What is the full range of actions individuals are now expected to do if they are to optimally benefit from their health care? The CFAH 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.

CFAH Engagement Behavior Framework* includes these behaviors:

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 Health Care 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

Promote Health

  • 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 Preventive 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 the 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)