Unmet Needs and Strategies to Promote Patient Engagement in The Arab World: Experts' Opinion

Unmet Needs and Strategies to Promote Patient Engagement in The Arab World: Experts' Opinion | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Unmet Needs and Strategies to Promote Patient Engagement in The Arab World: Experts' Opinion Yehia Nabil, Anwar Eldaw, Dalia El-Shourbagy, Dima Ibrahim, Hanan Al Torkistani, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3825755/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The significance of Patient Engagement (PE) is widely acknowledged as a crucial element in fostering positive health outcomes, elevating care quality, and streamlining healthcare systems. Despite its recognized advantages, the level of patient engagement in Arab nations remains suboptimal. Methods A high-level assembly was convened in Dubai, assembling eleven distinguished patient advocates from diverse Arab countries. Their collective aim was to dissect the obstacles hindering patient engagement in the Arab world and propose pragmatic strategies to surmount them. First, a series of five open-ended, comprehensive questions were posed and thoroughly deliberated upon. Second, the barriers to patient engagement within the experts’ respective communities were debated. A qualitative thematic analysis was conducted and two reports were generated by two independent researchers from the original meeting recordings. Results This paper highlights the importance of patient engagement in advancing healthcare and categorizes barriers to patient engagement as patient-related, provider-related, or system/government related. The experts identified the primary gaps in patient engagement and proposed strategies to promote it, with a primary focus on motivating both patients and providers towards shared decision-making. Conclusions This paper amalgamates the insights and recommendations distilled from this expert gathering, juxtaposing them within the broader context of existing literature on patient engagement. Offering a comprehensive viewpoint, this article delves into the challenges and opportunities intrinsic to bolstering patient engagement in the Arab world. Moreover, it spotlights invaluable tools often overlooked within Arab countries. The practical insights furnished in this piece serve as a roadmap for administrators and decision-makers, providing guidance to enhance patient engagement on both a national and institutional scale. Arab Countries Patient engagement patient experience patient satisfaction healthcare services healthcare system 1. BACKGROUND Patient engagement (PE) delineates the active participation of patients in decisions concerning their healthcare, demonstrating a profound ability to empower patients and significantly enhance healthcare outcomes ( 1 ). The extent and facets of PE exhibit variability contingent upon factors such as the setting, context, patient attributes, and disease characteristics ( 2 ). Within the realm of patient empowerment, various components align with patient engagement, encompassing the act of posing questions, collaborating in decision-making processes, granting patients autonomy over their care, and eliciting patient feedback ( 1 , 2 ). The nature of patient engagement (PE) is contingent upon a myriad of factors, including patients' comprehension of their condition, their rapport and reliance on healthcare providers, and their access to care ( 1 ). The unique attributes of individual patients dictate the extent to which they should participate and engage in decisions regarding their healthcare ( 3 ). Consequently, patients can be broadly categorized based on their medical expertise, capacity for informed decision-making, and whether their primary ailment is chronic or acute ( 3 ). It is imperative to discern between medical knowledge and the general level of education. For instance, a patient holding a PhD in literature might exhibit less inclination to engage in their healthcare decisions compared to a science student. Patients with higher educational attainment, decision-making capability, and chronic health issues necessitate a deeper and more involved level of engagement than those with lower educational levels, impaired decision-making capacities, or acute health problems ( 4 ). These predictors of PE can amalgamate into an overall PE score that positively correlates with the recommended level of engagement for optimal health outcomes and patient contentment ( 4 ). While acknowledging this correlation aids providers in tailoring engagement levels to individual patient needs and expectations, engaging patients with transient, acute problems lacks substantial literature. At its essence, PE empowers patients by bestowing a sense of authority over their healthcare. Yet, the value of PE transcends patient outcomes and satisfaction, influencing research, protocols, and overall care quality ( 1 ). Educating patients about their condition and management plan nurtures this sense of authority and accountability. It amplifies shared decision-making processes and encourages the regular solicitation of feedback concerning concerns, adherence, and potential side effects ( 4 ). Achieving adequate levels of PE mandates significant time investment from both patients and providers, coupled with healthcare system optimization and strategic utilization of appropriate media channels to target diverse community segments ( 5 ). While the literature thoroughly establishes the importance of PE, a dearth of information exists regarding patient engagement in Arab countries. In this expert opinion and narrative review, we amalgamate insights and recommendations from an expert meeting within the broader spectrum of existing literature on patient engagement, offering a comprehensive outlook on the challenges and prospects associated with promoting patient engagement in the Arab world. 2. METHOD 2.1 Setting and Participants A high-level meeting was convened in Dubai. Eleven renowned advocates for patient engagement were invited to participate in the meeting. From Saudi Arabia, a consultant in pediatric oncology, a consultant and head of the infectious diseases department, the general director of infectious diseases control at the Ministry of Health, and a nursing director of ambulatory care services. From the United Arab Emirates, a consultant in infectious diseases, the founder of AlignnEficient Health Consultancies, the general secretary of the international family medicine conference and head of medical insurance regulation, and the producer and presenter of sky news Arabia representing the press. From Egypt, a consultant in medical oncology and a cancer survivor patient and motivational speaker, From Lebanon, a patient advocate. The meeting was sponsored by Gilead Sciences and organized by an independent organization (CCM group). 2.2 Approach In the first part of the meeting, a set of five open-ended comprehensive questions were prepared to guide the discussion (Questions are provided in Table 1 ). In the second part, Experts were asked to list the barriers against patient engagement in their communities and suggest ways to overcome them. Experts were divided into two groups allowing for more suggestions to be proposed. The meeting was recorded. Table 1 Questions that guided the group discussion Questions that guided the group discussion 1-How can you see the value of patient engagement/inclusions? 2-What could be the tools to identify PE models? 3-How can we motivate the patients to be engaged? 4-How can we foster the medical community towards more patient involvement? 