ENGAGEMENT BEHAVIOR FRAMEWORK
What is the full range of actions individuals are now expected to do if they are to optimally benefit from their health care? The Engagement Behavior Framework assembles a comprehensive list of measurable actions that individuals and/or their caregivers must perform in order to maximally benefit from the health care available to them.
Find Good Health Care
- Find provider(s) who meet personal criteria (e.g., performance, cost, geographic access, personal style), will take new patients and accept personal insurance.
- Use all available comparative performance information (including cost data) to identify prospective providers.
- Establish a relationship with a health care professional or group.
- Use all available comparative performance information (including cost data) to identify prospective health care facilities.
- Seek and use the appropriate health care setting when professional attention is required.
Communicate with Healthcare Professionals
- Prepare in advance of appointments a list of questions and issues for discussion with the health care professional.
- Bring a list of all current medications (including supplements and alternative products) and be prepared to discuss their benefits and side effects.
- Report accurately on the history and current status of physical and mental symptoms.
- Ask questions when any explanations or next steps are not clear and express any concerns about recommendations or care experiences.
Organize Health Care
- Make appointments; inquire about no-show policies; arrive on time.
- Assess whether the facility can accommodate unique needs (e.g., physical navigation, hearing or visual impairment, translation services) and arrange for assistance.
- Bring documentation of health insurance coverage.
- Bring another person to assist if the patient is frail, confused, unable to move around or unable to remember the conversation with the provider.
- Bring a summary of medical history, current health status and recent test results to visits as appropriate.
- Ensure that relevant medical information is conveyed between providers and institutions.
- Obtain all test results and appointment records and maintain personal health record.
Pay for Health Care
- Compare coverage options; match to personal values, needs and preferences; and select coverage.
- Gather and submit relevant eligibility documentation if applying for or seeking to maintain public insurance (e.g., Medicaid, Medicare, SCHIP); compare coverage options if applicable; match to personal values, needs and preferences; and select affordable, quality coverage.
- Before seeking treatment, ascertain benefit coverage restrictions or incentives such as mental health benefits limitations, pre-certification requirements, access restrictions to specialists or adjunct health providers, and variables in co-pays for specific types of care or providers.
- Maintain or adjust coverage in the event of changes in employment, eligibility or family status (i.e., job change, marriage, divorce, birth of child).
- Maintain all receipts for drugs, devices and services; submit any documentation of services or payments upon request or as needed for third-party payers (e.g., private insurance, medical/flexible health savings accounts or public payers).
Make Good Treatment Decisions
- Gather additional expert opinions on any serious diagnosis prior to beginning any course of treatment.
- Ask about the evidence for the efficacy (risks and benefits) of recommended treatment options.
- Evaluate treatment options.
- Negotiate a treatment plan with the provider(s).
Participate in Treatment
- Learn about any newly prescribed medications and devices, including possible side effects or interactions with existing medications and devices.
- Fill or refill prescriptions on time, monitor medication effectiveness and consult with prescribing clinician when discontinuing use.
- Maintain devices.
- Evaluate and receive recommended diagnostic and follow-up tests in discussion with health care providers.
- Monitor symptoms and conditions (e.g., for diabetes — monitor glucose regularly, check feet; for depression — medication and/or counseling and monitor symptoms; for hypertension — measure blood pressure regularly, maintain blood pressure diary), including danger signs that require urgent attention.
- Set and act on priorities for changing behavior to optimize health and prevent disease.
- Identify and secure services that support changing behavior to maximize health and functioning and maintain those changes over time.
- Manage symptoms by following treatment plans, including diet, exercise and substance use agreed upon by them and their provider.
Get Preventative Health Care
- Evaluate recommended screening tests in discussion with health care provider.
- Act on referrals for early detection screenings (e.g., breast cancer, colon cancer), and follow up on positive findings.
- Get recommended vaccines and participate in community-offered screening/wellness activities as appropriate.
Plan for End of Life
- Complete advance directives and medical power of attorney; file with personal records.
- Discuss directives with family physician and other health care providers, appropriate family and/or significant others.
- Review documents annually; update and distribute as needed.
Seek Health Knowledge
- Assess personal risks for poor health, disease and injury, and seek opportunities to increase knowledge about health and disease prevention.
- If diagnosed with a chronic disease, understand the condition(s), the risks and benefits of treatment options and personal behavior change(s) by seeking opportunities to improve health/disease knowledge.
- Know personal health targets (e.g., target blood pressure) and what to do to meet them.
CFAH Engagement Behavior Framework – Full Version
*Gruman J, Holmes-Rovner M, French ME, Jeffress D, Sofaer S, Shaller D, Prager DC. From patient education to patient engagement: Implications for the field of patient education. Patient Education and Counseling. March 2010 (Vol. 78, Issue 3, Pages 350-356, DOI: 10.1016/j.pec.2010.02.002)