Health engagement is the idea that individuals undergoing treatment should have knowledge about and a proactive role in the healthcare proceedings of their diagnoses and subsequent treatment.[1]

As practitioner interest in patient activation and engagement has grown, there are now several frameworks proposing how health engagement can be achieved in both conventional and virtual care models. Most, including the Patient Health Engagement model, propose elements that are considered critical to building and sustaining engagement.

As it stands, there is still no formal consensus on many of the finer details; however, good progress is being made on learning more about engagement in the field of blended care, and several actors have made a number of strong proposals in this regard. Coaches also have an important role to play as facilitators that can greatly enhance the user experience for those undergoing medical treatment, as we shall see.

What is Health Engagement?

Health engagement refers to the practice of promoting individuals to active agents in their healthcare.[1][2] Whilst this is a relatively new phenomenon, its premise is simple; a person receiving care should take a degree of ownership and have a say in their health and any associated diagnoses and treatments administered.

The Growing Interest in Patient Health Engagement

There are still many challenges currently hindering this approach to modern healthcare. However, patient engagement initiatives are getting more widespread attention and deserve serious consideration from all parties and stakeholders involved.

Any such talks should consider anyone who can bring this practice to fruition, provide enough reasons to withhold its implementation, or help in the designing of an applicable framework.[3]

Patient engagement initiatives are getting more widespread attention and deserve serious consideration from all parties and stakeholders involved.

In pursuing any talks related to the adoption of such a model in healthcare, due consideration should and must be given to those who stand to lose or gain the most. Particular consideration, due to the very nature of the subject, should be given to those who for one reason or another might be in more vulnerable positions without infringing on the liberties afforded to individuals in modern society.[4][5]

Striking such a balance is of the utmost importance as is adhering to international human rights decrees as afforded by a modern society that places the right of each and every individual at the core of its mission.

The Benefits of Health Engagement

Putting patients as a deciding agent in the process, and by extension possible outcome, of their care might sound as a basic human right.

In principle, this might be effectively true. After all responsibility and accountability are not only ingrained in our way of living but enshrined in the constitutions of democratic societies.

Any individual should also have the right in which diagnosis and subsequent medication is afforded to said individual when these become necessary not withstanding the fact that primary healthcare providers are susceptible to error and pertinent information is readily available.[6]

The Role of Accountability

By affording a degree of ownership and accountability, the responsibility and manner in which the individual shares the road to recovery progresses who ultimately stands to gain the most. Depending on its implementation this may free up resources, which can be put to use in providing more healthcare services to those who need them.

As we live in a finite world, resources will always be limited and by sharing such responsibilities all incentivized parties are given a seat at the table.

There are also several mental health benefits in treating patients by inviting them to assert their wishes and concerns more openly.[7]

Health Engagement: What Can Go Wrong?

Medical literature, as complex as it is, might not be accessible or understandable for everyone. However, it’s been argued, the rise of social media has given an almost criminal reach to pseudo-science, which can convince individuals to pursue sham diagnoses.[8]

The Dangers of Misinformation

As a result, we see some potential downsides to misguided attempts to activate, inform, and engage patients in the healthcare process. Specifically, there is a risk that vulnerable individuals could be coerced or maliciously influenced by a third party for the latter’s gain, which may or may not become evident in the administration of any healthcare proceedings.

Furthermore, influence by uninformed individuals with no medical experience even if done in good faith, can derail and negatively affect the recovery and possibly longevity of those receiving care. All of these points and any other possible negative outcomes need to be taken into due consideration.

Pros and Cons of Health Engagement

What do we know so far, then, about the pros and cons of patient health engagement?

In the following table, a brief overview of some key arguments made in the research.

Advantages

Disadvantages

  • Patients who are involved in healthcare decision-making are more likely to stick to treatment and medication plans, leading to better symptom and condition management.[9][10]
  • Vulnerable people need may need protection[4][5]
  • Such improved outcomes may include enhanced physical function, greater confidence, and lower patient anxiety, amongst other attitude, quality of life, and clinical benefits.[11][12]
 
  • By positively impacting patient health outcomes and symptom management, health engagement efforts may reduce unplanned or emergency hospital visits and admissions, reducing the burden on healthcare institutions.[12][13]
 
  • Well-informed and well-supported patients are more apt to make healthy lifestyle choices. With a greater sense of empowerment, they are also more likely to make personally relevant treatment or therapy decisions.[14]
 

Factors Impacting Health Engagement

Studies show that several factors can influence the decision-making processes afforded by a health engagement model.

Other elements that may positively impact an individual’s willingness and ability to become share responsibility and become more engaged include[15]:

  • Socio-economic factors
  • Age
  • Ethnicity
  • Condition severity
  • Required treatment frequency, and
  • Cultural dispositions.

Healthcare can be a delicate subject and many different factors can affect the willingness of an individual to participate or remain as a passive agent. The policy under which such measures are effective will need to include all stakeholders to ensure an inclusive policy is ratified.

