. 2021 Oct 4;56(Suppl 1):990–1005. doi: 10.1111/1475-6773.13857

TABLE 3.

Conceptualization and key considerations in person and family engagement models

	Carman ²² and Bennett ⁸	Grande ²³	Gruman ²⁴	Graffigna ¹⁴	Higgins ²¹	Kimerling ²⁵
Definition of engagement	“Patients, families, their representatives, and health professionals working in active partnership at various levels across the health care system—direct care, organizational design and governance, and policy making—to improve health and health care” (Carman 2013)	“The process of actively involving and supporting patients in health care and treatment decision making activities” Classified according to three levels [(a) information provision, (b) patient activation, and (c) patient–provider collaboration]	“Actions individuals must take to obtain the greatest benefit from the health care services available to them”	“A developmental process involving a recovered patient's capacity to plan realistic life projects (i.e., meaningful life aims that the patient might generate unless living with the disease condition) and to be goal oriented—even if living with a disease.”	“The desire and capability to actively choose to participate in care in a way uniquely appropriate to the individual, in cooperation with a health care provider or institution, for the purposes of maximizing outcomes or improving experiences of care” Consists of four defining attributes: personalization, access, commitment, and therapeutic alliance.	“Behaviors associated with optimal benefit from health services.” Propensity to engage in care conceptualized as the cumulative self‐efficacy to engage in behaviors across four domains: self‐management, health information use, collaborative communication, and health care navigation.
Purpose of engagement (stated or implied)	To satisfy desires and expectations of patients and families in health care To improve health outcomes, quality, safety To control costs	As an ethical practice To improve outcomes (adherence, decisional conflict, confidence, health status, costs)	A requirement of receiving health care; minimizing demands on professionals; societal expectations	A requirement in the daily practice of health care organizations, and as a potential way to make the health care system “more effective and efficient”	Identifies 21 intended consequences of engagement, including patient safety, reducing costs, coordinating care, and identifying best practices.	To improve population health outcomes.
Key considerations
System factors as barriers or facilitators of direct‐level engagement	Considered	Considered	Considered	Considered	Considered	Considered
Level of focus	Direct Organizational design and governance Policy making	Direct level of care	Direct level of care	Direct level of care	Direct level of care	Direct level of care
Co‐production of care (patients as experts and stated or implied necessity of engagement)	Considered	Considered	Considered	Considered	Not considered	Not considered
Burdens/costs of engagement on individuals	Considered	Emphasized	Emphasized	Not considered	Not considered	Emphasized
Burdens/costs of engagement on clinicians and systems	Not considered	Considered	Considered	Not considered	Not considered	Not considered
Unique needs of vulnerable populations (e.g., by literacy, income, psychiatric comorbidity)	Considered	Considered	Considered	Considered	Considered	Emphasized
Role of family/friends distinct from individual engagement	Carman: Not considered Bennet: Considered	Not considered	Not considered	Considered	Considered	Not considered
Persons with MCC	Not considered	Not considered	Not considered	Not considered	Not considered	Not considered
The need to make engagement easy	Considered	Emphasized	Not considered	Not considered	Not considered	Emphasized
The diversity of outcomes that matter most to individuals and need for individual involvement on identifying outcomes to target/measure	Not considered	Not considered	Not considered	Not considered	Not considered	Not considered
Identification of individual behaviors	Not considered	Considered	Emphasized	Not considered	Not considered	Emphasized
Identifying health and health care as just one domain among many other important life domains	Not considered	Not considered	Not considered	Considered	Not considered	Considered
Identification of behavior change strategies/theories	Not considered	Not considered	Considered	Emphasized	Considered	Considered

Abbreviation: MCC, multiple chronic condition.