Abstract
Introduction: Patient empowerment is a key concept in healthcare, evolving from an individual perspective to a broader vision that incorporates psychological, behavioral, and social aspects. However, its varied interpretations pose challenges for measurement and application. Objectives: This study analyzes patient empowerment and its related concepts, identifying key dimensions used in research. Methodology: A narrative review of key publications was conducted, focusing on definitions, conceptual frameworks, and measurement approaches. Studies relevant to the standardization and practical application of empowerment were analyzed. Results: Definitions and measurement tools vary widely. Core dimensions include self-efficacy, self-management, patient participation, and shared decision-making, but no universal standard exists for assessment. Conclusions: A consensus on patient empowerment and standardized measurement tools is needed to enable comparable assessments of its impact. A systematic review is recommended to consolidate knowledge and improve its application in clinical practice.
References
World Health Organization. Healthy Cities Effective Approach to a Changing World Disponible en: https://www.who.int/publications-detail-redirect/9789240004825 [Consultado 19 de marzo de 2024].
Lorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M. Effect of a self-management program on patients with chronic disease. Eff Clin Pract. 2001; 4(6): 256-62. doi: https://doi.org/10.1207/S15324796ABM2601_01
Lorig KR, Ritter PL, González VM. Hispanic chronic disease self-management: a randomized community-based outcome trial. Nurs Res. 2003; 52(6): 361-9. doi: https://doi.org/10.1097/00006199-200311000-00003
Lorig KR, Ritter P, Stewart AL, Sobel DS, Brown BW, Bandura A, et al. Chronic disease self-management program: 2-year health status and health care utilization outcomes. Med Care.2001; 39(11): 1217-23. doi: https://doi.org/10.1097/00005650-200111000-00008
Yu DSF, Li PWC, Li SX, Smith RD, Yue SCS, Yan BPY. Effectiveness and Cost-effectiveness of an Empowerment-Based Self-care Education Program on Health Outcomes Among Patients With Heart Failure: A Randomized Clinical Trial. JAMA Netw Open.2022; 5(4): e225982. doi: https://doi.org/10.1001/jamanetworkopen.2022.5982
Mogueo A, Oga-Omenka C, Hatem M, Kuate Defo B. Effectiveness of interventions based on patient empowerment in the control of type 2 diabetes in sub-Saharan Africa: A review of randomized controlled trials. Endocrinol Diabetes Metab. 2021; 4(1): e00174. doi: https://doi.org/10.1002/edm2.174
Riemann L, Lubasch JS, Heep A, Ansmann L. The Role of Health Literacy in Health Behavior, Health Service Use, Health Outcomes, and Empowerment in Pediatric Patients with Chronic Disease: A Systematic Review. Int J Environ Res Public Health. 2021; 18(23): 12464. doi: https://doi.org/10.3390/ijerph182312464
Hsieh WL, Li IH, Liu WI. Effects of empowerment-based illness management on the medication adherence and recovery of persons with schizophrenia: A systematic review and meta-analysis. Int J Ment Health Nurs. 2023; 32(4): 1008-24. doi: https://doi.org/10.1111/inm.13123
Náfrádi L, Nakamoto K, Schulz PJ. Is patient empowerment the key to promote adherence A systematic review of the relationship between self-efficacy, health locus of control and medication adherence. PLoS One. 2017; 12(10): e0186458. doi: https://doi.org/10.1371/journal.pone.0186458
Freire P, Pedagogía del Oprimido. 04310, Mexico: Siglo XXI Ediciones Pedagogía del Oprimido, 1970 | ISBN 978-968-23-0236-7
Conger JA, Kanungo RN. The empowerment process: Integrating theory and practice. The Academy of Management Review. 1988; 13(3): 471-82. doi: https://doi.org/10.2307/258093
Fumagalli LP, Radaelli G, Lettieri E, Bertele’ P, Masella C. Patient Empowerment and its neighbours: clarifying the boundaries and their mutual relationships. Health Policy. 2015; 119(3): 384-94. doi: https://doi.org/10.1016/j.healthpol.2014.10.017
Acuña Mora M, Sparud-Lundin C, Moons P, Bratt EL. Definitions, instruments and correlates of patient empowerment: A descriptive review. Patient Education and Counseling. 2022; 105(2): 346-55. doi: https://doi.org/10.1016/j.pec.2021.06.014
Funnell MM, Anderson RM, Arnold MS, Barr PA, Donnelly M, Johnson PD, et al. Empowerment: an idea whose time has come in diabetes education. Diabetes Educ. 1991; 17(1): 37-41. doi: https://doi.org/10.1177/014572179101700108
Rappaport J. Terms of empowerment/exemplars of prevention: toward a theory for community psychology. Am J Community Psychol. 1987; 15(2): 121-48. doi: https://doi.org/10.1007/BF00919275
Zimmerman MA. Psychological empowerment: issues and illustrations. Am J Community Psychol. 1995; 23(5): 581-99. doi: https://doi.org/10.1007/BF02506983
Corrigan PW, Garman AN. Considerations for research on consumer empowerment and psychosocial interventions. Psychiatr Serv. 1997; 48(3): 347-52. doi: https://doi.org/10.1176/ps.48.3.347
World Health Organization. Health Promotion Glossary of Terms 2021. Disponible en: https://www.who.int/publications-detail-redirect/9789240038349. [consultado 19 de marzo de 2024].
