Wednesday, August 20, 2014

Just What Is "Patient Engagement" in Health Care?

According to this paper by Barello et al in the Journal of Participatory Medicine, the muddled answer depends on when it was used as well as your professional background.

Using a densely written "lexicographic qualitative analysis" to dive into over 250 scientific papers, the authors found that the term has evolved and may still be in its infancy. When it first began to regularly appear about 15 years ago, the term "patient engagement" was used in behavioral and nursing contexts to describe a dimension of established one-on-one provider-patient care.  Since then, it's been used in a biomedical sense to portray a new relationship between a system and a patient.

The authors point out that how "engagement" is achieved depends on a spectrum of patient perspectives that range from unaware to really motivated.  The Population Health Blog suggests that one way to think about it may be the transtheoretical "readiness to change" model.

The one thing that has been missing in the scientific papers is the patients' perspective.  Ironically, no one has asked and cataloged their answers in any systemic manner.

Last but not least, it's unclear if real purpose of achieving patient "engagement" is greater autonomy, relationship-building, making health care more responsive, reducing costs, or improving public health.  As a result, it's a catchphrase has become all things to all people.

While this lacks the all-important input of folks like this and may also be an exercise in tautology, the Population Health Blog managed to extract something of a definition for the term: a span of cognitive processes that seeks participation, compliance, learning  and self-management in health care, including disease, prevention and health.

Image from Wikipedia


1 comment:

HealthMessaging said...


It's not often that one acknowledges that patients even have an opinion about "patient engagement." If asked I hazard to guess that nearly 100% of people would say that they are already engaged in their health albeit in ways not measured or deemed legitimate by health professionals.

82% of US adults for example see their doctor at least once a year - the average being 3xs per year and double that for people with chronic conditions. Before one ever shows up for the appt. a person engages in a series of "cognitive processes" - do I need to see a doctor, is my condition serious, what does the internet say about my symptoms, which kind of doctor do I need to see, etc... What about this suggests that patients are unengaged?

Similarly, most people will tell you they try and watch what they eat, wear seat belts and wash their hands. This too is a sign of engagement...albeit not the same as doing what doctors tell them to do.

The reality is, as your post suggests, the concept of patient engagement has been co-opted by individual segments of health care professionals and vendors to suit their own needs. Chief among these "interest groups" are HIT folks who believe that a patient is engaged when they are using the health IT or application they develop. Or clinicians who believe that a patient is engaged only when they are doing what the doctor thinks is in the patient's best interest (as defined by clinicians).

Steve Wilkins
Mind the Gap