Making Sense of “Consumer Engagement” Initiatives to Improve Health and Health Care: A Conceptual Framework to Guide Policy and Practice

Abstract

Context: Policymakers and practitioners continue to pursue initiatives designed to engage individuals in their health and health care despite discordant views and mixed evidence regarding the ability to cultivate greater individual engagement that improves Americans' health and well-being and helps manage health care costs. There is limited and mixed evidence regarding the value of different interventions.Methods: Based on our involvement in evaluating various community-based consumer engagement initiatives and a targeted literature review of models of behavior change, we identified the need for a framework to classify the universe of consumer engagement initiatives toward advancing policymakers' and practitioners' knowledge of their value and fit in various contexts. We developed a framework that expanded our conceptualization of consumer engagement, building on elements of two common models, the individually focused transtheoretical model of behavior and the broader, multilevel social ecological model. Finally, we applied this framework to one community's existing consumer engagement program.Findings: Consumer engagement in health and health care refers to the performance of specific behaviors ("engaged behaviors") and/or an individual's capacity and motivation to perform these behaviors ("activation"). These two dimensions are related but distinct and thus should be differentiated. The framework creates four classification schemas, by (1) targeted behavior types (self-management, health care encounter, shopping, and health behaviors) and by (2) individual, (3) group, and (4) community dimensions. Our example illustrates that the framework can systematically classify a variety of consumer engagement programs, and that this exercise and resulting characterization can provide a structured way to consider the program and how its components fit program goals both individually and collectively. Conclusions:Applying the framework could help advance the field by making policymakers and practitioners aware of the wide range of approaches, providing a structured way to organize and characterize interventions retrospectively, and helping them consider how they can meet the program's goals both individually and collectively.

experience of preoperative patient education for women preparing for and recovering from total knee replacement

“…As noted by Mittler et al (2013) In the context of chronic illness, support in the form of timely and individualized information can affect how these factors influence patient behaviors. The evolving view of chronic illnesses and education is also underscored by the transition of illness from acute to chronic, in which the disease becomes part of the patient's identity (Nettleton, 2006).…”

“…Time, experience, and the course of illness can dramatically affect both the ability and desire to participate" (Gerteis et al, 1993, p.28). In addition, there are no agreed-upon definitions that express which behaviors are engaged, nor are there boundaries defining the actual capacity of patients to become engaged through patient engagement initiatives (Mittler et al, 2013).…”

“…The PHE model draws from consumer perspectives, including the engaging consumers in health and healthcare communities framework (ECHC) developed by Mittler, Martsolf, Telenko, and Scanlon (2013). The focus on consumer psychology in engagement has gained support in part because of characterizations of engagement as a "wild card" (Mittler et al, 2013) and also as the next "blockbuster" drug (Dentzer, 2013).…”

“…Patient engagement programs are typically aimed at increasing patient involvement, primarily through providing information and support that expands the patient's capacity to understand and use accurate information to modify or improve health and healthcare experiences. Patient engagement is, therefore, multidimensional, bridging the relationship between patients and their health through the performance of specific actions (Mittler et al, 2013).…”

“…Such recognition brought greater value to the patient narrative. Mittler et al (2013) introduced the importance of understanding behavioral aspects of patient encounters from the perspective of consumer psychology. Mittler et al (2013) expanded the conceptual model of patient engagement to include the social perspectives of patient activation that were first noted by Davis et al (2007).…”