Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities

Abstract

Designing culturally sensitive personalized interventions is essential to sustain patients' involvement in their treatment and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and self-determination for their own health and health care. We propose a patient-centered, multilevel activation and empowerment framework (individual-, health care professional-, community-, and health care delivery system-level) to inform the development of culturally informed personalized patient activation and empowerment (P-PAE) interventions to improve population health and reduce racial and ethnic disparities. We discuss relevant Affordable Care Act payment and delivery policy reforms and how they affect patient activation and empowerment. Such policies include Accountable Care Organizations and value-based purchasing, patient-centered medical homes, and the community health benefit. Challenges and possible solutions to implementing the P-PAE are discussed. Comprehensive and longitudinal data sets with consistent P-PAE measures are needed to conduct comparative effectiveness analyses to evaluate the optimal P-PAE model. We believe the P-PAE model is timely and sustainable and will be critical to engaging patients in their treatment, developing patients' abilities to manage their health, helping patients express concerns and preferences regarding treatment, empowering patients to ask questions about treatment options, and building up strategic patient-provider partnerships through shared decision making.

Keywords: education; empowerment; health behavior; health disparities; health policy; patient; race/ethnicity.

Figure 1

Patient-Centered Multi-Level Personalized Patient Activation and Empowerment Framework Note: Our proposed patient-centered multi-level activation and empowerment framework is adapted from the existing literature, including patient-centered outcomes research (PCORI, 2013a; Selby, Beal, & Frank, 2012), the social behavior model (Janz & Becker, 1984), the chronic care model (Wagner, Davis, Schaefer, Von Korff, & Austin, 1999; Barr et al., 2003; Brownson et al., 2007), shared decision-making framework (Sandman, Granger, Ekman, & Munthe, 2012; Légaré & Witteman, 2013; Légaré et al., 2011), health literate care model (Koh, Brach, Harris, & Parchman, 2013), and patient activation and empowerment literature (Hibbard et al., 2008; Aujoulat, Marcolongo, Bonadiman, & Deccache, 2008; Anderson & Funnell, 2010; Feste & Anderson, 1995; Hibbard, Mahoney, Stockard, & Tusler, 2005; Holmström & Röing, 2010; Carman et al., 2013).