5-What could be the instrumental solutions/ ideas to leverage patient engagement? (Define, Enumerate and Describe How) 2.3 Analysis The recordings from both groups and the common discussion were transcribed. Despite the structured approach used during the meeting, a thematic analysis was conducted for the transcript in order to remove redundancies and group related ideas. Two reports were then generated by two independent researchers. All ideas deemed relevant to the topic were extracted and reported in the present Expert Opinion paper. Various suggestions were supported where possible with literature. The authors of this paper comprise the experts who actively participated in the meeting. 3. EXPERTS INSIGHTS 3.1 The Value of Patient Engagement PE plays a critical role in advancing healthcare on various levels (6). Encouraging patients to engage in their healthcare is essential for achieving patient-centered care, improving health outcomes, and fostering trust between patients and healthcare providers (6). PE also benefits physicians, healthcare systems, and societies (7). It can result in improved healthcare outcomes, decreased rates of preventable medical errors, efficient allocation of resources, and higher cost-effectiveness for healthcare systems and communities (8). For healthcare providers, patient engagement can lead to decreased medical errors and misdiagnoses, improved compliance, trust, and enhanced medical research outcomes (9). Patients who engage in their healthcare experience a reduction in the duration and severity of symptoms with an associated reduction in treatment costs and re-admission rates. They feel empowered and responsible for their health (6). Overall, patient engagement is a vital aspect of healthcare delivery that can lead to better health outcomes for patients, healthcare providers, and healthcare systems (8). Patient Engagement is an old concept, and its value is well-established. However, to date, multiple barriers impede the attainment of proper PE in healthcare (2). These can be classified into three categories, patient-related, provider-related, and system or government related. 3.2 Patient-related Barriers to PE Multiple barriers discourage patients from engaging with their healthcare plan. They include the lack of awareness of the importance of PE and the fear and anxiety associated with more knowledge or a new diagnosis, patients' fear of stigmatization, the need for empowerment, and the lack of sufficient information about their health condition and management options (2, 10). Patients are rarely familiar with their rights and the idea that they are responsible for their health (7). Patients with limited health literacy may have difficulty understanding medical jargon or treatment options (2). Moreover, language and cultural barriers may create communication difficulties for patients who do not speak the same language as their healthcare providers or come from different cultural backgrounds. Finally, patients who do not trust their healthcare providers or the healthcare system may also be reluctant to engage fully in their healthcare (6). 3.3 Provider and system-related barriers to PE Time constraints in busy clinical settings are one of the main obstacles because a limited time with patients makes it challenging to engage patients fully (12). Language or cultural barriers prevent effective communication, especially when healthcare providers lack training in patient engagement techniques, such as shared decision-making, motivational interviewing, or patient education (11). Communication and Language Barriers: Language barriers or communication gaps between healthcare providers and patients can impede effective engagement. The Arab world has diverse populations with different languages and dialects, making communication challenging in healthcare settings. Finally, providers may not be incentivized to engage patients fully in their care, particularly in healthcare models where providers are paid based on the number of services provided rather than patient outcomes (14). Organizational barriers include limited resources, staff, technology, and funding. Inadequate technology or tools, including patient portals, telehealth, or remote monitoring devices in developing countries, promote the belief that a patient's opinion is unimportant (15). Fragmented care makes it difficult to coordinate care and engage patients fully. Limited patient access to healthcare services, particularly for marginalized or underserved populations, can further complicate patient engagement efforts, especially in healthcare systems prioritizing their needs over those of patients (2). Inadequate patient education, coupled with complex healthcare policies that are difficult for patients to understand, can make it challenging for patients to engage fully in their healthcare (13). Finally, the lack of accountability for engaging patients in their care discourages efforts to improve patient engagement (16). Further obstacles not recognized during the meeting encompass challenges faced by patients with demanding schedules or conflicting priorities, potentially impeding their attendance at appointments or involvement in self-care practices. The compounded issue arises with restricted access to healthcare services and financial barriers, particularly affecting preventive care and instances necessitating multiple follow-up appointments (11). Attitudes and perceptions, such as a lack of regard for patient autonomy or the assumption that patients are disinterested or incapable of actively engaging in their healthcare, also pose hurdles to fostering patient engagement (13, 19). 3.4 Strategies to Promote Patient Engagement Strategies to promote PE can be categorized by stakeholders into ways to motivate patients to be engaged, ways to motivate providers to involve patients, and organizational methods that can enable and facilitate PE. A summary of the main barriers and strategies for PE is detailed in Table 2. Table 2. Summary of main gaps and effective strategies in Patients' Engagement Patient Journey Stakeholder Patient Engagement Challenge/Barrier Strategy/Solution Awareness Authorities Lack of Health literacy Include preventive medicine and essential healthcare awareness in school education Authorities Lack of comprehensive programs Exhaustive National Awareness programs with a focus on preventable, most prevalent local and chronic diseases Authorities Misleading information by non-experts Leveraging technology to provide correct knowledge. Set guidelines to prevent non-experts from teaching medical information. Diagnosis Physicians Time constraints Set a limited number of patients per clinic Patients Fear and anxiety Train Health care providers on proper communication and listening skills Government Limited access to healthcare Integrated healthcare pathways, telehealth, and clear referral systems Fragmented care Multidisciplinary teams and unified patient records Limited resources Increase the budget to cover the procurement of needed tests and material Treatment Authorities Inadequate technology introduce patient portals and telehealth systems Physicians Lack of accountability Solicit patients' feedback through an anonymous reporting system and patient satisfaction surveys. Patients Lack of understanding of complex healthcare policies Have trained medical staff in call centers to help in patient navigation and basic inquiries Throughout patient journey All stakeholders Unaware of the value of PE Educating all stakeholders about the value of PE via national, local, and institutional campaigns and awareness programs as well as via social media. Patients Language and cultural barriers Provide multilingual material and resources. Physicians Language and cultural barriers Professional development opportunities for providers