Unraveling the meaning of patient engagement: A concept analysis

https://doi.org/10.1016/j.pec.2016.09.002Get rights and content

Highlights

  • A concept analysis of patient engagement was performed using the Rogers Method.

  • Four attributes were identified: personalization, access, commitment, and therapeutic alliance.

  • The definition and attributes may serve as a foundation for understanding and increasing engagement.

Abstract

Objective

Patient engagement has been credited with contributing to improved outcomes and experiences of care. Patient engagement has become a widely used term, but remains a poorly understood concept in healthcare. Citations for the term have increased throughout the healthcare-related disciplines without a common definition. This study seeks to define the concept by identifying its attributes in the context of its use.

Methods

A concept analysis of the scientific literature in the health disciplines was performed using the Rogers method.

Results

The analysis revealed four defining attributes of patient engagement: personalization, access, commitment and therapeutic alliance. Patient engagement is defined as the desire and capability to actively choose to participate in care in a way uniquely appropriate to the individual, in cooperation with a healthcare provider or institution, for the purposes of maximizing outcomes or improving experiences of care.

Conclusion

Patient engagement is both process and behavior and is shaped by the relationship between the patient and provider and the environment in which healthcare delivery takes place.

Practice implications

The definition and the identified attributes serve as a heuristic in designing patient engagement strategies and as a basis for future development of the patient engagement concept in healthcare.

Introduction

As contemporary healthcare evolves from a disease-centered to a patient-centered model [1], the concept of patient engagement assumes a pivotal role. The use of the term patient engagement has rapidly expanded in the health sciences. The concept has been referenced in literature published on patient-centered medical homes [2], comparative effectiveness research [3], use of technology for inpatient settings [4], ambulatory chronic care management [5], patient safety for prevention of adverse events [6] and controlling healthcare costs [7]. Definitions of patient engagement have varied over time and across contexts, however, rendering the essential nature of the concept elusive. Nevertheless, the US National Coordinator (ONC) of Health Information Technology has described patient engagement as one of the most underutilized resources in healthcare and a potential “blockbuster drug” [8], but has not referenced a definition of the concept.

The frequency of citations of the term “patient engagement” in the scientific literature has increased markedly since the introduction of the term in the 1990s, tripling between 2010 and 2013 in Web of Science. One reason for this increase is that the federal government now offers reimbursement for the use of health information technology to enhance patient engagement [9]. Conversations in social media and coverage by industry analysts reveal concerns about what patient engagement is and how to achieve it [10]. These concerns have arisen in part due to recent policy guidelines by the Centers for Medicare and Medicaid Services (CMS) that tie provider reimbursement to levels of patient engagement [11].

Accompanying this emphasis on patient engagement is emerging evidence of an association between patient engagement and quality in healthcare [12]. The meaning of the concept of patient engagement deserves close scrutiny to inform future practice, policy and research for improving quality of care. Outcomes research requires specific constructs and variables to measure the impact of patient engagement strategies, while efforts to improve the experiences of care may benefit from new insight into the definition of the concept of patient engagement. The varied and numerous references to patient engagement in the literature, combined with the emerging evidence of its potential to influence quality of care, constitute a relevant case for an in-depth analysis to construct a definition by determining the core attributes of the concept. Hence, the aim of this paper is to present a concept analysis of patient engagement to assemble that definition.

Section snippets

Methods

Roger’s Evolutionary Method [13] was used as the basis for this concept analysis. The method is comprised of six components described below where appropriate.

Identification of the concept of interest and associated expressions

The concept of patient engagement was identified due to its frequent, wide ranging references in recent literature.

No appropriate surrogate terms for patient engagement were identified as no other term proposes the same breadth of concept. We searched for definitions of related expressions such as patient-centered care, patient involvement, participation, activation and empowerment. Patient-centered care is defined by the Institute of Medicine as “Providing care that is respectful of and

Discussion

The large number of attributes assigned to each of the three domains (processes, behaviors, environment) suggests that the concept of patient engagement touches upon myriad dimensions of healthcare delivery. The concept influences relationships between actors in healthcare who execute processes, impact individual patient behaviors, and drive institutional practices. Many of the articles reviewed were published by interdisciplinary teams, with co-authors from medicine, nursing, public health,

Conflict of interest

The authors declare that they have no actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations within three years of beginning the submitted work that could inappropriately influence, or be perceived to influence, their work.

Acknowledgements

Tracy Higgins was supported by the VA 9-11 GI Bill, the generous participation of the Columbia School of Nursing in the VA Yellow Ribbon Program, and the Jonas Veterans Healthcare Scholar Program.

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