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Behind the psychology of patient engagement: How to unlock motivators and overcome barriers

With our evolving patient-centric healthcare system, patients are increasingly shifting from passive recipients to active participants in their care. To establish patient engagement as a standard practice across diverse clinical settings, activities must be accessible and designed to meet the unique needs of individuals from all backgrounds. (1)

For patients, choosing to engage in their personal healthcare journey can be overwhelming—this choice involves a wide range of complex cognitive and emotional processes. Psychological factors, such as motivation, trust, and self-efficacy, play a critical role in shaping patient collaboration with industry professionals. (2,3) Although some progress has been achieved in this field—for example, Graffigna and Barello have described the Patient Health Engagement model, an innovative tool that quantifies the psychological aspects of active participation—research into the psychology underlying patient engagement is sparse. (3) By leveraging evidence-based psychological techniques, we, as an industry, can empower patients in their decision to engage in their care, thereby benefiting diverse stakeholders.

What motivates patients?

To enhance the psychological drive behind patient involvement, we must unlock well-established motivators. Research has identified extensive motives that inspire patients to work alongside their healthcare providers and take control of their care. These range from personal ambitions—such as self-fulfilment, compensation, and educational opportunities—to more altruistic reasons, including improved health outcomes for future patients and stronger patient-provider partnerships. (2,4)

Translating this knowledge into action by adopting patient-centric approaches that motivate patients and underline greater participation is essential.

The foundation of all patient engagement is built on communication. By disseminating lay-friendly, accurate information across widely accessible platforms, we create opportunities to improve health literacy and inform patients about peer groups, upcoming clinical trials, and their value at a personal and community level. (5)

Taking this a step further, the way in which we communicate with patients matters. Leveraging effective communication tools—for example, sharing relatable anecdotes—can make the healthcare experience less intimidating and reach broader patient populations. These skills help build trust and close the gap between patients and providers. (6)

Why are patients hesitant to participate?

An alternative route to enhancing patient involvement is to mitigate persisting psychological barriers to their contribution. Maybe you know someone with a phobia of needles, or perhaps someone who dislikes the dentist—even these routine medical exposures can trigger anxiety for many. So, when individuals are diagnosed with conditions that threaten their overall health or quality of life, they typically experience negative emotions. These psychological factors may reduce patients’ willingness to engage in their healthcare journey, often due to a lack of trust in providers or disease-related stigma. More specifically, fear of interventional risks (e.g., side effects or symptom recurrence) and uncertainty about their treatment group—whether they are receiving the placebo or the study drug—may contribute to patient withdrawal from clinical settings. (7)

Leveraging drivers and overcoming barriers

Understanding the psychological drivers and barriers to participation is essential to develop effective strategies to promote patient engagement. This paves the way for behavioural science: the translation of scientific knowledge about human behaviour into practical, evidence-based approaches that influence positive action. (8)

Firstly, creating an environment of psychological safety, where patients feel comfortable voicing their needs and concerns or asking questions, is imperative for successful two-way interactions that foster mutual respect. (9) Additionally, adopting a shared decision-making approach to patient care can enhance involvement. According to the NICE shared decision-making guidelines (2019), involving patients in decisions regarding their treatment plan empowers them with the knowledge of potential benefits and risks, enabling them to make informed, supported choices. (10)

A more strategic approach to encourage patients to take an active role in managing their health is through positive reinforcement. This is a concept in which an individual is rewarded for favourable behaviour. In turn, they develop an association between the two, increasing their likelihood of repeating the behaviour in anticipation of the reward. (11) The reward could be as simple as a healthcare provider acknowledging the patient’s engagement with a kind word. Alternatively, patients may seek a peer support group to gain a community so they feel less alone in their condition. 

Alongside technological advances, gamification (applying game-inspired features to real-world scenarios) has become a well-established method of positive reinforcement in healthcare. 

For children, adolescents, and young adults with diabetes, self-monitoring blood glucose levels is a daily necessity. Given the frequency of recommended testing, it can feel like a chore for many. In response, Bayer HealthCare developed the DIDGET system to motivate adherence by integrating blood glucose monitoring into video gaming. When individuals consistently test their blood glucose, they earn benefits that can be used in video games, thereby reinforcing positive testing behaviour. This is a valuable tool, particularly for young patients, as adopting safe blood glucose monitoring practices early on leads to effective, deep-rooted habits. (12)

Image of Bayer's Didget blood glucose meter from newatlas.com:At Synthesis, we recognise that promoting patient engagement is a complex, multifaceted process requiring effort from multiple stakeholders. Our team of specialist medical writers is dedicated to providing patient-friendly, accurate information that empowers patients, improves health literacy, and raises awareness of engagement activities to drive participation. Beyond this, we believe in the power of effective collaboration between research teams and patient engagement and advocacy groups to build trust and strengthen patient partnerships within the industry. Contact us at info@synthesishealth.co.uk to learn how we can support your partnerships with patients and their advocates, leveraging simple communication techniques and positive reinforcement strategies to modernise clinical settings.

References

  1. Higgins T, Larson E, Schnall R. Unraveling the meaning of patient engagement: A concept analysis. Patient Educ Couns. 2017;100(1):30-36. doi:10.1016/j.pec.2016.09.002

  2. Raab C, Gambashidze N, Brust L, Weigl M, Koch A. Motivation for patient engagement in patient safety: a multi-perspective, explorative survey. BMC Health Serv Res. 2024;24(1):1052. Published 2024 Sep 11. doi:10.1186/s12913-024-11495-x

  3. Graffigna G, Barello S. Spotlight on the Patient Health Engagement model (PHE model): a psychosocial theory to understand people's meaningful engagement in their own health care. Patient Prefer Adherence. 2018;12:1261-1271. Published 2018 Jul 19. doi:10.2147/PPA.S145646

  4. McCarron TL, Noseworthy T, Moffat K, et al. Understanding the motivations of patients: A co-designed project to understand the factors behind patient engagement. Health Expect. 2019;22(4):709-720. doi:10.1111/hex.12942

  5. Alkhatib AJ, Alzoubi A, Alharoun M, et al. The Impact of Patient Engagement on Healthcare: A Systematic Review of Unveiling the Benefits of Patient Engagement in Healthcare. Multicriteria Algorithms with Applications. 2024;3:23-31. doi: 10.61356/j.mawa.2024.311661

  6. https://www.openhealthgroup.com/news/23-07-2024/the-science-behind-patient-stories/

  7. Ferguson MC, McNicol E, Kleykamp BA, et al. Perspectives on Participation in Clinical Trials Among Individuals With Pain, Depression, and/or Anxiety: An ACTTION Scoping Review. J Pain. 2023;24(1):24-37. doi:10.1016/j.jpain.2022.09.001

  8. Ghebreyesus TA. Using behavioural science for better health. Bull World Health Organ. 2021;99(11):755. doi:10.2471/BLT.21.287387

  9. Fukami T. Patient engagement with psychological safety. Dialogues Health. 2023;3:100153. Published 2023 Sep 17. doi:10.1016/j.dialog.2023.100153

  10. National Institute for Health and Care Excellence shared decision making guideline (2021)

  11. The Power of Positive Reinforcement: Using Behavioral Techniques to Enhance Patient Engagement (2023)

  12. Deeb LC, Parkes JL, Pardo S, et al. Performance of the DIDGET blood glucose monitoring system in children, teens, and young adults. J Diabetes Sci Technol. 2011;5(5):1157-1163. Published 2011 Sep 1. doi:10.1177/193229681100500518