Abbreviations: PE Patient engagement 4. DISCUSSION The results provided in this qualitative thematic analysis are important in informing administrators about strategies that can be employed to enhance patient engagement. Many of the ideas and suggestions presented during the meeting are largely supported in the literature (2, 7). In order to motivate patients to engage with their care plan, clear communication is key. Healthcare providers should encourage patients to ask questions and express their concerns to improve their understanding of their health and treatment (13). Patients need to have educational materials customized to meet their interests and learning preferences, with multilingual material catering to patients from different cultural backgrounds (2). Patients should be given opportunities to express their preferences and participate in shared decision-making (7). Personalized care helps meet each patient's unique needs and preferences regarding the form and level of engagement. It is also essential to explain to patients the value and necessity of their engagement in a way that makes them see it as a need and not an option (13). Finally, having trained healthcare workers in call centers to provide quick answers improve access to care and patients' navigation, and employing ways to empower patients to communicate with their providers, such as having a caretaker who knows the patient's medical history and has time to listen, communicating with patients as equals without underestimating their understanding are crucial to motivate patients to be involved (7). Several strategies can be employed to solve the attitudinal and belief problem and foster a medical community that prioritizes patient involvement (13). First, healthcare providers should practice building trust with patients and communicating information with empathy, using techniques such as the sandwich method, highlighting positive aspects, and maintaining realistic expectations (6). Additionally, providers should receive training and education on the importance of patient engagement, implementing key performance indicators that promote a patient-centered culture, active listening, and encouraging feedback through surveys and focus groups (13). Technology such as electronic health records, online portals, and mobile apps can facilitate patient involvement just as involving patients in quality improvement initiatives by inviting them to participate in focus groups, committees, and advisory councils can ensure that quality improvement projects are aligned with patient needs and preferences (15). Regular patient experience and satisfaction surveys can also provide valuable insights (16). Finally, improving financial coverage for all healthcare services can empower all patients and significantly improve their engagement (17). To achieve patient engagement, stakeholders can employ various tactics depending on the stage of the patient's journey. During the awareness stage, integrating primary preventive medicine education into school curricula can improve community awareness and encourage people to participate in their healthcare decisions. Providing clear and accessible information about a patient's condition and medications can empower patients to engage more effectively (7, 13). During the diagnosis stage, integrating healthcare pathways, training healthcare providers on communication skills, and involving patients in decision-making can enhance the quality and outcome of healthcare (12). In the treatment stage, leveraging technology and social media to connect with patients, providing patient support programs, and involving patients' representatives in decision-making, quality improvement projects, and research can improve continuity of care and outcomes (12). Cultural differences play a significant role (18). In some Arab societies, there might be a traditional hierarchical view of the doctor-patient relationship, where the doctor's authority is unquestioned. This can discourage patients from actively participating in their healthcare decisions. Limited policies or initiatives that promote patient-centered care or encourage patient engagement might contribute to lower levels of active involvement in healthcare decisions. Stigma associated with certain health conditions or seeking healthcare services might discourage individuals from actively engaging with healthcare providers. 5. CONCLUSION Patient engagement is a collective responsibility that requires the active participation of patients, healthcare providers, the healthcare system, and government agencies (18). A patient-centered approach that prioritizes the needs and preferences of patients is critical for supporting patients in their healthcare journey. Educating stakeholders about the value and benefits of patient engagement is an important first step in achieving this goal. By prioritizing patient engagement and providing necessary resources and support, a more effective healthcare system can be created. Addressing these disparities in patient engagement in the Arab world involves implementing culturally sensitive approaches, improving health literacy, enhancing communication between patients and healthcare providers, investing in healthcare infrastructure, and creating policies that prioritize patient-centered care. Encouraging active involvement in healthcare decisions and promoting awareness about the benefits of patient engagement can help bridge these gaps and improve healthcare outcomes in the region. Future research efforts must be directed toward the creation of standardized and validated measures of PE. This will facilitate the identification of PE's predictors and enable quantifying the effectiveness of strategies to enhance patient engagement. Abbreviations PE Patient Engagement Declarations 6.1 Ethics approval and consent to participate All methods were carried out in accordance with relevant guidelines and regulations. All experimental protocols were reviewed and approved by Gilead Sciences, Inc. Informed consent was obtained from all participants (experts) who attended the meeting. The approval of the Dubai Scientific Research Ethics Committee at the Dubai Health Authority is not necessary in expert opinion studies including experts who are willing to participate. 6.2 Consent for publication Not applicable 6.3 Availability of data and materials Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study. The original meeting notes and recordings are available from the corresponding author upon request. 6.4 Competing interests Y.N is an employee of Gilead Sciences, Inc. All other authors declare that they have no competing interests. 6.5 Funding The patient engagement meeting and the publishing of this manuscript are funded by Gilead Sciences, Inc. 6.6 Authors' contributions Y.N. conceptualized and defined the scope and aims of the manuscript. Y.N. coordinated the meeting. Y.N. and R.M. drafted the entire manuscript. A.E., D.E., D.I., H.A., M.A., M.F. and S.A. critically reviewed, revised, and contributed to the content. All authors approved the final version of the manuscript. 6.7 Acknowledgements Authors would like to thank Mrs. Josette Hage Chahine, Mrs. Salam Alfeel, Ms. Nojood Assiri, Ms. Yasmin Yousr, and Dr. Hazar Kanj for their valuable input. References Higgins T, Larson E, Schnall R. Unraveling the meaning of patient engagement: a concept analysis. Patient Educ Couns. 2017;100(1):30–6. Newman B, Joseph K, Chauhan A, Seale H, Li J, Manias E, Walton M, Mears S, Jones B, Harrison R. Do patient engagement interventions work for all patients? A systematic review and realist synthesis of interventions to enhance patient safety. Health Expect. 