The role of Patient Health Engagement Model (PHE-model) in affecting patient activation and medication adherence: A structural equation model

Abstract

BackgroundIncreasing bodies of scientific research today examines the factors and interventions affecting patients’ ability to self-manage and adhere to treatment. Patient activation is considered the most reliable indicator of patients’ ability to manage health autonomously. Only a few studies have tried to assess the role of psychosocial factors in promoting patient activation. A more systematic modeling of the psychosocial factors explaining the variance of patient activation is needed.ObjectiveTo test the hypothesized effect of patient activation on medication adherence; to test the the hypothesized effects of positive emotions and of the quality of the patient/doctor relationship on patient activation; and to test the hypothesized mediating effect of Patient Health Engagement (PHE-model) in this pathway.Material and methodsThis cross-sectional study involved 352 Italian-speaking adult chronic patients. The survey included measures of i) patient activation (Patient Activation Measure 13 –short form); ii) Patient Health Engagement model (Patient Health Engagement Scale); iii) patient adherence (4 item-Morinsky Medication Adherence Scale); iv) the quality of the patients’ emotional feelings (Manikin Self Assessment Scale); v) the quality of the patient/doctor relationship (Health Care Climate Questionnaire). Structural equation modeling was used to test the hypotheses proposed.ResultsAccording to the theoretical model we hypothesized, research results confirmed that patients’ activation significantly affects their reported medication adherence. Moreover, psychosocial factors, such as the patients’ quality of the emotional feelings and the quality of the patient/doctor relationship were demonstrated to be factors affecting the level of patient activation. Finally, the mediation effect of the Patient Health Engagement model was confirmed by the analysis.ConclusionsConsistently with the results of previous studies, these findings demonstrate that the Patient Health Engagement Model is a critical factor in enhancing the quality of care. The Patient Health Engagement Model might acts as a mechanism to increase patient activation and adherence.

The Mediating Role of the Patient Health Engagement Model on the Relationship Between Patient Perceived Autonomy Supportive Healthcare Climate and Health Literacy Skills

“…The psychological process of engagement as described by the PHE-model involves four developmental phases, namely, blackout, arousal, adhesion, and eudaimonic project. The PHE-model theorizes possible psychological trajectories of engagement along a continuum from a position of disengagement (namely, blackout), where patients experience feelings of psychological vulnerability connected to the illness and feel psychologically frozen and feel paralyzed, to a position of full engagement (namely, eudaimonic project) where patients become totally aware of their disease and its implications and have elaborated and accepted their "new identity" of patient and became able to embrace a more positive and satisfactory approach to their life [11][12][13][14]. In this scenario, to foster the patient's emotional elaboration, of much relevance is the ability of healthcare professionals to promote a healthcare climate which is supportive of the patient's autonomy, which has been associated with numerous positive patient outcomes [15].…”

Patient Heal Thyself: Reducing Hospital Readmissions with Technology‐Enabled Continuity of Care and Patient Activation

“…In studies that do not incorporate TECC, patients with higher activation demonstrate better self-care than those with lower activation (Begum et al 2011, Fowles et al 2009, Graffigna et al 2017, Greene and Hibbard 2012, Harvey et al 2012, Zimbudzi et al 2017). This better self-care generally leads to better health Hibbard 2012, Greene et al 2015), and fewer hospital admissions (Begum et al 2011, Mitchell et al 2014.…”

Making Active Surveillance a path towards health promotion: A qualitative study on prostate cancer patients’ perceptions of health promotion during Active Surveillance

“…Participants discussed the relevance of being considered as leading actor of the care and AS process, so to take responsibility for their health too. There is increasing literature on the potential that engaging patients in their health and care may have for health and well-being outcomes of individuals (Graffigna, Barello, & Bonanomi, 2017;Greene & Hibbard, 2012;Gruman et al, 2010). Recent studies have been also conducted on cancer patients, showing how giving patients a starring role in their health and care may improve quality of care too (Hibbard, Mahoney, & Sonet, 2016;Martinez, Schwartz, Freres, Fraze, & Hornik, 2009).…”