Healthcare services worldwide are designed around the key idea of delivering the best quality patient care possible. And when it comes to gold standards in practice, a patient-oriented service is all about building and sustaining engagement.

In this article, we’ll consider what patient health engagement looks like and introduce the Patient Health Engagement (PHE) Model. We’ll look at what the research says on getting patients more involved in their own mental health, and how technology can play a vital role.

What is Patient Health Engagement?

Conversations around healthcare services – and especially in the mental health field – typically revolve around what institutions can do to improve patient treatment, from new equipment funding to outreach programs in rural communities and advancements in the field. But the dynamic has always been rather one-sided; it’s the professionals that think of ways to improve treatment, and then present them to the patients as fact.

However, more and more research seems to suggest this dynamic is not enough, and that for optimal health engagement, patients themselves should be more involved in their treatment.

The Patient Health Engagement (PHE) Model

The Patient Health Engagement (PHE) model is a psychological framework designed to explain how patient engagement works and develops.[1] In other words, it offers practitioners a structured understanding of how and why clients may actively seek solutions or information about their well-being while, in other instances, the majority of legwork lies with the healthcare system.

Based on qualitative literature reviews of narrative research, the model suggests four patient experiences on their journey toward patient engagement: “patients’ motivation and self-determination to become an active player in the healthcare journey.”[1]

PHE Model

Source: Graffinga et al.[2]

  • In the Blackout position, patients still lack adaptive strategies for coping with their health issues. Feelings of overwhelmedness often lead them to take a passive role toward managing their situation – this responsibility typically lies with the system.
  • Arousal describes the experience of hyper-attention to symptoms, which cause stress and negative emotions.
  • Next, Adhesion, wherein individuals become more accepting of their status as ‘a patient,’ viewing themselves as more than ‘an ill body’.
  • The Eudaimonic Project experience describes a patient’s full acceptance of their role as such, viewing it as one of numerous identities and becoming more involved in proactive behaviors such as searching for information.

Understanding the patient experience in terms of psychosocial elements allows healthcare providers to adapt and improve interventions – their psychoeducation, treatment designs, and the psychological tools they implement.[3][4]

But surely, there’s more to it?

Why Does It Matter?

Engagement is ultimately about developing collaborative partnerships between patients, health professionals, and key stakeholders to improve healthcare and outcomes – for individuals, and for society more broadly.[3]

More specifically, research shows that improved patient health engagement is linked to:

  • Better health outcomes for patients. In a study of diabetic patients, for instance, lower scores of patient activation (which falls under the PHE umbrella) were related to poorer results.[5][6][7]
  • Improved population health. Proactive patient input and in intervention and system design facilitates more population-appropriate healthcare with fewer resources.[8][9]
  • Lower costs to healthcare systems. For example, research[9] shows that lower patient activation was related to an increased tendency toward unhealthy behaviors and use of preventative screening services. More effective, efficient use of limited resources. Linked directly to the last point, more responsible use of scarce healthcare facilities and resources is increasingly crucial as we see growing demand for more responsive, transparent public systems.

Clearly, patient engagement is critical – so how can we increase it?

One logical place to start is by developing the means to assess and measure its development over time, so as to identify what interventions and initiatives are most effective at improving PHE.[10]

Measuring Patient Health Engagement

Based on the PHE Model, the Patient Health Engagement Scale (PHE Scale) measures patients’ bottom-up development based on the different aforementioned stages.[11][12]

Originally with 9 items, the PHE scale was reduced to 5 and is a self-report questionnaire encompassing several measures, such as 13 Patient Activation items (PAM-13) and 4 items on medication-taking behavior (MMAS-4).

In response to the sentence stem “Thinking about my health status…” patients choose answers from a 7-point scale, such as[13]:

  • (1) “I feel psychologically frozen and blocked” – (7) “I feel positive”
  • (1) “I feel totally oppressed by my illness” – (7) “I have a sense of purpose despite my illness”
  • (1) “I feel dazed” – (7) “I feel peaceful”

Using the scale, it’s possible to take a more scientifically-based approach to engaging patients in planning, designing, and implementing initiatives that promote better quality outcomes.

How To Improve Engagement

Different practitioners have different approaches to encourage more activation and engagement from patients – so what does the research say?