2021;24(6):1905–23. Gruman J, Rovner MH, French ME, Jeffress D, Sofaer S, Shaller D, Prager DJ. From patient education to patient engagement: implications for the field of patient education. Patient Educ Couns. 2010;78(3):350–6. Smith SK, Dixon A, Trevena L, Nutbeam D, McCaffery KJ. Exploring patient involvement in healthcare decision making across different education and functional health literacy groups. Soc Sci Med. 2009;69(12):1805–12. Perestelo-Perez L, Gonzalez-Lorenzo M, Perez-Ramos J, Rivero-Santana A, Serrano-Aguilar P. Patient involvement and shared decision-making in mental health care. Curr Clin Pharmacol. 2011;6(2):83–90. Kiselev J, Suija K, Oona M, Mellenthin E, Steinhagen-Thiessen E. Patient involvement in geriatric care–results and experiences from a mixed models design study within project INTEGRATE. Int J Integr care. 2018;18(1). Coulter A, Ellins J. Effectiveness of strategies for informing, educating, and involving patients. BMJ. 2007;335(7609):24–7. Snyder H, Engström J. The antecedents, forms and consequences of patient involvement: a narrative review of the literature. Int J Nurs Stud. 2016;53:351–78. Schwappach DL, Hochreutener MA, Wernli M. Oncology nurses' perceptions about involving patients in the prevention of chemotherapy administration errors. InOncology nursing forum 2010 Mar 1 (Vol. 37, No. 2, p. E84). Oncology Nursing Society. Coulter A, Parsons S, Askham J. World Health Organization. Where are the patients in decision-making about their own care?. Srinivasan M, Phadke AJ, Zulman D, Israni ST, Madill ES, Savage TR, Downing NL, Nelligan I, Artandi M, Sharp C. Enhancing patient engagement during virtual care: a conceptual model and rapid implementation at an academic medical center. NEJM Catalyst Innovations in Care Delivery. 2020;1(4). Reynolds J, Beresford R. An active, productive life: narratives of, and through, participation in Public and patient Involvement in Health Research. Qual Health Res. 2020;30(14):2265–77. Hibbard J, Lorig K. The dos and don'ts of patient engagement in busy office practices. J Ambul Care Manag. 2012;35(2):129–32. Hoerger TJ, Perry R, Farrell K, Teixeira-Poit S. Can incentives improve Medicaid patient engagement and prevent chronic diseases? N C Med J. 2015;76(3):180–4. Irizarry T, DeVito Dabbs A, Curran CR. Patient portals and patient engagement: a state of the science review. J Med Internet Res. 2015;17(6):e148. Thompson AG. The meaning of patient involvement and participation in health care consultations: a taxonomy. Soc Sci Med. 2007;64(6):1297–310. Caveney BJ. Health insurance incentives to enhance patient engagement. N C Med J. 2015;76(3):182–3. Graffigna G, Barello S, Riva G, Corbo M, Damiani G, Iannone P, et al. Italian Consensus Statement on Patient Engagement in Chronic Care: Process and Outcomes. Int J Environ Res Public Health. 2020;17(11):4167. Barello S, Palamenghi L, Graffigna G. The Mediating Role of the Patient Health Engagement Model on the Relationship Between Patient Perceived Autonomy Supportive Healthcare Climate and Health Literacy Skills. Int J Environ Res Public Health. 2020;17(5):1741. Additional Declarations Competing interest reported. Y.N. is an employee of Gilead Sciences, Inc. All other authors declare that they have no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Y.N. is an employee of Gilead Sciences, Inc. All other authors declare that they have no competing interests.","formattedTitle":"Unmet Needs and Strategies to Promote Patient Engagement in The Arab World: Experts' Opinion","fulltext":[{"header":"1. BACKGROUND","content":"\u003cp\u003ePatient engagement (PE) delineates the active participation of patients in decisions concerning their healthcare, demonstrating a profound ability to empower patients and significantly enhance healthcare outcomes (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The extent and facets of PE exhibit variability contingent upon factors such as the setting, context, patient attributes, and disease characteristics (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Within the realm of patient empowerment, various components align with patient engagement, encompassing the act of posing questions, collaborating in decision-making processes, granting patients autonomy over their care, and eliciting patient feedback (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe nature of patient engagement (PE) is contingent upon a myriad of factors, including patients' comprehension of their condition, their rapport and reliance on healthcare providers, and their access to care (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The unique attributes of individual patients dictate the extent to which they should participate and engage in decisions regarding their healthcare (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Consequently, patients can be broadly categorized based on their medical expertise, capacity for informed decision-making, and whether their primary ailment is chronic or acute (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). It is imperative to discern between medical knowledge and the general level of education. For instance, a patient holding a PhD in literature might exhibit less inclination to engage in their healthcare decisions compared to a science student.\u003c/p\u003e \u003cp\u003ePatients with higher educational attainment, decision-making capability, and chronic health issues necessitate a deeper and more involved level of engagement than those with lower educational levels, impaired decision-making capacities, or acute health problems (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). These predictors of PE can amalgamate into an overall PE score that positively correlates with the recommended level of engagement for optimal health outcomes and patient contentment (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). While acknowledging this correlation aids providers in tailoring engagement levels to individual patient needs and expectations, engaging patients with transient, acute problems lacks substantial literature.\u003c/p\u003e \u003cp\u003eAt its essence, PE empowers patients by bestowing a sense of authority over their healthcare. Yet, the value of PE transcends patient outcomes and satisfaction, influencing research, protocols, and overall care quality (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Educating patients about their condition and management plan nurtures this sense of authority and accountability. It amplifies shared decision-making processes and encourages the regular solicitation of feedback concerning concerns, adherence, and potential side effects (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Achieving adequate levels of PE mandates significant time investment from both patients and providers, coupled with healthcare system optimization and strategic utilization of appropriate media channels to target diverse community segments (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile the literature thoroughly establishes the importance of PE, a dearth of information exists regarding patient engagement in Arab countries. In this expert opinion and narrative review, we amalgamate insights and recommendations from an expert meeting within the broader spectrum of existing literature on patient engagement, offering a comprehensive outlook on the challenges and prospects associated with promoting patient engagement in the Arab world.