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Patient Empowerment and its neighbours: Clarifying the boundaries and their mutual relationships


  • Fumagalli, Lia Paola
  • Radaelli, Giovanni
  • Lettieri, Emanuele
  • Bertele’, Paolo
  • Masella, Cristina


Patients are increasingly encouraged to become active players in self-care and shared decision-making. Such attention has led to an explosion of terms – empowerment, engagement, enablement, participation, involvement, activation – each having multiple and overlapping meanings. The resulting ambiguity inhibits an effective use of existing evidence. This study addresses this problem by delivering an evidence-based concept mapping of these terms that delineates their boundaries and mutual relationships. We implemented a literature review of contributions associated to patient empowerment, activation, engagement, enablement, involvement, and participation. We implemented a keyword-based strategy collecting contributions published in PubMed database in the 1990–2013 timespan. A total of 286 articles were selected. The results identified three distinct interpretation of patient empowerment, either conceived as a process, an emergent state or as a participative behaviour. Most definitions recognize empowerment as the combination of ability, motivation and power opportunities. A concept mapping for patient empowerment, activation, enablement, engagement, involvement, and participation was then delineated. The concept map consists of two dimensions (nature and focus of concept) and marks distinctions and relationships between the concepts. The resulting concept map paves the way for a number of future research directions that can help improve our understanding of the antecedents and consequences of patient empowerment policies.

Suggested Citation

  • Fumagalli, Lia Paola & Radaelli, Giovanni & Lettieri, Emanuele & Bertele’, Paolo & Masella, Cristina, 2015. "Patient Empowerment and its neighbours: Clarifying the boundaries and their mutual relationships," Health Policy, Elsevier, vol. 119(3), pages 384-394.
  • Handle: RePEc:eee:hepoli:v:119:y:2015:i:3:p:384-394
    DOI: 10.1016/j.healthpol.2014.10.017

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    References listed on IDEAS

    1. Aujoulat, Isabelle & Marcolongo, Renzo & Bonadiman, Leopoldo & Deccache, Alain, 2008. "Reconsidering patient empowerment in chronic illness: A critique of models of self-efficacy and bodily control," Social Science & Medicine, Elsevier, vol. 66(5), pages 1228-1239, March.
    2. O'Cathain, Alicia & Goode, Jackie & Luff, Donna & Strangleman, Tim & Hanlon, Gerard & Greatbatch, David, 2005. "Does NHS Direct empower patients?," Social Science & Medicine, Elsevier, vol. 61(8), pages 1761-1771, October.
    3. Fox, N.J. & Ward, K.J. & O'Rourke, A.J., 2005. "The 'expert patient': empowerment or medical dominance? The case of weight loss, pharmaceutical drugs and the Internet," Social Science & Medicine, Elsevier, vol. 60(6), pages 1299-1309, March.
    4. Smith, Sian K. & Dixon, Ann & Trevena, Lyndal & Nutbeam, Don & McCaffery, Kirsten J., 2009. "Exploring patient involvement in healthcare decision making across different education and functional health literacy groups," Social Science & Medicine, Elsevier, vol. 69(12), pages 1805-1812, December.
    5. Jones, Ian Rees & Berney, Lee & Kelly, Moira & Doyal, Len & Griffiths, Chris & Feder, Gene & Hillier, Sheila & Rowlands, Gillian & Curtis, Sarah, 2004. "Is patient involvement possible when decisions involve scarce resources? A qualitative study of decision-making in primary care," Social Science & Medicine, Elsevier, vol. 59(1), pages 93-102, July.
    6. Segal, Leonie, 1998. "The importance of patient empowerment in health system reform," Health Policy, Elsevier, vol. 44(1), pages 31-44, April.
    7. Anderson, Joan M., 1996. "Empowering patients: Issues and strategies," Social Science & Medicine, Elsevier, vol. 43(5), pages 697-705, September.
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    1. repec:eee:tefoso:v:120:y:2017:i:c:p:240-251 is not listed on IDEAS
    2. repec:spr:eujhec:v:19:y:2018:i:5:d:10.1007_s10198-018-0965-3 is not listed on IDEAS


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