Making sense of "consumer engagement" initiatives to improve health and health care: a conceptual framework to guide policy and practice.

The Milbank Quarterly

PubMedID: 23488711

Mittler JN, Martsolf GR, Telenko SJ, Scanlon DP. Making sense of "consumer engagement" initiatives to improve health and health care: a conceptual framework to guide policy and practice. Milbank Q. 2013;91(1):37-77.
CONTEXT
Policymakers and practitioners continue to pursue initiatives designed to engage individuals in their health and health care despite discordant views and mixed evidence regarding the ability to cultivate greater individual engagement that improves Americans' health and well-being and helps manage health care costs. There is limited and mixed evidence regarding the value of different interventions.

METHODS
Based on our involvement in evaluating various community-based consumer engagement initiatives and a targeted literature review of models of behavior change, we identified the need for a framework to classify the universe of consumer engagement initiatives toward advancing policymakers' and practitioners' knowledge of their value and fit in various contexts. We developed a framework that expanded our conceptualization of consumer engagement, building on elements of two common models, the individually focused transtheoretical model of behavior and the broader, multilevel social ecological model. Finally, we applied this framework to one community's existing consumer engagement program.

FINDINGS
Consumer engagement in health and health care refers to the performance of specific behaviors ("engaged behaviors") and/or an individual's capacity and motivation to perform these behaviors ("activation"). These two dimensions are related but distinct and thus should be differentiated. The framework creates four classification schemas, by (1) targeted behavior types (self-management, health care encounter, shopping, and health behaviors) and by (2) individual, (3) group, and (4) community dimensions. Our example illustrates that the framework can systematically classify a variety of consumer engagement programs, and that this exercise and resulting characterization can provide a structured way to consider the program and how its components fit program goals both individually and collectively.

CONCLUSIONS
Applying the framework could help advance the field by making policymakers and practitioners aware of the wide range of approaches, providing a structured way to organize and characterize interventions retrospectively, and helping them consider how they can meet the program's goals both individually and collectively.