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Impact, barriers and facilitators of the ‘Ask Me 3’ Patient Communication Intervention in a primary care center in Barcelona, Spain: a mixed-methods analysis

Raluca Oana Groene, Ignasi Bolíbar, Carlos Brotons


Introduction: The study aims at assessing the effectiveness of the "Ask Me 3" intervention in increasing the empowerment of patients, while identifying barriers and facilitators to its implementation in primary care.

Methods: The study combined quantitative and qualitative methodologies. The quantitative component employed a quasi-experimental design in which participants were assigned to either the Ask me 3 intervention or a control group. Qualitatively, all patients responded after the medical consultation to a questionnaire where empowerment was assessed through the Patient Enablement Instrument. Subsequently, a focus group with patients and another with medical doctors were conducted to identify barriers and facilitators of the Ask me 3 intervention. A content thematic analysis based on literal transcriptions identified barriers and facilitators of Ask me 3.

Results: Overall, empowerment levels were low, especially in women and older patients, but higher in people with low health literacy. Adjusted patients’ level of empowerment was significantly higher in the intervention than in the control group (OR = 3.59; CI: 1.53-8.42). The intervention did not extend the duration of the medical consultation.

Conclusion and practical implications: Even a simple intervention such as Ask me 3 can contribute to an increase in patients’ level of empowerment. Question-asking interventions have the potential to increase patients’ control over decisions affecting their health and are therefore important instruments for the advancement of person-centered healthcare.


Barriers, facilitators, family medicine, general practice, patient empowerment, patient-provider communication, person-centered care, person-centered medicine, primary care, intervention, public health, evaluation.

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