\u003c/p\u003e"},{"header":"2. METHOD","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Setting and Participants\u003c/h2\u003e \u003cp\u003eA high-level meeting was convened in Dubai. Eleven renowned advocates for patient engagement were invited to participate in the meeting. From Saudi Arabia, a consultant in pediatric oncology, a consultant and head of the infectious diseases department, the general director of infectious diseases control at the Ministry of Health, and a nursing director of ambulatory care services. From the United Arab Emirates, a consultant in infectious diseases, the founder of AlignnEficient Health Consultancies, the general secretary of the international family medicine conference and head of medical insurance regulation, and the producer and presenter of sky news Arabia representing the press. From Egypt, a consultant in medical oncology and a cancer survivor patient and motivational speaker, From Lebanon, a patient advocate. The meeting was sponsored by Gilead Sciences and organized by an independent organization (CCM group).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Approach\u003c/h2\u003e \u003cp\u003eIn the first part of the meeting, a set of five open-ended comprehensive questions were prepared to guide the discussion (Questions are provided in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In the second part, Experts were asked to list the barriers against patient engagement in their communities and suggest ways to overcome them. Experts were divided into two groups allowing for more suggestions to be proposed. The meeting was recorded.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuestions that guided the group discussion\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestions that guided the group discussion\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1-How can you see the value of patient engagement/inclusions?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2-What could be the tools to identify PE models?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3-How can we motivate the patients to be engaged?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4-How can we foster the medical community towards more patient involvement?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5-What could be the instrumental solutions/ ideas to leverage patient engagement? (Define, Enumerate and Describe How)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Analysis\u003c/h2\u003e \u003cp\u003eThe recordings from both groups and the common discussion were transcribed. Despite the structured approach used during the meeting, a thematic analysis was conducted for the transcript in order to remove redundancies and group related ideas. Two reports were then generated by two independent researchers. All ideas deemed relevant to the topic were extracted and reported in the present Expert Opinion paper. Various suggestions were supported where possible with literature.\u003c/p\u003e \u003cp\u003eThe authors of this paper comprise the experts who actively participated in the meeting.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. EXPERTS INSIGHTS","content":"\u003cp\u003e3.1 The Value of Patient Engagement\u003c/p\u003e\n\u003cp\u003ePE plays a critical role in advancing healthcare on various levels (6). Encouraging patients to engage in their healthcare is essential for achieving patient-centered care, improving health outcomes, and fostering trust between patients and healthcare providers (6). PE also benefits physicians, healthcare systems, and societies (7). It can result in improved healthcare outcomes, decreased rates of preventable medical errors, efficient allocation of resources, and higher cost-effectiveness for healthcare systems and communities (8). For healthcare providers, patient engagement can lead to decreased medical errors and misdiagnoses, improved compliance, trust, and enhanced medical research outcomes (9). Patients who engage in their healthcare experience a reduction in the duration and severity of symptoms with an associated reduction in treatment costs and re-admission rates. They feel empowered and responsible for their health (6). Overall, patient engagement is a vital aspect of healthcare delivery that can lead to better health outcomes for patients, healthcare providers, and healthcare systems (8).\u003c/p\u003e\n\u003cp\u003ePatient Engagement is an old concept, and its value is well-established. However, to date, multiple barriers impede the attainment of proper PE in healthcare (2). These can be classified into three categories, patient-related, provider-related, and system or government related.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.2 Patient-related Barriers to PE\u003c/p\u003e\n\u003cp\u003eMultiple barriers discourage patients from engaging with their healthcare plan. They include the lack of awareness of the importance of PE and the fear and anxiety associated with more knowledge or a new diagnosis, patients\u0026apos; fear of stigmatization, the need for empowerment, and the lack of sufficient information about their health condition and management options (2, 10). Patients are rarely familiar with their rights and the idea that they are responsible for their health (7).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients with limited health literacy may have difficulty understanding medical jargon or treatment options (2). Moreover, language and cultural barriers may create communication difficulties for patients who do not speak the same language as their healthcare providers or come from different cultural backgrounds. Finally, patients who do not trust their healthcare providers or the healthcare system may also be reluctant to engage fully in their healthcare (6).\u003c/p\u003e\n\u003cp\u003e3.3 Provider and system-related barriers to PE\u003c/p\u003e\n\u003cp\u003eTime constraints in busy clinical settings are one of the main obstacles because a limited time with patients makes it challenging to engage patients fully (12). Language or cultural barriers prevent effective communication, especially when healthcare providers lack training in patient engagement techniques, such as shared decision-making, motivational interviewing, or patient education (11). Communication and Language Barriers: Language barriers or communication gaps between healthcare providers and patients can impede effective engagement. The Arab world has diverse populations with different languages and dialects, making communication challenging in healthcare settings.\u003c/p\u003e\n\u003cp\u003eFinally, providers may not be incentivized to engage patients fully in their care, particularly in healthcare models where providers are paid based on the number of services provided rather than patient outcomes (14).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOrganizational barriers include limited resources, staff, technology, and funding. Inadequate technology or tools, including patient portals, telehealth, or remote monitoring devices in developing countries, promote the belief that a patient\u0026apos;s opinion is unimportant (15). Fragmented care makes it difficult to coordinate care and engage patients fully. Limited patient access to healthcare services, particularly for marginalized or underserved populations, can further complicate patient engagement efforts, especially in healthcare systems prioritizing their needs over those of patients (2). Inadequate patient education, coupled with complex healthcare policies that are difficult for patients to understand, can make it challenging for patients to engage fully in their healthcare (13). Finally, the lack of accountability for engaging patients in their care discourages efforts to improve patient engagement (16).