title: Patient Empowerment and its neighbours: clarifying the boundaries and their mutual relationships.
abstract: 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.
authors.affiliation: Politecnico di Milano, Department of Management, Economics and Industrial Engineering, P.zza Leonardo da Vinci 32, 20133 Milan, Italy.
authors.forename: Lia Paola
authors.initials: LP
authors.lastname: Fumagalli
authors.affiliation: Politecnico di Milano, Department of Management, Economics and Industrial Engineering, P.zza Leonardo da Vinci 32, 20133 Milan, Italy; Warwick Business, University of Warwick, CV4 7AL, Coventry (UK).
authors.forename: Giovanni
authors.initials: G
authors.lastname: Radaelli
authors.affiliation: Politecnico di Milano, Department of Management, Economics and Industrial Engineering, P.zza Leonardo da Vinci 32, 20133 Milan, Italy. Electronic address: emanuele.lettieri@polimi.it.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Lettieri
authors.affiliation: Politecnico di Milano, Department of Management, Economics and Industrial Engineering, P.zza Leonardo da Vinci 32, 20133 Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bertele'
authors.affiliation: Politecnico di Milano, Department of Management, Economics and Industrial Engineering, P.zza Leonardo da Vinci 32, 20133 Milan, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Masella
mesh_terms: D003210:Concept Formation; D006801:Humans; D010358:Patient Participation; D009626:Terminology as Topic
keywords: Patient activation; Patient empowerment; Patient enablement; Patient engagement; Patient involvement; Patient participation