Table 5.

The proposed hierarchical framework of patient empowerment levels.

Hierarchical level of patient empowerment	Definition of level
Level 1: Motivated patient	The motivated patient is motivated to adhere to treatment and information given by the professional but lets the professional take the leading role within health care consultation.
Level 2: Self-cared patient	The self-cared patient takes control over disease and seeks information and knowledge that will help improve self-management or takes a leading role in health consultation. The patient uses the online community in order to get a second opinion or support potential void of information or knowledge from health care, regarding emotional or social aspects of living with the disease. At this level, the patient is thus more driven and uses online communities as complements as to traditional health care and has taken ownership of the disease.
Level 3: Producing patient	The producing patient means that the patient is not just a passive consumer of care since the patient wants to help others by sharing their experiences with disease and health care process. The context behind helping others might depend on the patient wanting to learn, and simultaneously gain status and satisfaction, in order to improve emotional or mental health. Additionally, the context of learning and gaining status or satisfaction and how it improves emotional or mental health could be an outcome of helping others.
Level 4: Patient activist	Collective empowerment is considered to be the patient having the aim of informing or helping others in order to develop or change policies and awareness in health care. Patients’ experiences become evidence-based and used by health care professionals.