 102:(7)24A-24C

Negarandeh R, Oskouie F, Ahmadi F, Nikravesh M, Hallberg IR. Patient advocacy: barriers and facilitators. BMC Nurs. 2006; 5:(1)

Palmer C, Roessler RT. Requesting classroom accommodations: self-advocacy and conflict resolution training for college students with disabilities. J Rehabil.. 2000; 66:(3)38-43

Payne VL, Singh H, Meyer AN, Levy L, Harrison D, Graber ML. Patient-initiated second opinions: systematic review of characteristics and impact on diagnosis, treatment, and satisfaction. Mayo Clin Proc.. 2014; 89:(5)687-696

Pickett SA, Diehl SM, Steigman PJ, Prater JD, Fox A, Shipley P, Grey DD, Cook JA. Consumer empowerment and self-advocacy outcomes in a randomized study of peer-led education. Community Ment Health J.. 2012; 48:(4)420-430

Polit DF, Beck CT. Nursing research: Principles and methods.Philadelphia (PA): Lippincott Williams & Wilkins; 2004

Prabsangob K, Somrongthong R, Kumar R. Health literacy among Thai elderly population with type-2 diabetes living in rural area of Thailand. Pak J Public Health. 2018; 8:(1)27-31

Ronnebaum ED, Schmer C. Patient advocacy and the Affordable Care Act: the growing need for nurses to be culturally aware. Open J Nurs. 2015; 05:(03)237-245

Ruggiano N, Edvardsson D. Person-centeredness in home- and community-based long-term care: current challenges and new directions. Soc Work Health Care. 2013; 52:(9)846-861

Samadi SA, McConkey R. Autism in developing countries: lessons from Iran. Autism Res Treat. 2011; 2011:1-11

Selected findings of the 2016 National Population and Housing Census. 2018. (accessed 17 August 2019)

Siddiqi S, Elasady R, Khorshid I Patient Safety Friendly Hospital Initiative: from evidence to action in seven developing country hospitals. Int J Qual Health Care. 2012; 24:(2)144-151

Smith SG, Jackson SE, Kobayashi LC, Steptoe A. Social isolation, health literacy, and mortality risk: Findings from the English Longitudinal Study of Ageing. Health Psychol.. 2018; 37:(2)160-169

Tennant B, Stellefson M, Dodd V eHealth literacy and Web 2.0 health information seeking behaviors among baby boomers and older adults. J Med Internet Res.. 2015; 17:(3)

Self-help groups as a tool for economic empowerment of persons with disability. (accessed 17 August 2019)

Traynor K. Personal medication record campaigns get underway. Am J Health Syst Pharm. 2007; 64:(17)1781-1784

Tuttle CG, Silva JA. Self-advocacy: the ultimate teen guide.Lanham (MD): Scarecrow Press; 2007

Nursing advocacy: a concept clarification in context of procedural pain care. 2008. (accessed 17 August 2019)

Williams PA, Wold G. Basic geriatric nursing.St Louis (MI): Mosby; 2015

Wiltshire J, Cronin K, Sarto GE, Brown R. Self-advocacy during the medical encounter: use of health information and racial/ethnic differences. Med Care. 2006; 44:(2)100-109

Wolf MS, Gazmararian JA, Baker DW. Health literacy and functional health status among older adults. Arch Intern Med. 2005; 165:(17)1946-1952

Young L, Kupzyk K, Barnason S. The impact of self-management knowledge and support on the relationships among self-efficacy, patient activation, and self-management in rural patients with heart failure. J Cardiovasc Nurs. 2017; 32:(4)E1-E8

Older adults' self-advocacy in patient safety: a cross-sectional study

12 September 2019
Volume 28 · Issue 16



patient advocacy is a major nursing role, which is linked to supporting, encouraging and reinforcing self-advocacy in patients. Patient safety is an important nursing outcome, especially in older adults.


older adults' self-advocacy regarding patient safety behaviour and its relationship with some demographic characteristics were assessed.


a valid older adult patients' self-advocacy questionnaire, which included subscales of behaviour, self-efficacy, attitude and outcome efficacy (range of scores=0–63), was used. In this cross-sectional study, 230 patients aged over 60 years were selected using a stratified sampling method.


an association was found between total self-advocacy score (mean=40.16; SD=9.6) and rural living (β=–0.168; P=0.016) using multiple linear regression analysis. Similar findings were found between questionnaire subscales and sex, rural living, occupation and age.


older adults, especially women, those of advanced age and those in rural areas, may benefit from nursing interventions to improve their self-advocacy in patient safety.

Older adults' health is one of the most concerning world issues. Their healthcare has gained more importance in recent decades because of medical advances and the increase in the older population (Ghasemi et al, 2017). In Iran, the proportion of the population aged over 60 years is rising continually, and accounted for 9.35% of people in the country in 2016 (about 7.5 million people) (Statistical Center of Iran (SCI), 2018).

A general concern around the care of older adults is patient safety (Williams and Wold, 2015). Factors such as frailty, disease and polypharmacy (Palmer and Roessler, 2000) as well as complexity of care raise the risk of undesirable events in older adults (Le Pogam et al, 2015). Evaluation of safety hazards and making environmental modifications can improve safety (Williams and Wold, 2015). Self-advocacy has been suggested as one of the most effective approaches in promoting older adults' safety (Bishop, 2012; Elder et al, 2008; Jonikas et al, 2013).

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