What makes patients engaged: a metanarrative review and multilevel perspectiveon patient engagement

Patient engagement is increasingly recognized as a crucial aspect for healthcare quality, safety, and outcomes. While literature highlights its multidimensional nature, encompassing individual behaviors, relational dynamics, organizational practices, and social influences, there remains limited integration of these perspectives. This complexity makes it difficult to understand how to define and promote patient engagement, as its antecedents and mechanisms are not fully understood. The aim of the present study is to provide a comprehensive framework that clarifies the antecedents of patient engagement and guides its implementation across the healthcare system to benefit patients and providers alike. Drawing on the meta-narrative review approach, four databases (SCOPUS, Web of Science, PubMed, and PsycINFO) were used to collect and synthesize multiple systematic reviews and meta-analyses on the topic of patient engagement. Fifty-one items were included in the review. Data extracted were inductively categorized by levels, factors, and elements associated with patient engagement. Findings highlight the multilevel nature of patient engagement, characterized by individual, task, relational, organizational, and social levels. The emerged integrative model maps interconnected factors and highlights patient engagement's complexity and dynamic nature. The model offers a theoretical framework to diagnose and promote engagement, empowering patients, and enhancing the quality of the healthcare service.