Increasing Individual Patient Health Engagement

While larger samples are required for further evidence, at least 5 core strategies can be identified. According to mixed-methods studies by academics and healthcare institutions, practitioners can do the following[14]:

  1. Emphasize patient ownership. Professionals can take on more of a coaching role to encourage ownership by highlighting and underscoring the fact that a patient is responsible for their health and well-being, rather than their practitioner.
  2. Partner with patients. Practitioners who saw the greatest improvements in patient engagement described setting goals with them, collaborating on strategies, and jointly solving problems. Together, they identified ways forward that were more likely to appeal to and be effective for their clients.
  3. Identify small steps. Breaking down goals into subgoals helped clients view health outcomes as more manageable. Examples included coming up with tactics to gradually decrease cigarettes smoked per day.
  4. Schedule frequent follow-up visits to solve problems, celebrate successes, or both. “The door is always open” is the premise for regular, frequent follow-ups, which practitioners identified as an effective way to motivate clients and help them overcome obstacles to improvement.
  5. Show concern and care for patients. Perhaps the most relatable strategy for most practitioners, this was a way to show support for progress, at least 50% of professionals described telling their patients how much they care about them.

How Healthcare Organizations Can Improve Engagement

Elsewhere in the literature, several factors have been identified to enhance active patient engagement in larger-scale initiatives – at the community or societal level.

According to studies[4], these include:

  • Techniques for improving how patients engage in the design of healthcare initiatives, such as assigning patients to steering committees in specific contexts and co-creating mission statements for projects.[15]
  • Recruiting, including, and giving voice to more patients (than staff or providers) while collaborating on changes, policies, planning documents, and other important decisions.[16]
  • Ensuring more receptive contexts to enable more patient involvement when working together on procedures or facility redesigns.[17]

At a broader, higher-up level, these and other actions had a range of positive outcomes, such as improved healthcare tools, education, and policy. Even more encouragingly, most patients viewed such engagement activities positively – overall a promising implication for the future of enhanced healthcare, processes, and service delivery.[18][4]

The Role of Technology

Technology can help medical practices better engage patients in their care by automating certain processes. As a blended care practitioner, it’s good to know how best to leverage digital clinical solutions such as video therapy, smartphone apps, and electronic health records (EHRs) strategically to maximize your positive impact and deliver better quality health services.

Technology can help medical practices better engage patients in their healthcare by automating certain processes.

Let’s match up some of the different advantages we’ve already identified with the key benefits of different telehealth tech.

Mobile Applications

Many smartphone apps use the experience sampling methodology (ESM) to collect user data on moods and physiological state throughout the day.[19]

One key advantage of such approaches lies in giving practitioners more information – a broader picture – of a client’s well-being and mental state over time, without the need for in-person sessions. Professionals are better armed with personalized information about what might constitute effective goals, and actionable steps toward desired health goals.[14]

Related: Therapy Apps: Choosing the Right Therapist App for Your Practice

EHR and CRM

Electronic health records (EHR) and healthcare customer relationship management (HCRM) platforms makes it easier for practitioners to collect and analyze patient data automatically. With more advanced capabilities such as device tracking and cloud-based storage help medical practitioners easily stay updated with the patient’s health conditions and be able to offer better advice, tailored to their needs.[20] These technologies can also help doctors personalize the care they offer to their patients.

When practitioners don’t know any personal attributes of the patient, it can be a lot more difficult for the patient to connect with the patient, and that may affect how the patients ultimately handle their treatment.

Video Therapy

Video conferencing and VOIP technologies enable easier collaboration across distances, as well as between patients and practitioners who are geographically remote.[21] Regarding Greene and colleagues’[14] finding that more inclusive, receptive contexts enable engagement by bringing together patients in remote locations, video tech creates opportunities to involve more patients in decision-making.

In a Nutshell

Perhaps the most powerful premise of blended care is that by removing key barriers to more frequent contact, it enables more follow-ups and between-session communication. As providers utilize increasingly more tried-and-tested ways to provide patient support, celebrate successes, and problem-solve together, we see much higher chances of boosting patient health engagement.

Simply by enabling more communication and removing mental healthcare barriers for more people, it’s only a matter of time before individual advantages are felt at the community, societal, and global level.

Final Thoughts

Health engagement is becoming more and more of a necessity in the world of modern medicine. Patients’ expectations regarding their health care are continuously changing, and the attitude and system of traditional health care providers must keep up with the times.

While patients can do more to make their voices heard, it’s ultimately the responsibility of healthcare providers to create a context in which patients feel comfortable doing so.

Overall, as findings show, the positive effects of deeper health engagement have hugely promising potential impacts for communities, patients, and individual practitioners. Have you got your own techniques for encouraging better patient health engagement? Or have you, as a patient, had a superb experience that you’d like others to know about? Join the conversation, tell us below.