\u003c/p\u003e\n\u003cp\u003eFurther obstacles not recognized during the meeting encompass challenges faced by patients with demanding schedules or conflicting priorities, potentially impeding their attendance at appointments or involvement in self-care practices. The compounded issue arises with restricted access to healthcare services and financial barriers, particularly affecting preventive care and instances necessitating multiple follow-up appointments (11). Attitudes and perceptions, such as a lack of regard for patient autonomy or the assumption that patients are disinterested or incapable of actively engaging in their healthcare, also pose hurdles to fostering patient engagement (13, 19).\u003c/p\u003e\n\u003cp\u003e3.4 Strategies to Promote Patient Engagement\u003c/p\u003e\n\u003cp\u003eStrategies to promote PE can be categorized by stakeholders into ways to motivate patients to be engaged, ways to motivate providers to involve patients, and organizational methods that can enable and facilitate PE. A summary of the main barriers and strategies for PE is detailed in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Summary of main gaps and effective strategies in Patients\u0026apos; Engagement\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.224489795918368%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient Journey\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eStakeholder\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"74.48979591836735%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient Engagement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.555555555555557%\"\u003e\n \u003cp\u003e\u003cstrong\u003eChallenge/Barrier\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"69.44444444444444%\"\u003e\n \u003cp\u003e\u003cstrong\u003eStrategy/Solution\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.34020618556701%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAwareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003eAuthorities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.68041237113402%\" valign=\"top\"\u003e\n \u003cp\u003eLack of Health literacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51.54639175257732%\" valign=\"top\"\u003e\n \u003cp\u003eInclude preventive medicine and essential healthcare awareness in school education\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.27906976744186%\" valign=\"top\"\u003e\n \u003cp\u003eAuthorities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.58139534883721%\" valign=\"top\"\u003e\n \u003cp\u003eLack of comprehensive programs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.13953488372093%\" valign=\"top\"\u003e\n \u003cp\u003eExhaustive National Awareness programs with a focus on preventable, most prevalent local and chronic diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.27906976744186%\" valign=\"top\"\u003e\n \u003cp\u003eAuthorities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.58139534883721%\" valign=\"top\"\u003e\n \u003cp\u003eMisleading information by non-experts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.13953488372093%\" valign=\"top\"\u003e\n \u003cp\u003eLeveraging technology to provide correct knowledge.\u003c/p\u003e\n \u003cp\u003eSet guidelines to prevent non-experts from teaching medical information.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.34020618556701%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eDiagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003ePhysicians\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.68041237113402%\" valign=\"top\"\u003e\n \u003cp\u003eTime constraints\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51.54639175257732%\" valign=\"top\"\u003e\n \u003cp\u003eSet a limited number of patients per clinic\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.27906976744186%\" valign=\"top\"\u003e\n \u003cp\u003ePatients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.58139534883721%\" valign=\"top\"\u003e\n \u003cp\u003eFear and anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.13953488372093%\" valign=\"top\"\u003e\n \u003cp\u003eTrain Health care providers on proper communication and listening skills\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.27906976744186%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eGovernment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.58139534883721%\" valign=\"top\"\u003e\n \u003cp\u003eLimited access to healthcare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.13953488372093%\" valign=\"top\"\u003e\n \u003cp\u003eIntegrated healthcare pathways, telehealth, and clear referral systems\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.555555555555557%\" valign=\"top\"\u003e\n \u003cp\u003eFragmented care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"69.44444444444444%\" valign=\"top\"\u003e\n \u003cp\u003eMultidisciplinary teams and unified patient records\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.555555555555557%\" valign=\"top\"\u003e\n \u003cp\u003eLimited resources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"69.44444444444444%\" valign=\"top\"\u003e\n \u003cp\u003eIncrease the budget to cover the procurement of needed tests and material\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.34020618556701%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eTreatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003eAuthorities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.68041237113402%\" valign=\"top\"\u003e\n \u003cp\u003eInadequate technology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51.54639175257732%\" valign=\"top\"\u003e\n \u003cp\u003eintroduce patient portals and telehealth systems\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.27906976744186%\" valign=\"top\"\u003e\n \u003cp\u003ePhysicians\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.58139534883721%\" valign=\"top\"\u003e\n \u003cp\u003eLack of accountability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.13953488372093%\" valign=\"top\"\u003e\n \u003cp\u003eSolicit patients\u0026apos; feedback through an anonymous reporting system and patient satisfaction surveys.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.27906976744186%\" valign=\"top\"\u003e\n \u003cp\u003ePatients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.58139534883721%\" valign=\"top\"\u003e\n \u003cp\u003eLack of understanding of complex healthcare policies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.13953488372093%\" valign=\"top\"\u003e\n \u003cp\u003eHave trained medical staff in call centers to help in patient navigation and basic inquiries\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.34020618556701%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eThroughout patient journey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\" valign=\"top\"\u003e\n \u003cp\u003eAll stakeholders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.68041237113402%\" valign=\"top\"\u003e\n \u003cp\u003eUnaware of the value of PE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51.54639175257732%\" valign=\"top\"\u003e\n \u003cp\u003eEducating all stakeholders about the value of PE via national, local, and institutional campaigns and awareness programs as well as via social media.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.27906976744186%\" valign=\"top\"\u003e\n \u003cp\u003ePatients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.58139534883721%\" valign=\"top\"\u003e\n \u003cp\u003eLanguage and cultural barriers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.13953488372093%\" valign=\"top\"\u003e\n \u003cp\u003eProvide multilingual material and resources.