Despite widespread usage in aging and health services, the concept of person-centeredness (PC) does not have a single, universal definition. This definitional challenge may be due, in part, to desired parsimony that oversimplifies the concept’s intrinsic complexity. To better understand the inherent breadth and depth of PC, 116 experts in health- and aging-related policy and practice participated in meetings to discuss PC as a concept, which led to a multilevel conceptualization of the term at the macro, meso, and micro levels. The focus, implementation, and challenges of PC were identified at these interrelated levels, creating a nuanced, contextual model. In addition, the model’s application to current measurement of PC is detailed, and recommendations are made for additional review and development to best measure PC at all levels. This innovative multilevel approach makes explicit the innately contextual nature of PC as a value-based concept, with application for policy, practice, and research.
AARP Public Policy Institute. (2023). Innovation and opportunity: A state scorecard on long-term services and supports for older adults, people with physical disabilities, and family caregivers (2023 ed.). https://doi.org/10.26419-2Fppi.00203.001
2.
ArmstrongT. L.SwartzmanL. C. (2001). Cross-cultural differences in illness models and expectations for the health care provider-client/patient interaction. In Handbook of cultural health psychology (pp. 63–84). Academic Press. https://doi.org/10.1016/B978-012402771-8/50005-2
3.
ArnoldM. H.KerridgeI.LipworthW. (2020). An ethical critique of person-centred healthcare. European Journal for Person Centered Healthcare, 8(1), 34–44. https://www.ejpch.org/ejpch/article/view/1818
4.
BangerterL. R.HeidA. R.AbbottK.Van HaitsmaK. (2017). Honoring the everyday preferences of nursing home residents: Perceived choice and satisfaction with care. The Gerontologist, 57(3), 479–486. https://doi.org/10.1093/geront/gnv697
5.
BehrensL.Van HaitsmaK.BrushJ.BoltzM.VolpeD.KolanowskiA. M. (2018). Negotiating risky preferences in nursing homes: A case study of the Rothschild person-centered care planning approach. Journal of Gerontological Nursing, 44(8), 11–17. https://doi.org/10.3928/00989134-20171206-02
6.
BeiraoG.PatricioL.FiskR. (2017). Value cocreation in service ecosystems: Investigating health care at the micro, meso, and macro levels. Journal of Service Management, 28(2), 227–249. https://doi.org/10.1108/JOSM-11-2015-0357
CaldwellS. E.MaysN. (2012). Studying policy implementation using a macro, meso and micro frame analysis: The case of the Collaboration for Leadership in Applied Health Research & Care (CLAHRC) programme nationally and in North West London. Health Res Policy Sys, 10, 32. https://doi.org/10.1186/1478-4505-10-32
9.
EdvardssonD.InnesA. (2010). Measuring person-centered care: A critical comparative review of published tools. The Gerontologist, 50(6), 834–846. https://doi.org/10.1093/geront/gnq047
10.
EdvardssonD.KochS.NayR. (2009). Psychometric evaluation of the English Language Person-Centered Climate Questionnaire--Patient version. Western Journal of Nursing Research, 31(2), 235–244. https://doi.org/10.1177/0193945908326064
11.
Efird-GreenL.GranthamL.ZimmermanS. (in review). Definitions of person-centeredness for persons with dementia in the United States: A systematic scoping review.
12.
EtzR. S.ZyzanskiS. J.GonzalezM. M.RevesS. R.O’NealJ. P.StangeK. C. (2019). A new comprehensive measure of high-value aspects of primary care. The Annals of Family Medicine, 17(3), 221–230. https://doi.org/10.1370/afm.2393
13.
FazioS.PaceD.FlinnerJ.KallmyerB. (2018). The fundamentals of person-centered care for individuals with dementia. The Gerontologist, 58(suppl_1), S10–S19. https://doi.org/10.1093/geront/gnx122
14.
GkioulekaA.HuijtsT.BeckfieldJ.BambraC. (2018). Understanding the micro and macro politics of health: Inequalities, intersectionality & institutions—A research agenda. Social Science & Medicine, 200, 92–98. https://doi.org/10.1016/j.socscimed.2018.01.025
JamesI.AndershedB.TernestedtB. M. (2009). The encounter between informal and professional care at the end of life. Qualitative Health Research, 19(2), 258–271. https://doi.org/10.1177/1049732308329309
17.
JohnstoneM. J.HutchinsonA. M.RawsonH.RedleyB. (2016). Nursing strategies for engaging families of older immigrants hospitalized for end-of-life care: An Australian study. Journal of Patient Experience, 3(3), 57–63. https://doi.org/10.1177/2374373516667004
18.
JohnstoneM. J.KanitsakiO. (2009). Ethics and advance care planning in a culturally diverse society. Journal of Transcultural Nursing: Official Journal of the Transcultural Nursing Society, 20(4), 405–416. https://doi.org/10.1177/1043659609340803
19.
