The fast pace of change in the healthcare system requires patients to be more and more aware of their care options and be active agents in evaluating options about where and when to seek care. Patients are no longer passive recipients of care; instead, they are empowered consumers of medical products and services and are recognized to be real partners in the process by which those products/services are developed. Patients increasingly act as advocates for new treatments, and many be fully engaged in making decisions about their care. However, unless promoting the active role of patients is today identified as a priority to promote care quality, a wide debate still exists on how to translate this principle into practice and how to assess initiatives whose goal is to increase the level of patient participation in their care. Measuring patient engagement along the care course might ensure that the medical care truly serves the patient’s needs, priorities, and preferences.
Measuring patient engagement in healthcare is a crucial step for improving patient’s care experience and outcomes. To assume that all patients will respond to these situations in the same way is counterproductive.
Unless the measurement of patient engagement is today a big issue for policy makers and healthcare practitioners , only few scientifically validated assessment tools currently exist to help identify patients’ level of involvement in their healthcare, which are mainly focused on the assessment of patients’ behavioural ability to self-manage their care or on their level of literacy (e.g. Patient Activation Measurement )(PAM), The Patient Enablement Instrument (PEI), The Partners in Health (PIH) scale)
However, growing acknowledgement is played to the emotional and psychodynamic components of the patients’ illness experience that appears to be the first movers of patients’ confidence and ability to acquire information about their health status and to master self-management behaviors. The emotive component of engagement, conceived as the patients’ process of elaboration and adjustment to the disease, has also being demonstrated to be a crucial mediator of patients’ activation and adherence (Graffigna et al., 2015).
The patient’s illness experience is recognized to be mutable and unstable across time. This aspect impacts on the patient’s both availability and ability to actively engage in his/her process of care management. Although healthcare professionals and scholars agree in recognizing the importance of the emotional elaboration of the patients’ illness journey in the chronic care management process, so far validated tools to assess this aspect have been neglected. To our knowledge an original contribution in this direction is given by the recently developed Patient Health Engagement scale (PHE-s). The PHE-s developed by Graffigna and colleagues (2015a) is a measure of patient engagement psychological experience that is grounded in rigorous conceptualization and appropriate psychometric methods. The scale consists of 5 ordinal items and was developed based on the authors’ conceptual model of patient engagement (PHE model), which features four evolutionary stages along a continuum of engagement.
The PHE model, offers clinicians a general picture of the patients’ global attitudes toward their health conditions and treatment management. Particularly, it describes an evolutionary process of patient engagement featuring four subsequent phases (i.e. blackout; arousal; adhesion; eudaimonic project). According to this model, patient engagement appears to be a function of the patients’ emotional elaboration toward their health and care management.
The Patient Health Engagement Scale (PHE-s), based on this model, allows to briefly and easily assess the level of emotional elaboration of a patient concerning his/her health condition by simply asking five straight forward questions. This set of questions — and the alternative of answers that the model offers — may orient clinicians, managers, and other professionals in dealing with interventions aimed to sustain patients’ self-care abilities in assessing primary psychological needs and care expectations. Basically, the PHE-s questions the patients’ stage of psychological elaboration about the mutated health condition and of their engagement needs (way of “feeling” when reflecting on health status). This instrument is today the only one specifically dedicated to assess the degree of emotional elaboration and adjustment reached by the patient concerning his/her own health condition when engaging in health management. The specificity of this scale lays in the fact that it allows not only to assess the actual patient’s attitude towards his/her health condition, but also to forecast the patient’s risk for disengagement in health management and thus design preventive targeted intervention to optimize care pathways.
The PHE-s is a patient self-administrable questionnaire developed with the aim of diagnosing the level of patient engagement in their healthcare process that is function of his/her degree of emotional elaboration of the new health condition. This tool allows clinicians to move from a style of interaction that is clinician-directed and focuses on patients’ adherence to treatments, to one that supports patients’ motivation and autonomy in the care process, matches patients’ level of engagement, and ultimately increases engagement. The information from the PHE-s might help guide the discussion and the action plan for care. The clinician who is in charge when administering the scale to the patient has to introduce and explain to the subject the aim of the questionnaire by specifying that to be effective in answering the proposed questions, the patient should refer to how he/she is currently living/experiencing his/her health status. The response options featuring this instrument (i.e. ordinal scale) allow patients to easily mirror with the current emotional states related to their disease condition. The ordinal structure of the response options also allows subjects to position themselves along an experiential continuum.
TO LEARN MORE ON THE PHE SCALE, YOU CAN READ Measuring patient engagement: development and psychometric properties of the Patient Health Engagement (PHE) Scale.