["Teilhabe" (social participation) of patients in health care research: relations to similar concepts and overview of assessment instruments]

The great significance of the concept of participation in health care policy is in contrast with the comparatively low resonance that the participation construct ("Teilhabe" in German) has found in scientific circles. It can be argued that this is due in part to the insufficient specification of the term in the ICF ("International Classification of Functioning, Disability and Health") and the lack of suitable measuring instruments. This article deals with the question of what approaches to defining participation currently exist and what methods are conceivable for facilitating the integration of the construct in health services research. Based on a review of German and international literature on participation, the construct is differentiated from related concepts such as "social capital," "social network," "social support," and "community integration". It is recommended that participation should be understood as "social role participation". The possibility this entails of referring to existing research traditions and available studies leads to the necessity that a comprehensive measurement of participation should include five dimensions of this construct: performance, capability, importance, context factors, and satisfaction. A review of the available instruments for measuring participation shows that most of them cover the ICF domains that are important in this context to a sufficient extent. However, there are the following areas for improvement: a) No measuring instrument includes all five relevant dimensions of participation, b) None of the instruments take non-health-related obstacles to participation (context factors) into consideration, c) The possibility of a version with parallel content for proxy assessment is rarely used, d) The published methods available to German-speaking users cover participation only globally or are older and do not incorporate experience with the ICF. In view of the significance of the participation construct in the German health care system, studies on new or ongoing developments of assessment instruments that meet these challenges would be welcomed.