Guendalina Graffigna

The concept of engagement: a systematic analysis of the ongoing marketing debate

Consumer.engagement.is.emerging.as.a.central.concern.in.brand.management.strategies ..Nonetheless,. the. concept. is. new. in. market. research. and. has. been.dealt.with.so.far.in.widely.differing.and.sometimes.contradictory.ways.in.both.the. academic. and. professional. literature,. so. understanding. the. true. nature.of.engagement.is.now.both.timely.and.necessary ..The.basic.aim.of.this.study.is. to. outline. and. explore. the. different. perspectives. in. the. current. debate. on.engagement.by.conducting.an.exploratory.and.systematic.content.analysis.(using.purpose-designed.T-lab.software).of.the.concept.of.engagement.in.the.marketing.and.communication.literature,.both.academic.and.professional ..The.results.of.the.analysis.raise.urgent.managerial.and.methodological.issues.relating.to.the.concept.and.practice.of.engagement,.and.point.to.future.research.directions.aimed.at.a.broader.and.deeper.understanding.of.the.concept .

eHealth for patient engagement: A Systematic Review

eHealth interventions are recognized to have a tremendous potential to promote patient engagement. To date, the majority of studies examine the efficacy of eHealth in enhancing clinical outcomes without focusing on patient engagement in its specificity. This paper aimed at reviewing findings from the literature about the use of eHealth in engaging patients in their own care process. We undertook a comprehensive literature search within the peer-reviewed international literature. Eleven studies met the inclusion criteria. eHealth interventions reviewed were mainly devoted to foster only partial dimensions of patient engagement (i.e., alternatively cognitive, emotional or behavioral domains related to healthcare management), thus failing to consider the complexity of such an experience. This also led to a great heterogeneity of technologies, assessed variables and achieved outcomes. This systematic review underlines the need for a more holistic view of patient needs to actually engage them in eHealth interventions and obtaining positive outcomes. In this sense, patient engagement constitute a new frontiers for healthcare models where eHealth could maximize its potentialities.

How to engage type-2 diabetic patients in their own health management: implications for clinical practice.

BackgroundPatient engagement (PE) is increasingly regarded as a key factor in the improvement of health behaviors and outcomes in the management of chronic disease, such as type 2 diabetes. This article explores (1) the reasons for disengagement of diabetic patients and their unique subjective attitudes from their experience and (2) the elements that may hinder PE in health management.Methods29 Type-2 uncontrolled diabetes patients were asked to keep a one-week diary related to their experience of disease management, according to the narrative inquiry qualitative approach. They were interviewed to ascertain reasons for PE. The elicited narratives were subjected to interpretive content analysis.ResultsThe findings suggest that patients give meaning to their diabetes and its management through a complex frame of subjective experiential dimensions (cognitive/thinking, behavioral/conative and emotional/feeling), which have an impact on the spheres of daily life that are considered to be crucial in the management of diabetes (diet, physical activity, therapy, doctor-patient relationship) for each patient. These results suggest that PE develops along a continuum featuring four subsequent phases (blackout, arousal, adhesion, eudaimonic project). Several unmet needs related to the different phases of the PE continuum were discovered and illuminated possible types of support.ConclusionsOur findings appear to confirm some features of PE detected by previous research, such as a behavioral component. We were also able to shed light on the synergic roles played by other subjective dimensions of patient experience (the cognitive/thinking and the emotional/feeling components) in orienting PE towards the care process. The article suggests a possible framework to deeply understand the PE process useful to orient really attuned actions to support it. These results suggest the importance of developing patient engagement assessment tools that are more firmly grounded in the individual patient experience.

Technologies For Patient Engagement

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The Influence of Setting on Findings Produced in Qualitative Health Research: A Comparison between Face-to-Face and Online Discussion Groups about HIV/AIDS

The authors focus their analysis in this article on online focus groups (FGs), in an attempt to describe how the setting shapes the conversational features of the discussion and influences data construction. Starting from a review of current dominant viewpoints, they compare face-to-face discussion groups with different formats of online FGs about AIDS, from a discourse analysis perspective. They conducted 2 face-to-face FGs, 2 chats, 2 forums, and 2 forums+plus+chat involving 64 participants aged 18 to 25 and living in Italy. Their findings seem not only to confirm the hypothesis of a general difference between a face-to-face discussion setting and an Internet-mediated one but also reveal differences among the forms of online FG, in terms of both the thematic articulation of discourse and the conversational and relational characteristics of group exchange, suggesting that exchanges on HIV/AIDS are characterized by the setting. This characterization seems to be important for situating the choice of tool, according to research objectives, and for better defining the technical aspects of the research project.

