A conceptual review of engagement in healthcare and rehabilitation

Abstract

A conceptual review of engagement in healthcare and rehabilitationPurpose: This review sought to develop an understanding of how engagement in healthcare has been conceptualized in the literature in order to inform future clinical practice and research in rehabilitation. A secondary purpose was to propose a working definition of engagement.Method: EBSCO and SCOPUS databases and reference lists were searched for papers that sought to understand or describe the concept of engagement in healthcare or reported the development of a measure of engagement in healthcare. We drew on a Pragmatic Utility approach to concept analysis.Results: Thirty-one articles met the criteria and were included in the review. Engagement appeared to be conceptualized in two inter-connected ways: as a gradual process of connection between the healthcare provider and patient; and as an internal state which may be accompanied by observable behaviors indicating engagement. Conclusion:Our review suggests engagement to be multi-dimensional, comprising both a coconstructed process and a patient state. While engagement is commonly considered a patient behavior, the review findings suggest clinicians play a pivotal role in patient engagement. This review challenges some understandings of engagement and how we work with patients, and highlights conceptual limitations of some measures. Introduction'Patient engagement' is a term increasingly used in rehabilitation and the broader healthcare context [1]. Several authors have argued the benefits of rehabilitation are limited if the patient is not fully engaged in the process [2,3]. For example, levels of engagement have been associated with improved functional improvement during inpatient rehabilitation and levels of functioning after discharge. Levels of engagement have also been associated with lower levels of depression and with higher levels of affect, adherence and attendance [2,4]. In addition, within clinical rehabilitation practice, the 'engaged patient' is perhaps identified as being the 'desirable patient', one who is easy for providers to work with [5]. On the face of it, these findings suggest that patient engagement is both positive and desirable.While the term 'engagement' is increasingly used in clinical practice and research, there has been relatively little critical exploration of what 'engagement' means and the underpinning concept/s the term may represent. Research of engagement appears to be in its early days, with little consensus on what engagement is, what leads to a patient being perceived as engaged or disengaged or indeed, how engagement occurs. The term engagement is used in multiple ways in the literature, variably referring to patient actions and behaviors such as accessing services [6], retention within services [7,8], enthusiasm [2] and self-management of health conditions [8], or referred to a hospital's provision of health resources and social media usage [9], and to the interaction between the patient and healthcare provider [10].It could be argued that it does not matt...

Predictors of adherence to home-based physical therapies: a systematic review

“…Within the field of rehabilitation, the term 'engagement' is also increasingly used in relation to patients' self-management of their health. This term not only encompasses notions of whether a patient's behaviour is adherent, but also of interaction with professionals and identifying relevant information too [8][9][10]. Whilst important to acknowledge this broader concept of engagement, the focus of this review is primarily upon whether patients' behaviour is adherent to recommendations and, as such, the term 'adherence' will be used throughout.…”

A fine balance and a shared learning journey: Exploring healthcare engagement through the experiences of youth with Neuromuscular Disorders

“…Present findings suggest that youth with NMD experience healthcare engagement similarly to adults, as a co-constructed process to develop a healthcare partnership (Bright et al, 2015).…”

“…The semi-structured interview guide was developed from definitions of engagement specific to healthcare (Bright et al, 2015) and high school education (Liem & Martin, 2012;Martin, 2007).…”

“…Studies involving youth with NMD have used the term engagement when referring to notions of shared decision making (Hull et al, 2012) and self-management (Nierse et al, 2013). Bright, Kayes, Worrall, and McPherson (2015) describe healthcare engagement as a co-constructed process and a state of connection between the HCP and patient. However, this conceptual review excluded child and adolescent services.…”

The Design Process and Usability Assessment of an Exergame System to Facilitate Strength for Task Training for Lower Limb Stroke Rehabilitation

“…This has promoted beneficial patient outcomes for different long-term conditions, including upper limb stroke rehabilitation [5,10,11], and more effective recovery [12]. While there exist systems designed for upper-limb stroke rehabilitation [5,13,14] and for improving gait and balance [15][16][17], only one was found targeted specifically towards lower limb stroke rehabilitation [18].…”