Cerezo PG, Juvé-Udina ME, Delgado-Hito P. Concepts and measures of patient empowerment: a comprehensive review. Rev Esc Enferm USP. 2016; 50(4): 664-671. doi: http://dx.doi.org/10.1590/S0080-623420160000500018
Stepanian N, Larsen MH, Mendelsohn JB, Mariussen KL, Heggdal K. Empowerment interventions designed for persons living with chronic disease - a systematic review and meta-analysis of the components and efficacy of format on patient-reported outcomes. BMC Health Serv Res. 2023; 23(1): 911. doi: https://doi.org/10.1186/s12913-023-09895-6
Newland P, Lorenz R, Oliver BJ. Patient activation in adults with chronic conditions: A systematic review. J Health Psychol. 2021; 26(1): 103-14. doi: https://doi.org/10.1177/1359105320947790
Pekonen A, Eloranta S, Stolt M, Virolainen P, Leino-Kilpi H. Measuring patient empowerment - A systematic review. Patient Educ Couns 2020; 103(4): 777-87. doi: https://doi.org/10.1016/j.pec.2019.10.019
Bravo P, Edwards A, Barr PJ, Scholl I, Elwyn G, McAllister M, et al. Conceptualising patient empowerment: a mixed methods study. BMC Health Services Research. 2015; 15(1): 252. doi: https://doi.org/10.1186/s12913-015-0907-z
Barr PJ, Scholl I, Bravo P, Faber MJ, Elwyn G, McAllister M. Assessment of patient empowerment--a systematic review of measures. PLoS One. 2015; 10(5): e0126553. doi: https://doi.org/10.1371/journal.pone.0126553
Acuña Mora M, Sparud-Lundin C, Moons P, Bratt EL. Definitions, instruments and correlates of patient empowerment: A descriptive review. Patient Educ Couns. 2022; 105(2): 346-55. doi: https://doi.org/10.1016/j.pec.2021.06.014
Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Advances in Behaviour Research and Therapy. 1978; 1(4): 139-61. doi: https://doi.org/10.1016/0146-6402(78)90002-4
Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004; 39(4pt1): 1005-26. doi: https://doi.org/10.1111/j.1475-6773.2004.00269.x
World Health Organization. Patient empowerment and health care. In: WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care 2009. Disponible en: https://www.who.int/publications-detail-redirect/9789241597906 [consultado 14 de abril de 2024].
Hudon C, St-Cyr Tribble D, Légaré F, Bravo G, Fortin M, Almirall J. Assessing enablement in clinical practice: a systematic review of available instruments. J Eval Clin Pract.2010;16(6):1301-8. https://doi.org/10.1111/j.1365-2753.2009.01332.x
James J. Patient Engagement | Health Affairs Brief 2013. Disponible en: https://www.healthaffairs.org/do/10.1377/hpb20130214.898775/full/ [consultado 20 de marzo de 2024].
Graffigna G, Barello S, Bonanomi A, Lozza E. Measuring patient engagement: development and psychometric properties of the Patient Health Engagement (PHE) Scale. Front Psychol. 2015; 6:274. doi: https://doi.org/10.3389/fpsyg.2015.00274
Martz E by E, editor. Promoting Self-Management of Chronic Health Conditions: Theories and Practice. Oxford, New York: Oxford University Press; 2017. 560 p.
Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003; 26(1): 1-7. doi: https://doi.org/10.1207/S15324796ABM2601_01
Hibbard JH, Greene J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff (Millwood). 2013; 32(2): 207-14. doi: https://doi.org/10.1377/hlthaff.2012.1061

This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2025 Johanna Rios, Pedro Amariles