Furthermore, opinions from different healthcare or mental health experts can also ensure as much as possible that as many factors are taken into account to ensure no undue pressure is placed on any individual who might already be in a fragile state that has necessitated the introduction of any such policy or framework in the first place.

The Psychological Perspective

There is scant information available on the positive, or indeed negative, psychological effects of patients undertaking health engagement.[16]

Studies have been very limited both in scope and reach, and as such, this remains a subject that needs further in-depth investigation. Specifically, more tests are required on how well or badly this would play out in real-world situations on a larger (regional or international) scale.

Areas for Future Research

We have already seen that several different elements can greatly influence an individual’s views on health engagement structures. There is no reason to believe that these same factors will not show distinct characterizations in studies carried out to assess the psychological effects of health or client engagement.

Before any judgment is passed, however, such studies need to be pushed forward in the agenda of those responsible as prominently as possible; there is as much to be gained from further research as there is to lose – as we’ve seen in our look at the benefits and things to look out sections above.

Engagement Models

Engagement models look at a number of different aspects that fall under the remits of health engagement, and aim to measure an individual’s level of engagement on each individual factor.

Engagement models have been proposed to measure the level of engagement patients undertaking health engagements adopt.

Engagement models basically look at a number of different aspects that fall under the remits of health engagement and aim to measure an individual’s level of engagement on each individual factor.

Having some sort of success criteria management can help optimize the health engagement model that is ultimately pursued (if this indeed becomes the case) by ensuring that the most effective model is actually rolled out thus ensuring the greatest degree of success. Ultimately, what gets measured, is what tends to be improved upon in practice.[17]

Measuring Engagement

Through the engagement model utilized, a score can be given which as one proposal suggests can range from blackout (patient feels overwhelmed and withdraws into a passive state) to a eudaimonic project (in which the patient becomes a fully aware and active participant). Of course, different models might score each patient differently. However, a common protocol is imperative to ensure results are relate-able and as such can be collated so that the bigger picture can become visible to all.

This ensures that more criteria are included in the study to ensure a more compatible model can ultimately be made available.[18]

Challenges to Adopting Health Engagement

Like any other industry, the medical sector includes companies with primarily financial interests. We have seen numerous scandals involving doctors, drug companies, and insurance companies where profit incentives took precedence over the patient’s health.

Of course, the patient’s interests are always going to be aligned with their well-being however, we must look at history to understand what sort of challenges we might be faced with in the future.

A Need For Regulation

Regulatory frameworks need to be beefed up to ensure that no underhanded maneuvres are carried out to the detriment of the patient with new policies and framework not being immune to teething issues.

Judging the competence of the patient to take decisions can also be fraught with difficulties since a patient can be given the choice to perform euthanasia as an example. Whilst the merits of such rights are beyond the scope of this article, unintended consequences can still be present and effective measures against any unintended outcomes, whatever they might be need to be secured in place.

Determining these parameters might not always be a black on white affair; indeed it might be a murky grey area that leaves room for interpretation and as such room for abuse especially for more vulnerable patients.

Available Literature

Whilst scholarly literature might be readily available on bookshelves, accessibility to those who do not have a medical background needs to be afforded on a continuous basis. In order to engage patients in the administration of their health, a holistic, 360-degree approach needs to be taken so that all stakeholders can understand and be fully aware of the entire situation.

Making literature available can ensure that interested parties regardless of their disposition can keep themselves updated and informed of the latest updates and as well as advancements in both the fields of health engagement and telehealth.

What to Look Forward To

By giving patients an active role in their health, the most incentivized person gets a say and – from many standpoints – this is a good thing. At the end of the day, all humans are susceptible to error and having an extra pair of eyes can administer many benefits.

On the other hand, patients will also need to understand the legal and administrative side of the medical industry including the process by which medicine is released for market consumption, the implications of possible side-effects and the short and long term implications of available treatments and their overall health.

Initial feedback has mostly been positive and this can give hope to those who look forward to the introduction of such frameworks. This can allow patients to maximize their recovery process, improve their engagement levels and by offering a deeper understanding of the medical implications lead a healthier life.

Health is an important factor in the quality of life and the longevity of our life and by democratizing healthcare there is much to be gained.

After all, what is understood is more likely to be followed.

The Role of Coaching

Coaches are in a unique position to facilitate health engagement by interfacing between medical staff and the patients themselves. As the medical field can be quite technical in nature, someone who is able to comprehend the medical terms and jargon can then proceed to translate these into layman’s terms thus ensuring there is a lower barrier to entry to health engagement and the benefits it has to offer.

By implementing established frameworks, such as intrinsic coaching, they can often offer support and motivation that helps patients become more actively involved in their own health goals.

This being a sensitive subject, which can literally be the difference between life and death, a code of ethics can be ratified to ensure everything is done above board at all times.

Mental health coaches, in particular, also have the added benefit of experience with walking clients through difficult experiences and this knowledge and all of the experience that comes with it can be leveraged for the benefit of all. Whilst this might be of a more sensitive nature than what most coaches have to deal with throughout their career, undoubtedly a number of coaches have had to walk through clients through such difficult times.

