Engaging patients in health management: towards a preliminary theoretical conceptualization

Engaging patients in their own healthcare is now widely acknowledged as a critical ingredient for high-performance health systems as it may improve quality of care and reduce service delivery costs. However, despite the increasing debate about "patient engagement" (PE), this phenomenon remains conceptually and empirically under-developed, often used as a synonymous of other terms such as patient involvement or patient participation. In order to contribute to the conceptual foundation of PE, the aims of this study are twofold: 1. mapping the current trend of peer reviewed literature about engagement in health in terms of time frames, disciplinary perspectives, countries more active in the debate, terms mainly used to connote individuals in the care process; 2. detecting, comparing and synthesizing the main definitions that are currently orienting the literature debate, by casting light on theoretical gaps and suggesting potential lines for future research development. The keywords "patient engagement" OR "consumer engagement" OR "client engagement" OR "citizen engagement" were searched using databases more likely to cover the core research publication in health issues (PubMed/Ovid MEDLINE; Ovid PsycInfo; SCOPUS), within the peer-reviewed literature in the years 2000-2013. We conducted both bibliometric analysis and qualitative content analysis on a sub-sample constituted by the only studies that provided a definition of engagement. Out of 1286 papers initially retrieved, only 753 resulted pertinent because explicitly concerning "patient engagement". Furthermore, out of them only 16 contributes attempted to provide a definition of PE as an autonomous concept. However, these definitions are fragmented and various depending on the disciplinary landmarks to which authors belong. Furthermore, among the contributes that attempt a specific conceptualization of PE, the frameworks provided appear often partial, merely taxonomic and not able to cast light on the dynamic nature of engagement. Basing on these results, we suggest to look at engagement as an evolving concept that needs for a recover of an "ecological" foundation, mainly rooted in the deeper analysis of patients' perspectives, and finalized to provide insights about this process drivers at the individuals, relational, and organizational levels.