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.27906976744186%\" valign=\"top\"\u003e\n \u003cp\u003ePhysicians\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.58139534883721%\" valign=\"top\"\u003e\n \u003cp\u003eLanguage and cultural barriers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"58.13953488372093%\" valign=\"top\"\u003e\n \u003cp\u003eProfessional development opportunities for providers\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAbbreviations: \u003cstrong\u003ePE\u0026nbsp;\u003c/strong\u003ePatient engagement\u003c/p\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eThe results provided in this qualitative thematic analysis are important in informing administrators about strategies that can be employed to enhance patient engagement. Many of the ideas and suggestions presented during the meeting are largely supported in the literature (2, 7).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn order to motivate patients to engage with their care plan, clear communication is key. Healthcare providers should encourage patients to ask questions and express their concerns to improve their understanding of their health and treatment (13). Patients need to have educational materials customized to meet their interests and learning preferences, with multilingual material catering to patients from different cultural backgrounds (2).\u003c/p\u003e\n\u003cp\u003ePatients should be given opportunities to express their preferences and participate in shared decision-making (7). Personalized care helps meet each patient\u0026apos;s unique needs and preferences regarding the form and level of engagement. It is also essential to explain to patients the value and necessity of their engagement in a way that makes them see it as a need and not an option (13). Finally, having trained healthcare workers in call centers to provide quick answers improve access to care and patients\u0026apos; navigation, and employing ways to empower patients to communicate with their providers, such as having a caretaker who knows the patient\u0026apos;s medical history and has time to listen, communicating with patients as equals without underestimating their understanding are crucial to motivate patients to be involved (7).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSeveral strategies can be employed to solve the attitudinal and belief problem and foster a medical community that prioritizes patient involvement (13). First, healthcare providers should practice building trust with patients and communicating information with empathy, using techniques such as the sandwich method, highlighting positive aspects, and maintaining realistic expectations (6). Additionally, providers should receive training and education on the importance of patient engagement, implementing key performance indicators that promote a patient-centered culture, active listening, and encouraging feedback through surveys and focus groups (13).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTechnology such as electronic health records, online portals, and mobile apps can facilitate patient involvement just as involving patients in quality improvement initiatives by inviting them to participate in focus groups, committees, and advisory councils can ensure that quality improvement projects are aligned with patient needs and preferences (15). Regular patient experience and satisfaction surveys can also provide valuable insights (16). Finally, improving financial coverage for all healthcare services can empower all patients and significantly improve their engagement (17).\u003c/p\u003e\n\u003cp\u003eTo achieve patient engagement, stakeholders can employ various tactics depending on the stage of the patient\u0026apos;s journey. During the awareness stage, integrating primary preventive medicine education into school curricula can improve community awareness and encourage people to participate in their healthcare decisions. Providing clear and accessible information about a patient\u0026apos;s condition and medications can empower patients to engage more effectively (7, 13). During the diagnosis stage, integrating healthcare pathways, training healthcare providers on communication skills, and involving patients in decision-making can enhance the quality and outcome of healthcare (12). In the treatment stage, leveraging technology and social media to connect with patients, providing patient support programs, and involving patients\u0026apos; representatives in decision-making, quality improvement projects, and research can improve continuity of care and outcomes (12).\u003c/p\u003e\n\u003cp\u003eCultural differences play a significant role (18). In some Arab societies, there might be a traditional hierarchical view of the doctor-patient relationship, where the doctor\u0026apos;s authority is unquestioned. This can discourage patients from actively participating in their healthcare decisions. Limited policies or initiatives that promote patient-centered care or encourage patient engagement might contribute to lower levels of active involvement in healthcare decisions. Stigma associated with certain health conditions or seeking healthcare services might discourage individuals from actively engaging with healthcare providers.\u003c/p\u003e"},{"header":"5. CONCLUSION","content":"\u003cp\u003ePatient engagement is a collective responsibility that requires the active participation of patients, healthcare providers, the healthcare system, and government agencies (18). A patient-centered approach that prioritizes the needs and preferences of patients is critical for supporting patients in their healthcare journey. Educating stakeholders about the value and benefits of patient engagement is an important first step in achieving this goal. By prioritizing patient engagement and providing necessary resources and support, a more effective healthcare system can be created.\u003c/p\u003e\n\u003cp\u003eAddressing these disparities in patient engagement in the Arab world involves implementing culturally sensitive approaches, improving health literacy, enhancing communication between patients and healthcare providers, investing in healthcare infrastructure, and creating policies that prioritize patient-centered care. Encouraging active involvement in healthcare decisions and promoting awareness about the benefits of patient engagement can help bridge these gaps and improve healthcare outcomes in the region.\u003c/p\u003e\n\u003cp\u003eFuture research efforts must be directed toward the creation of standardized and validated measures of PE. This will facilitate the identification of PE\u0026apos;s predictors and enable quantifying the effectiveness of strategies to enhance patient engagement.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePatient Engagement\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e6.1 Ethics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll methods were carried out in accordance with relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003eAll experimental protocols were reviewed and approved by Gilead Sciences, Inc.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all participants (experts) who attended the meeting.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe approval of the Dubai Scientific Research Ethics Committee at the Dubai Health Authority is not necessary in expert opinion studies including experts who are willing to participate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.2 Consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.3 Availability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData sharing is not applicable to this article as no datasets were generated or analyzed during the current study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe original meeting notes and recordings are available from the corresponding author upon request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.4 Competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eY.N is an employee of Gilead Sciences, Inc. All other authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.5 Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient engagement meeting and the publishing of this manuscript are funded by Gilead Sciences, Inc.