Patient empowerment as capabilities for people with chronic condition supported by digital health technologies: a scoping review#

Authors#

Messaline Fomo, Liyousew Borga, Thomas Abel, Philip Santangelo, Sara Riggare, Jochen Klucken, Ivana Paccoud

Abstract#

Introduction: Patient empowerment is widely recognized for improving health outcomes, increasing patient satisfaction, and enhancing the overall effectiveness of healthcare. Digital medical devices and related health technologies hereafter called DMDs contribute to this empowerment by keeping patients informed, involved, and engaged in their own health. However, more evidence is needed to better understand which aspects of empowerment patients’ value when using DMDs and how DMDs can support these values. Drawing on Sen’s capability approach, this paper conceptualizes patient empowerment by defining various capabilities, resources and conversion factors that contribute to patient empowerment through DMDs.

Methods: We based our scoping review on the methodology recommended by the Joanna Briggs Institute (JBI) Manual for evidence synthesis and an a priori registered protocol. Articles were included if they focused on patient empowerment in relation to DMDs among patients with chronic diseases (cardiovascular diseases, diabetes, cancer, chronic respiratory diseases, and neurodegenerative diseases), with particular emphasis on the patient perspective. PubMed, Scopus, and Web of Science were searched for evidence published from January 2013 to April 2024. Data were extracted and thematically analyzed via a multidisciplinary workshop to identify empowerment components relevant to the capability framework, such as capabilities, DMD resources, and conversion factors.

Result: Our analysis identified three core capabilities to achieve patient empowerment supported by DMDs: health information and knowledge management, self-management, and emotional and social support. DMD resources supported these capabilities through distinct functional components, including informing patients, communication with the healthcare team, monitoring, behavior change interventions, individualized feedback, or peer support, each contributing to a varying degree. Conversion factors such as demographic and socioeconomic status, digital literacy, disease status, perceived value of DMDs, sociocultural values and norms, doctor-patient relationship, connectivity, and cost influenced the development of capabilities resulting from using DMDs.

Conclusion: While the capabilities related to patient empowerment in DMDs were clearly distinguishable, our analysis revealed a notable interconnectedness among these components. Our conceptualization of patient empowerment serves as a valuable resource for researchers seeking to understand or assess patient empowerment via DMDs. It also provides guidance for DMD developers, helping them design DMDs that enhance valued capabilities and account for the conversion factors and ultimately promote patient empowerment across diverse population groups.

Keywords: Patient empowerment, digital medical devices, DMDs, digital health, capability approach