KoganA. C.WilberK.MosquedaL. (2016). Person-centered care for older adults with chronic conditions and functional impairment: A systematic literature review. Journal of the American Geriatrics Society, 64(1), e1–e7. https://doi.org/10.1111/jgs.13873
20.
KuziemskyC. E.MonkmanH.PetersenC.WeberJ.BoryckiE. M.AdamsS.CollinsS. (2018). Big data in healthcare – defining the digital persona through user contexts from the micro to the macro. Contribution of the IMIA Organizational and Social Issues WG, 23(01), 82–89. https://doi.org/10.15265/IY-2014-0014
21.
LeidnerC.VennedeyV.HillenH.AnsmannL.StockS.KuntzL.PfaffH.HowerK. I.CoRe-Net Co-applicants. (2021). Implementation of patient-centred care: Which system-level determinants matter from a decision maker’s perspective? Results from a qualitative interview study across various health and social care organisations. BMJ Open, 11(9), Article e050054. https://doi.org/10.1136/bmjopen-2021-050054
NolteE.MerkurS.AnellA. (2020). The person at the centre of health systems: An introduction. In NorthJ.NolteE.MerkurS.AnellA. (Eds.), Achieving person-centred health systems: Evidence, strategies and challenges (European Observatory on Health Systems and Policies, pp. 1–18). Cambridge University Press. https://doi.org/10.1017/9781108855464.005
25.
Oosterveld-VlugM. G.PasmanH. R.van GennipI. E.de VetH. C.Onwuteaka-PhilipsenB. D. (2014). Assessing the validity and intra-observer agreement of the MIDAM-LTC; an instrument measuring factors that influence personal dignity in long-term care facilities. Health and Quality of Life Outcomes, 12, 17. https://doi.org/10.1186/1477-7525-12-17
26.
PyyhtinenO. (2017). Matters of scale: Sociology in and for a complex world. Canadian Review of Sociology/Revue Canadienne de Sociologie, 54(3), 297–308. https://doi.org/10.1111/cars.12151
27.
SawatzkyR.KwonJ. Y.BarclayR.ChauhanC.FrankL.van den HoutW. B.NielsenL. K.NolteS.SprangersM. A. G.Response Shift – in Sync Working Group. (2021). Implications of response shift for micro-meso-and macro-level healthcare decision-making using results of patient-reported outcome measures. Qual Life Res, 30(12), 3343–3357. https://doi.org/10.1007/s11136-021-02766-9
28.
SerpaS.FerreiraC. M. (2019). Micro, meso, and macro levels of social analysis. International Journal of Social Science Studies, 7(3), 120–124. https://doi.org/10.11114/ijsss.v7i3.4223
29.
SmithJ. B.WillisE. M.Hopkins‐WalshJ. (2022). What does person‐centred care mean, if you weren’t considered a person anyway: An engagement with person‐centred care and black, queer, feminist, and posthuman approaches. Nursing Philosophy, 23(3), Article e12401. https://doi.org/10.1111/nup.12401
30.
ThomasC.MorrisS. M.HarmanJ. C. (2002). Companions through cancer: The care given by informal carers in cancer contexts. Social Science & Medicine (1982), 54(4), 529–544. https://doi.org/10.1016/s0277-9536(01)00048-x
31.
Ward-GriffinC.McWilliamC. L.OudshoornA. (2012). Relational experiences of family caregivers providing home-based end-of-life care. Journal of Family Nursing, 18(4), 491–516. https://doi.org/10.1177/1074840712462134
32.
WhiteD. L.Newton-CurtisL.LyonsK. S. (2008). Development and initial testing of a measure of person-directed care. The Gerontologist, 48(suppl_1), 114–123. https://doi.org/10.1093/geront/48.Supplement_1.114
33.
WiigS.AaseK.von PlessenC.BurnettS.NunesF.WeggelaarA. M.Anderson-GareB.CalltorpJ.FulopN.For QUASER-team. (2014). Talking about quality: Exploring how ‘quality’ is conceptualized in European hospitals and healthcare systems. BMC Health Serv Res, 14, 478. https://doi.org/10.1186/1472-6963-14-478
34.
WileyN. (1988). The micro-macro problem in social theory. Sociological Theory, 6(2), 254–261. https://doi.org/10.2307/202119
ZimmermanS.AllenJ.CohenL. W.PinkowitzJ.ReedD.CoffeyW. O.ReedP.LeporeM.SloaneP. D.University of North Carolina-Center for Excellence in Assisted Living Collaborative. (2015). A measure of person-centered practices in assisted living: The PC-PAL. Journal of the American Medical Directors Association, 16(2), 132–137. https://doi.org/10.1016/j.jamda.2014.07.016
37.
ZimmermanS.MoczygembaW.SloaneP. D.FazioS. (in review). The need to reconstruct “person-centeredness” based on inherent tensions.
