Engage: Blog

Judith Hibbard | Feb 2013 | 0 COMMENT(S)

I am often asked the question, “How is patient activation related to consumer and patient engagement?” Activation is well defined— as the knowledge skill and confidence to manage one’s own health and health care—and is measured using the PAM (Patient Activation Measure).  However, engagement is less well defined.   Sometimes people refer to interventions to increase participation or involvement when they use the term “engagement.”  Sometimes they use the term “engagement” to refer to the resulting participation or involvement.  For now let’s define engagement as both of the efforts to increase meaningful participation, and the resulting involvement and participation.

First, some background:

Studies show that more activated patients report better care experiences on standardized measures such as CAHPS than less activated patients.  Alexander and colleagues (2012) found that higher activated patients were more likely to report a better quality of interpersonal interactions, more fairness, and more out of office contact than lower activated individuals.  Similarly, Maeng and colleagues (2012) found that chronic disease patients who were more activated were less likely to report care coordination problems than less activated patients.

Could it be that more activated patients have the skills and knowledge to get what they need from their providers and delivery systems as compared to less activated patients?

Interestingly, intervention studies that seek to increase patient’s skills in, for example, question formulation during a doctor office visit, show that the intervention actually increase patient activation, as well as the asking of questions (Deen 2010).

All of this indicates that people with a greater level of skills, knowledge and confidence (or those who are more activated) are more likely to meaningfully engage or participate in their care, presumably because they are better prepared to do so. The implication is that engagement strategies, aimed at increasing participation in care, should focus on increasing activation and/or the skills, knowledge, and confidence that patients need to be able elicit what they need from providers and delivery systems.


  • Alexander JA, Hearld LR, Mittler JN, Harvey J. Patient-physician role relationships and patient activation among individuals with chronic illness. Health Serv Res. 2012;47(3 Pt 1):1201-23.
  • Deen DLu WHRothstein DSantana LGold MRAsking questions: The effect of a brief intervention in community health centers on patient activationPatient Education and Counseling. August 2010
  • Maeng DD, Martsolf GR, Scanlon DP, Christianson JB. Care coordination for the chronically ill: understanding the patient’s perspective. Health Serv Res. 2012;47(5):1960–79.