Considering Patients’ Empowerment in Chronic Care Management: A Cross-Level Approach

This paper consists of an analysis of the concept of empowerment—which is often defined
as a key issue in health care—at the macro, meso, and micro levels by focusing on health care reform
in Belgium. Three research teams collected data and combined them in an inductive secondary
analysis. Our preliminary results demonstrate that patient empowerment does not always encompass
the same scientific reality. At the macro level, this concept is linked to the authorities’ wish to support
at-home care for chronic patients. At the meso level, the role of caregivers in maintaining patients’
autonomy, but also the social conditions of their lives, is a salient component of empowerment. At
the micro level, individual and personal features such as identity can influence patient empowerment
and behavior in the health care system. This cross-level research suggests that patient empowerment
is not sufficiently clearly defined at each level of the care production chain, which could impede the
reform of health care. This paper underlines the polysemy of a concept viewed as a milestone in
European health care policy and the necessity of a clear, collective definition to operationalize and
implement it.