2019/06/01 by Devon Greyson · 1 voice
Arts and Humanities · Health Professions · #Mental Health and Psychiatry #Patient Satisfaction in Healthcare #Patient-Provider Communication in Healthcare
paper · pdf · doi:10.1093/heapro/daz058
openalex publication_date 2019/06/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/30
The Ottawa Charter defined health promotion as, “the process of enabling people to increase control over, and to improve, their health,” including the necessity of “full and continuous access to information” (World Health Organisation, 1986). Over 20 years later, the Nairobi Conference’s Call to Action, moving health promotion forward in a global and increasingly connected context, contained a call to empower communities by including culture and traditions in health promotion, accompanied by a call for embracing information and communication technologies, including increased public access (7th Global Conference on Health Promotion, 2009). Today, widespread internet availability has opened up public access to both scientific and non-scientific health information, leading to more informationally-engaged individuals and populations. The terms “empowered” and “activated patients” are commonly used to describe informed and involved individuals (Hibbard and Gilburt, 2014), and evidence suggests that in many cases activation leads to better outcomes (Greene et al., 2013) and lower costs (Hibbard et al, 2013). In clinical care, patient empowerment has been accompanied by the rise of shared decision-making, including increased acknowledgement of the variation in values, beliefs, and preferences among patients (Veatch, 2009). However, shared decision-making is not universally understood or embraced. Some patients feel unduly burdened by expectations that they, as laypeople, will make medical decisions (Gerber and Eiser, 2001), while some health professionals feel challenged when patients resist norms of deference to medical expertise (Chiaramonte, 2008). Public health also communicates mixed messages about “activated” health decision making, risking confusion and resentment. For example, in response to growing concern over antimicrobial resistance, campaigns to discourage antibiotic overuse have become common. Patients frequently perceive these as encouraging them to question their health care providers’ antibiotic prescriptions. However, simultaneous campaigns aimed at encouraging vaccine uptake discourage such questioning of clinicians, and patients frequently feel shamed into taking their vaccination questions elsewhere (e.g., to online forums where they feel they won’t be judged). Access to health information carries the potential to improve the well-being of individuals and populations. However, expecting the public to act upon information in some cases, whilst chastising them for such behaviour in others, risks degrading trust in health promotion efforts. This is the activated patient paradox: We cannot expect the public to be empowered only when it is convenient to our objectives and ideology. Rather, health communication efforts should be coordinated, and health systems must anticipate activation by providing verifiable information to the public. Only then can we realize the potential of patient informational empowerment.