Engaging patients to recover life projectuality: an Italian cross-disease framework

PurposeChronic disease is recognized as having a large impact on patient quality of life (QoL), which can be defined as an individual’s satisfaction or happiness with life in domains he or she considers important. Policy makers and clinicians recognize increasingly that patients can safeguard their QoL by making healthy lifestyle choices and being actively engaged in their health care. However, in the emphasis on promoting patient engagement to enhance patients’ QoL, there is no consensus regarding the relationship between QOL and patient engagement, resulting in a lack of shared guidelines among clinicians on interventions. Furthermore, no studies have provided an in-depth exploration of the perspective of patients with chronic conditions who are engaged in their health care and their requirements to achieve an improved QoL. Given this theoretical gap, the present study attempted to explore the patient engagement experience and its relationship with patient QoL in the context of the Italian healthcare system and in relation to different chronic diseases.MethodsIn-depth qualitative interviews on a sample of 99 patients with a wide variety of chronic conditions (heart failure, chronic obstructive pulmonary disease, stroke, diabetes, and cancer).ResultsPatient engagement in health care can be defined as a context-based and cross-disease process that appears to enable patients to recover their life projectuality, which had been impaired by the onset of chronic disease. Successful patient engagement may also be related to a positive shift in the ways in which patients perceive self and life and experience empowerment to realize their life potential, thus improving quality of life. Patient engagement is a powerful concept capable of reflecting significant psychosocial changes that promote patient QoL along the care process. There appears to be theoretical and empirical justification for a broad definition of QoL.ConclusionsQoL deeply depends on the patient ability to engage in their care and on the health expectations they have. We propose a model of the relation between patient engagement and patients’ trajectories in critical event responses and use it to illustrate a new perspective on QoL. This research showed the heuristic value patient engagement as a is a key concept in the promotion of a patients’ experience-sensitive QoL interventions and assessment measures.

Giving patients a starring role in their own care: a bibliometric analysis of the on-going literature debate.

Patient‐centred care has been advocated as a key component of high‐quality patient care, yet its meanings and related actions have been difficult to ascertain.

‘Engage me in taking care of my heart’: a grounded theory study on patient–cardiologist relationship in the hospital management of heart failure

Objective In approaching the study and practice of heart failure (HF) management, authors recognise that the patient–doctor relationship has a central role in engaging patients in their care. This study aims at identifying the features and the levers of HF patient engagement and suggestions for orienting clinical encounters. Design Using a grounded theory approach, we conducted 22 in-depth interviews (13 patients with HF, 5 physicians and 4 caregivers). Data were collected and analysed using open, axial and selective coding procedures according to the grounded theory principles. Settings All interviews were conducted in an office in a university hospital located in a metropolitan area of Milan, Italy. Participants The data comprised a total of 22 patient, hospital cardiologist and caregiver interviews. Patients aged ≥18 years with New York Heart Association (NYHA) Functional Class of II or III were eligible to take part. Patients were recruited primarily through their referral cardiologist. Results The HF patient engagement process develops in four main phases that are characterised by different patients’ emotional, cognitive and behavioural dynamics that contribute to shape the process of a patients meaning making towards health and illness regarding their care. The emerging model illustrates that HF patient engagement entails a meaning-making process enacted by the patient after the critical event. This implies patients’ ability to give sense to their care experience and to their disease, symptomatology and treatments, and their changes along their illness course. Doctors are recognised as crucial in fostering patients’ engagement along all the phases of the process as they contribute to providing patients with self-continuity and give new meaning to their illness experience. Conclusions This study identifies the core experiential domains and the main levers involved in driving patients with HF to effectively engage in their disease management. The model emerging from this study may help clinicians think in a fresh way about encounters with patients and their role in fostering their patients’ health engagement.