References

  1. ^ 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.
  2. ^ Graffigna, G., Barello, S., Bonanomi, A., & Riva, G. (2017). Factors affecting patients’ online health information-seeking behaviours: The role of the Patient Health Engagement (PHE) Model. Patient Education and Counseling, 100(10), 1918.
  3. ^ Carman, K. L., & Workman, T. A. (2017). Engaging patients and consumers in research evidence: applying the conceptual model of patient and family engagement. Patient Education and Counseling, 100(1), 25.
  4. ^ Bombard, Y., Baker, G. R., Orlando, E., Fancott, C., Bhatia, P., Casalino, S., & Pomey, M. P. (2018). Engaging patients to improve quality of care: a systematic review. Implementation Science, 13(1), 98.
  5. ^ Remmers, C., Hibbard, J., Mosen, D. M., Wagenfield, M., Hoye, R. E., & Jones, C. (2009). Is patient activation associated with future health outcomes and healthcare utilization among patients with diabetes?. The Journal of Ambulatory Care Management, 32(4), 320.
  6. ^ Hibbard, J. H., & Greene, J. (2013). What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Affairs, 32(2), 207.
  7. ^ Heath, S. (2019). Patient Engagement Strategies for Improving Patient Activation. Retrieved from https://patientengagementhit.com/features/patient-engagement-strategies-for-improving-patient-activation/
  8. ^ Laurance, J., Henderson, S., Howitt, P. J., Matar, M., Al Kuwari, H., Edgman-Levitan, S., & Darzi, A. (2014). Patient engagement: four case studies that highlight the potential for improved health outcomes and reduced costs. Health Affairs, 33(9), 1627.
  9. ^ Greene, J., Hibbard, J. H., Sacks, R., Overton, V., & Parrotta, C. D. (2015). When patient activation levels change, health outcomes and costs change, too. Health Affairs, 34(3), 431.
  10. ^ Tzeng, H. M., & Marcus Pierson, J. (2017). Measuring patient engagement: which healthcare engagement behaviours are important to patients?. Journal of Advanced Nursing, 73(7), 1604.
  11. ^ Barello, S., Graffigna, G., Savarese, M., and Bosio, A. C. (2014). Engaging patients in health management: towards a preliminary theoretical conceptualization. Psicologia Della Salute, 3, 11.
  12. ^ Graffigna, G., Barello, S., Bonanomi, A., & Lozza, E. (2015). Measuring patient engagement: development and psychometric properties of the Patient Health Engagement (PHE) scale. Frontiers in Psychology, 6, 274.
  13. ^ 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.
  14. ^ Greene, J., Hibbard, J. H., Alvarez, C., & Overton, V. (2016). Supporting patient behavior change: approaches used by primary care clinicians whose patients have an increase in activation levels. The Annals of Family Medicine, 14(2), 148.
  15. ^ Macdonell, K., Christie, K., Robson, K., Pytlik, K., Lee S.K., & O'Brien, K. (2013). Implementing family-integrated care in the NICU: Engaging veteran parents in program design and delivery. Advancements in Neonatal Care, 13(4), 262.
  16. ^ Wistow, G., & Barnes, M. (1993). User involvement in community care: origins, purposes and applications. Public Administration, 71(3), 279.
  17. ^ Thomson, A., Rivas, C., & Giovannoni, G. (2015). Multiple sclerosis outpatient future groups: improving the quality of participant interaction and ideation tools within service improvement activities. BMC Health Services Research, 15(1), 105.
  18. ^ Lofters, A., Virani, T., Grewal, G., & Lobb, R. (2015). Using knowledge exchange to build and sustain community support to reduce cancer screening inequities. Progress in Community Health Partnerships: Research, Education, and Action, 9(3), 379.
  19. ^ van Os, J., Verhagen, S., Marsman, A., Peeters, F., Bak, M., Marcelis, M., & Simons, C. (2017). The experience sampling method as an mHealth tool to support self‐monitoring, self‐insight, and personalized health care in clinical practice. Depression and Anxiety, 34(6), 481.
  20. ^ O’Hara, D. (2019). Wearable technology for mental health. Retrieved from https://www.apa.org/members/content/wearable-technology
  21. ^ Godleski, L., Darkins, A., & Peters, J. (2012). Outcomes of 98,609 US Department of Veterans Affairs patients enrolled in telemental health services, 2006–2010. Psychiatric Services, 63(4), 383.

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