Intended for healthcare professionals

Analysis Analysis

Effectiveness of strategies for informing, educating, and involving patients

BMJ 2007; 335 doi: (Published 05 July 2007) Cite this as: BMJ 2007;335:24
  1. Angela Coulter, chief executive1,
  2. Jo Ellins, project manager (organisational development)2
  1. 1Picker Institute Europe, King's Mead House, Oxford OX1 1RX
  2. 2The NHS Centre for Involvement, Vanguard Centre, University of Warwick, Coventry CV4 7AL
  1. Correspondence to: angela.coulter{at}
  • Accepted 28 April 2007

Evidence that strategies to strengthen patient engagement are effective is substantial, argue Angela Coulter and Jo Ellins, but any strategy to reduce health inequalities must promote health literacy

Policymakers increasingly believe that encouraging patients to play a more active role in their health care could improve quality, efficiency, and health outcomes. But critics have dismissed talk about patient engagement and patient centred care as political correctness—a misplaced concern with the “touchy feely” aspects of health care, with no scientific basis and little relevance to the quest for excellence in clinical care. Who is right? To what extent is the planned shift towards greater patient engagement supported by robust research evidence?

Engaging patients

Patient focused quality interventions recognise and try to support patients in actively securing appropriate, effective, safe, and responsive health care. Initiatives may aim to engage patients in their own or their family's individual clinical care, or they may try to involve the public in improving the responsiveness of health services. This article focuses on the first of these two initiatives (box 1).

Box 1 Patient focused quality interventions

To improve health literacy
  • Provision of printed leaflets and health information packages

  • Provision of computer based and internet health information

  • Targeted approaches to tackle low levels of health literacy in disadvantaged groups

  • Targeted mass media campaigns

To improve clinical decision making
  • Patient decision aids

  • Training for clinicians in communication skills

  • Coaching and question prompts for patients

To improve self care
  • Self management education

  • Self monitoring and self administered treatment

  • Self help groups and peer support

  • Patient access to personal medical information

  • Patient centred telecare

To improve patient safety
  • Information to help choose safe providers

  • Patient involvement in infection control

  • Encouraging adherence to treatment regimens

  • Checking records and care processes

  • Patient reporting of adverse drug events


As part of a wider research initiative to collate and synthesise research on performance, quality, and cost effectiveness in health care, we searched the literature for evidence on patient …

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