The Ineffable Disease: Exploring Young People's Discourses About HIV/AIDS in Alberta, Canada

The ongoing epidemic of HIV/AIDS in Western societies (in particular in North America), where most of the population knows about the disease and how it is transmitted, suggests that providing information is not enough to change unsafe conduct. More complex psychosocial processes, mainly still unexplored, seem to underlie the translation of health knowledge about the disease and the infection into safe practices. In this article we explore the discourse of young people in Alberta about HIV/AIDS and discuss ways in which this information might be used to shape preventive strategies. We conducted eight focus groups with young people 18 to 25 years of age living in Edmonton, Alberta, Canada, and analyzed the data using psychosocial discourse analysis. The results confirm the role of young peoples interpersonal exchanges in determining HIV/AIDS preventive conduct and show the importance of social discourses about HIV/AIDS in mediating the impact of preventive campaigns on young peoples attitudes and beliefs.

Ensuring the Best Care for Our Increasing Aging Population: Health Engagement and Positive Technology Can Help Patients Achieve a More Active Role in Future Healthcare

The aging population (those aged 60 and over) continues to grow at a faster pace than at any time in human history. It is projected that by 2025 there will be 1.2 billion people in the world who will be 60 + years of age. This trend will only continue to grow as we advance further into the 21 century, as there will be an estimated 2 billion people aged 60 + , 1.6 billion of them living in developing countries. In European countries, those 65 + years of age will make up 23.5% of the population by 2030 according to the World Health Organization. It is obvious that older generations will continue to make up a greater proportion of the world population in the 21st century. Unfortunately, healthcare systems throughout much of the world are still based on 20th-century processes. This is leading to an ever-growing burden on our healthcare system. To meet the challenge of providing high-quality healthcare while keeping the costs and burdens within reasonable levels, we advocate shifting the current healthcare structure from a ‘‘disease-centered model’’ to a ‘‘citizen/client model’’ oriented to sustain patients’ participation in the management of their care. Due to advances in treatment and people living longer, chronic diseases are becoming more common amongst our population. This is contributing to the increasing burden on our current healthcare system. In fact, more than 83% of money spent on European Union healthcare each year goes toward the treatment of chronic diseases such as heart disease, stroke, cancer, and more. This trend is expected to continue burdening the health economic system over the next 10 years. In order for us to reduce this burden and sufficiently meet the needs of this growing segment of the population, healthcare organizations must have people take a more active role in their own health and well-being. A critical step toward this goal is patient engagement. The academic and managerial interests in patient engagement are vertiginously growing daily and are becoming a must for researchers, industries, and policy makers in healthcare arenas worldwide: from January 1 to May 12 2013, 28,300 new web indices appeared on Google.com with the key words ‘‘patient engagement.’’ Consistently, the US Department of Health and Human Services recently identified the goal of improving patients’ understanding of their health and related conditions so they take a more active role in their healthcare as the second of five health policy priorities. Here, we suggest conceptualizing patient engagement as the experience resulting from the conjoint emotional (feel), cognitive (think), and conative (act) enactment of individuals in their management of the health issue. The lack of synergy among these dimensions inhibits patients from full engagement, limiting the benefit of healthcare programs. Technology may offer a solution to this shortcoming. ‘‘Positive Technology’’ focuses on the use of technology for improving the quality of our personal experience, suggesting specific strategies to modify/improve each of the different dimensions involved, and generating motivation and engagement in the process. The use of Positive Technology tools and strategies allows the expansion of healthcare beyond the traditional doctor’s office and hospital to include advanced simulation technologies such as virtual reality or augmented reality, and spontaneous peer networks that encompass and utilize Web 2.0 properties (blogs, online communities, etc.) that are main fixtures of 21st-century living. Such a change from a disease-centered to a citizen/client model based on the engagement of patients in the management of their care thanks to positive technology will also benefit elderly people who are not as mobile and who cannot easily obtain the proper care from the current doctor’s office/ hospital setting where healthcare is commonly administered. This will allow the technological innovations constantly being