Table 1.

 Factors affecting patients’ willingness to participate in improving the safety of their own health care

Factor		Evidence/relevant information
1. Patient‐related	Knowledge/beliefs	The public is concerned about the risk of medical errors if hospitalised, 12, 13 75%feel health care is only moderately safe 12, 13 and 49%feel preventable medical errors are made‘somewhat often’or‘very often’ 14
		Patients understand the risk of medication errors and hospital acquired infections 15, 16
		59%of the public feel that patients’are‘somewhat often’or‘very often’partially responsible for errors in their own care 14
		Patients feel they have a role in reducing their susceptibility to patient safety incidents, including medication errors 16
	Demographic features	Younger patients generally want more involvement than older patients 18 , 19 , 20
		Females want more involvement than males 18
		Highly educated patients opt for a more active role than their less academic peers 18 , 19 , 20
	Emotions and coping style	Patients’ experiences with their illness can trigger negative emotions (e.g. anxiety). 25
		Negative emotions may heighten patients’ perceptions of vulnerability to negative life events, 26 , 27 which may catalyse their participation in safety‐related behaviours.
		Patients that use more active coping styles express greater preferences for involvement 28
2. Illness‐related	Stage/severity of illness	Some studies show patients with minor complaints are more likely to prefer an active role than patients with severe disease 18 , 29 but opposing findings show patients with serious illness/whose illness is further progressed, have higher preference for involvement 30
	Illness symptoms, treatment  plan and patients’ health outcomes	Patients’ preferences for involvement may change over time dependent on the symptoms of the illness 31
		Preference for involvement may be associated with illness symptoms and how these affect the functionality of the patient
		Preference for involvement may be associated with the type of treatment plan for the illness and how much opportunity for involvement this allows
		Preference for involvement may be associated with the likely impact that patient involvement will have on the patients’health outcomes
	Prior experience
	• Illness	Patients’ experience of illness is associated with higher preference for involvement for treatment of that illness. 32 Experience of a patient safety incident may have a similar effect in terms of an increased preference for involvement in safety‐related behaviours
	• Patient safety incidents	National and international organizations have been founded by victims of patient safety incidents (http://www.mrsasupport.co.uk; http://www.patientsafety.org)
3. Health care professional‐related	Knowledge/beliefs	58% physicians felt that patients were either‘very often’or‘somewhat often’ partially responsible for medical errors in their care. 14
	Interactions with patients	Clinicians generally express positive views on patient involvement 34
		Positive interactions with health professionals can encourage patient participation; 35 , 36
		Negative interactions can act as an inhibitor 37
	HCP’s professional role	100%patients were willing to ask a nurse whether they have washed their hands, but only 35%were willing to ask a doctor 15
4. Health care setting‐related	Health care setting	Patients have more difficulty communicating with hospital staff than their GP, 35 , 38 so may be less willing to engage in safety‐related behaviours which require direct communication with staff in the hospital setting.
		Emergency patients are typically unsure what is wrong with them so may be less willing to be involved than patients receiving ambulatory Care 39
5. Task‐related	Challenge to HCPs	It is likely that patients will be more willing to be involved in safety‐related behaviours that do not challenge the health care professionals’ clinical abilities.
	Medical knowledge  required	Patients prefer to be more involved in those aspects of their health care that do not require medical knowledge. 40

Note – For factors/relevant information: Bold face type indicates direct evidence of effect of factor on patients’ willingness to be involved in safety; Normal type indicates possible effect/indirect evidence and relevant observations drawn from TDM literature and other sources; Italic type indicates suggestive factors that could affect patients’ willingness to participate in safety.