By involving coaches such programs have a better shot at success; as such, everyone stands to gain more both in the short- and longer-terms.[19]

Related: The Nudge App Reviewed: What Is It, and Does It Work?

Final Thoughts

There are many benefits to health engagement, from improved quality of care to enhanced health outcomes and client satisfaction. However, there are also areas that need attention and considerable thought, in order to make sure engagement initiatives are implemented effectively.

In general, engagement benefits appear to outweigh the negatives, however, we must not forget those who might stand to lose.

Coaches, in particular, can have an enormous role to play; as facilitators and enablers in ensuring these programs’ smooth operation. With few substantial studies completed to date, it is still too early to say how things will ultimately play out – but it’s safe to say that health engagement will be discussed more and more in the near future.

References

  1. ^ Gruman, J., Rovner, M. H., French, M. E., Jeffress, D., Sofaer, S., Shaller, D., & Prager, D. J. (2010). From patient education to patient engagement: implications for the field of patient education. Patient Education and Counseling, 78(3), 350.
  2. ^ Greene, J., & Hibbard, J. H. (2012). Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes. Journal of General Internal Medicine, 27(5), 520.
  3. ^ Ferrer, L. (2015). Engaging patients, carers and communities for the provision of coordinated/integrated health services: strategies and tools. World Health Organization. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0004/290443/Engaging-patients-carers-communities-provision-coordinated-integrated-health-services.pdf
  4. ^ Kanstrup, A. M., Bertelsen, P., & Jensen, M. B. (2018). Contradictions in digital health engagement: An activity tracker’s ambiguous influence on vulnerable young adults’ engagement in own health. Digital Health, 4, 2055207618775192.
  5. ^ Lyles, C. R., & Sarkar, U. (2015). Health literacy, vulnerable patients, and health information technology use: where do we go from here?. Journal of General Internal Medicine, 30(3), 271.
  6. ^ Dishman, E. (2013). Healthcare should be a team sport. TED@Intel. Retrieved from https://www.ted.com/talks/eric_dishman_health_care_should_be_a_team_sport/
  7. ^ Coulter, A. (2012). Leadership for Patient Engagement. Working Paper: The King's Fund. Retrieved from https://www.kingsfund.org.uk/sites/default/files/leadership-patient-engagement-angela-coulter-leadership-review2012-paper.pdf
  8. ^ Palumbo, R., & Manna, R. (2018). What if things go wrong in co-producing health services? Exploring the implementation problems of health care co-production. Policy and Society, 37(3), 368.
  9. ^ Loh, A., Simon, D., Wills, C. E., Kriston, L., Niebling, W., & Härter, M. (2007). The effects of a shared decision-making intervention in primary care of depression: a cluster-randomized controlled trial. Patient Education and Counseling, 67(3), 324.
  10. ^ Davidson, P. M., Inglis, S. C., & Newton, P. J. (2013). Self-care in patients with chronic heart failure. Expert Review of Pharmacoeconomics & Outcomes Research, 13(3), 351.
  11. ^ de Silva D (2011). Helping People Help Themselves. London: The Health Foundation.
  12. ^ Challis, D., Hughes, J., Berzins, K., Reilly, S., Abell, J., & Stewart, K. (2010). Self-care and Case Management in Longterm Conditions: The effective management of critical interfaces. London: HMSO. Retrieved from https://www.netscc.ac.uk/hsdr/projdetails
  13. ^ Purdy, S. (2010). Avoiding hospitals admissions. What does research evidence say? The King’s Fund. Retrieved from https://www.kingsfund.org.uk/sites/files/kf/Avoiding-Hospital-Admissions-Sarah-Purdy-December2010.pdf
  14. ^ Mosen, D. M., Schmittdiel, J., Hibbard, J., Sobel, D., Remmers, C., & Bellows, J. (2007). Is patient activation associated with outcomes of care for adults with chronic conditions?. The Journal of Ambulatory Care Management, 30(1), 21.
  15. ^ Rodriguez, K. M. (2013). Intrinsic and extrinsic factors affecting patient engagement in diabetes self-management: perspectives of a certified diabetes educator. Clinical Therapeutics, 35(2), 170.
  16. ^ Graffigna, G., Barello, S., & Bonanomi, A. (2017). The role of Patient Health Engagement Model (PHE-model) in affecting patient activation and medication adherence: A structural equation model. PloS One, 12(6), e0179865.
  17. ^ Carman, K. L., Dardess, P., Maurer, M., Sofaer, S., Adams, K., Bechtel, C., & Sweeney, J. (2013). Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health Affairs, 32(2), 223.
  18. ^ Graffigna, G., & Barello, S. (2018). Spotlight on the Patient Health Engagement model (PHE model): a psychosocial theory to understand people’s meaningful engagement in their own health care. Patient Preference and Adherence, 12, 1261.
  19. ^ Vale, M. J., Jelinek, M. V., Best, J. D., & Santamaria, J. D. (2002). Coaching patients with coronary heart disease to achieve the target cholesterol:: A method to bridge the gap between evidence-based medicine and the “real world”—randomized controlled trial. Journal of Clinical Epidemiology, 55(3), 245.

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