Abstract

BackgroundThe prioritization of sustainable patient-centered care in contemporary health care has resulted in an increased focus on patient empowerment, which in turn is considered to facilitate patient independence, self-management, and self-efficacy. However, a definitional consensus of empowerment remains elusive, impeding efforts to translate the conceptual ideals of empowerment into a measurable entity associated with changes in health care behavior or outcomes. The rapid integration of technology in health care serves to add another layer of complexity in the measurability and operationalization of empowerment and helps to create a specific context in which this conceptual entity should be further examined.ObjectiveThe primary objective of this scoping review was to explore the concept of patient empowerment within the electronic health (eHealth) context. A further focus on the association or measurement of this concept in conjunction with tethered patient portal use was also employed.MethodsIn this scoping review, a six-step framework was used to guide the search and paper selection process. The review was initiated with two broad research questions, which are as follows: (1) What is the relationship between empowerment and the use of eHealth technologies from a patient perspective? (2) How is patient empowerment (and/or engagement or activation) influenced by accessing personal health information through a tethered patient portal? Multiple databases were employed in a comprehensive search strategy, and papers were primarily evaluated and selected for inclusion by 2 review authors, and a third author was consulted to resolve any issues in reaching consensus.ResultsFrom an initial count of 1387 publications, this review returned nine systematic or literature review papers and 19 empirical studies that pertained to patient empowerment (and/or engagement and activation) in relation to the use of tethered patient portals providing access to electronic health records (EHRs). Of the 19 empirical publications, only four were found to have used specific patient empowerment measures with significant variety in their identified conceptual elements.ConclusionsThere is a persistent lack of conceptual clarity in patient empowerment research, and this has extended to study within the eHealth context. The interchangeable use or conflation of terms such as patient empowerment, engagement, and activation, has further complicated the advancement of distinct conceptual measures. To more strongly align changes in patient empowerment with supportive eHealth solutions, the challenges of achieving a consensus on how best to operationalize and measure patient empowerment must be met.

Highlights

  • In addition to complex technological evolution and advancements, health care systems are undergoing a significant paradigmatic shift in response to the demand for care transformations that deliver on the long-standing promise of patient-centered care

  • The broad directive in this review was as follows: (1) What is the relationship between empowerment and the use of electronic health (eHealth) technologies from a patient perspective? This question supported the primary focus of the review on patient empowerment within eHealth

  • The scoping review resulted in the extraction of nine systematic or literature reviews and 19 empirical studies

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Summary

Introduction

In addition to complex technological evolution and advancements, health care systems are undergoing a significant paradigmatic shift in response to the demand for care transformations that deliver on the long-standing promise of patient-centered care. The multitude of applications of the term in the literature has established empowerment as a process, often of a transformative nature; a representation, or manifestation of purported key elements such as self-management and freedom of choice; an aspect or result of particular interventions themselves where often these results are measured through improved patient outcomes or reported self-management [1]. Whereas this conceptual manipulation of patient empowerment has supported a diverse array of associated study, it has been less helpful in the establishment of a concrete and comprehensive singular measure of patient empowerment. To more strongly align changes in patient empowerment with supportive eHealth solutions, the challenges of achieving a consensus on how best to operationalize and measure patient empowerment must be met

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