What makes a patient engaged: a multilevel integrative review of factors contributing to patient engagement

Background: Scholars and practitioners from diverse disciplines are increasingly exploring Patient Engagement (PE), defined as individual consensus and participation in health treatment. However, this heightened attention has generated contention over PE's definition and promotion. This study addresses the challenge through a multilevel integrative review to deepen PE understanding. Methods: Using the umbrella review approach, we synthesized literature from different disciplines (e.g., psychology, healthcare studies, medicine) by classifying antecedents of PE at different levels, namely from the individual level to the societal level. Findings: Our multilevel review provides an integrated understanding of PE as a multidimensional concept with antecedents and implications across various levels. At the individual level, we identified intra- and inter-individual factors with elements (e.g., trust, expectations, autonomy, motivation) shaping the PE experience. The task level included factors related to treatment, illness type, and technological devices, with specific elements (e.g., demands, usability, duration). The relational level encompassed healthcare providers and patients' perspectives (e.g., interprofessional communication, collaboration, and goal setting). The organizational level included factors like work environment planning, organizational resources, and policies, with specific elements (e.g., care planning and accessibility). The societal level considered factors like access to health programs and societal/cultural accounts (e.g., public/private distinctions and patient-centered care/approach). Discussion: This contribution introduces an integrated model, expanding perspectives beyond the traditional individual PE model to encompass multiple factors, including organizational and social spheres. The proposed multilevel perspective is applied for theoretical considerations (e.g., identifying antecedents and facilitating factors) and practical applications (e.g., enhancing healthcare service quality).