I recently came back to a milestone reading: “Patient engagement: what works” written by Angela Coulter on 2012. I truly suggest this paper for its clearness and concreteness. Angela Coulter is one of the most imminent scholars who dedicated her work and research to scientifically define what patient engagement is and how it may be achieved.
In her work, Angela reviews in sharping way interventions aimed at sustaining the active participation of patients in their care-management and she deducts three fundamental ingredients (or pillars) that can make an health initiative really able to engage patients. Those pillars are:
- IMPROVING HEALTH LITERACY: Health literacy is “the ability to read, understand and act upon health information, essential skills for making appropriate health decisions” (Institute of Medicine of the National Academies, 2004). Several studies have shown how a low level of patients’ health literacy is more associated with poor health, more frequent hospitalizations and use of emergency care, lower adherence to treatment, worse health behaviour and lower adoption of preventive conducts. In order to improve patients ability to really play a “starring role” in their care the first rule is guaranteeing a better (and more equal) access to health and medical information to patients. To become engaged, patients need first to understand what is their health condition (and its consequences) and to develop cognitive cues to decode medical prescriptions. In simpler terms: to be engaged patients need first to understand what they have and how they can best manage their condition.
- SUSTAINING (SHARED) PATIENTS’ DECISION MAKING: according to Angela’s work, the second gold rule to achieve patient engagement is sustaining a good partnership relationship between patients and their healthcare providers. Patients, once acquired enough health information to understand their health condition, need to be helped in making decision about their care. Healthcare professionals, thus, are claimed to sustain patients’ ability to take an active role in their healthcare journey; patients need to be empowered and sustained in order to become able to raise their voice regarding treatment options and choices. The objective of achieving a better participatory medicine is becoming a must today: patient engagement may be the first and most important ingredient in achieving this goal.
- PROVIDING QUALITY FEEDBACK ON CARE PROCESSES: another extremely important rule to improve patient engagement is improving the quality of the overall healthcare process. To sustain engagement, patients’ healthcare experience need to be improved. Patients’ satisfaction for the quality of healthcare services needs to be envisaged as the compass to reform healthcare in a better engaging way. Patients’ feedback on the quality of healthcare systems and services, thus, are extremely important to improve the quality of healthcare and to set the ground for better patient engagement.
I agree with Angela Coulter about the crucial role of these three “patient engagement pillars”.
However, moving from a CONSUMER PSYCHOLOGY PERSPECTIVE, I’m also convinced that a fourth “patient engagement pillar” should be considered (and achieved): PATIENTS EMOTIONAL SCAFFOLDING.
The emotional reaction of a patient in front of a new diagnosis, or a new symptom, is a fundamental ingredient of her/his healthcare experience. Patients’ ability to cope with these feelings (and to manage them) is a crucial precursor of patients ability to be engaged. A fully engaged patient, indeed, is an individual able to elaborate and accept the new health condition and to incorporate the new identity of “patient” in an EUDAIMONIC RE-CONFIGURATION of their “self” in an adaptive project of life. The experience of engagement depends, thus, on patients’ ability to become co-constructors of their health. Patients need to be helped in perceiving themselves as whole persons, positively included in their social context and able to enact situated and meaningful practices of health management. To become engaged, patients need to be sustained in elaborating their condition and in acquiring a sense of control on their disease course and treatment.
In order to achieve this goal, individuals need continuous counseling for empower their sense of agency and becoming effective in “engaging” their healthcare system in a positive co-planning of health and wellbeing.