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;6.6 Authors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eY.N. conceptualized and defined the scope and aims of the manuscript. Y.N. coordinated the meeting. Y.N. and R.M. drafted the entire manuscript. A.E., D.E., D.I., H.A., M.A., M.F. and S.A. critically reviewed, revised, and contributed to the content. All authors approved the final version of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.7 Acknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors would like to thank Mrs. Josette Hage Chahine, Mrs. Salam Alfeel, Ms. Nojood Assiri, Ms. Yasmin Yousr, and Dr. Hazar Kanj for their valuable input.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHiggins T, Larson E, Schnall R. Unraveling the meaning of patient engagement: a concept analysis. Patient Educ Couns. 2017;100(1):30\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNewman B, Joseph K, Chauhan A, Seale H, Li J, Manias E, Walton M, Mears S, Jones B, Harrison R. Do patient engagement interventions work for all patients? A systematic review and realist synthesis of interventions to enhance patient safety. Health Expect. 2021;24(6):1905\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGruman J, Rovner MH, French ME, Jeffress D, Sofaer S, Shaller D, Prager DJ. From patient education to patient engagement: implications for the field of patient education. Patient Educ Couns. 2010;78(3):350\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith SK, Dixon A, Trevena L, Nutbeam D, McCaffery KJ. Exploring patient involvement in healthcare decision making across different education and functional health literacy groups. Soc Sci Med. 2009;69(12):1805\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerestelo-Perez L, Gonzalez-Lorenzo M, Perez-Ramos J, Rivero-Santana A, Serrano-Aguilar P. Patient involvement and shared decision-making in mental health care. Curr Clin Pharmacol. 2011;6(2):83\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKiselev J, Suija K, Oona M, Mellenthin E, Steinhagen-Thiessen E. Patient involvement in geriatric care\u0026ndash;results and experiences from a mixed models design study within project INTEGRATE. Int J Integr care. 2018;18(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoulter A, Ellins J. Effectiveness of strategies for informing, educating, and involving patients. BMJ. 2007;335(7609):24\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSnyder H, Engstr\u0026ouml;m J. The antecedents, forms and consequences of patient involvement: a narrative review of the literature. Int J Nurs Stud. 2016;53:351\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchwappach DL, Hochreutener MA, Wernli M. Oncology nurses' perceptions about involving patients in the prevention of chemotherapy administration errors. InOncology nursing forum 2010 Mar 1 (Vol.\u0026nbsp;37, No. 2, p. E84). Oncology Nursing Society.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoulter A, Parsons S, Askham J. World Health Organization. Where are the patients in decision-making about their own care?.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSrinivasan M, Phadke AJ, Zulman D, Israni ST, Madill ES, Savage TR, Downing NL, Nelligan I, Artandi M, Sharp C. Enhancing patient engagement during virtual care: a conceptual model and rapid implementation at an academic medical center. NEJM Catalyst Innovations in Care Delivery. 2020;1(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReynolds J, Beresford R. An active, productive life: narratives of, and through, participation in Public and patient Involvement in Health Research. Qual Health Res. 2020;30(14):2265\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHibbard J, Lorig K. The dos and don'ts of patient engagement in busy office practices. J Ambul Care Manag. 2012;35(2):129\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoerger TJ, Perry R, Farrell K, Teixeira-Poit S. Can incentives improve Medicaid patient engagement and prevent chronic diseases? N C Med J. 2015;76(3):180\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIrizarry T, DeVito Dabbs A, Curran CR. Patient portals and patient engagement: a state of the science review. J Med Internet Res. 2015;17(6):e148.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThompson AG. The meaning of patient involvement and participation in health care consultations: a taxonomy. Soc Sci Med. 2007;64(6):1297\u0026ndash;310.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCaveney BJ. Health insurance incentives to enhance patient engagement. N C Med J. 2015;76(3):182\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGraffigna G, Barello S, Riva G, Corbo M, Damiani G, Iannone P, et al. Italian Consensus Statement on Patient Engagement in Chronic Care: Process and Outcomes. Int J Environ Res Public Health. 2020;17(11):4167.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarello S, Palamenghi L, Graffigna G. The Mediating Role of the Patient Health Engagement Model on the Relationship Between Patient Perceived Autonomy Supportive Healthcare Climate and Health Literacy Skills. Int J Environ Res Public Health. 2020;17(5):1741.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Arab Countries, Patient engagement, patient experience, patient satisfaction, healthcare services, healthcare system","lastPublishedDoi":"10.21203/rs.3.rs-3825755/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3825755/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe significance of Patient Engagement (PE) is widely acknowledged as a crucial element in fostering positive health outcomes, elevating care quality, and streamlining healthcare systems. Despite its recognized advantages, the level of patient engagement in Arab nations remains suboptimal.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA high-level assembly was convened in Dubai, assembling eleven distinguished patient advocates from diverse Arab countries. Their collective aim was to dissect the obstacles hindering patient engagement in the Arab world and propose pragmatic strategies to surmount them. First, a series of five open-ended, comprehensive questions were posed and thoroughly deliberated upon. Second, the barriers to patient engagement within the experts\u0026rsquo; respective communities were debated. A qualitative thematic analysis was conducted and two reports were generated by two independent researchers from the original meeting recordings.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThis paper highlights the importance of patient engagement in advancing healthcare and categorizes barriers to patient engagement as patient-related, provider-related, or system/government related. The experts identified the primary gaps in patient engagement and proposed strategies to promote it, with a primary focus on motivating both patients and providers towards shared decision-making.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis paper amalgamates the insights and recommendations distilled from this expert gathering, juxtaposing them within the broader context of existing literature on patient engagement. Offering a comprehensive viewpoint, this article delves into the challenges and opportunities intrinsic to bolstering patient engagement in the Arab world. Moreover, it spotlights invaluable tools often overlooked within Arab countries. The practical insights furnished in this piece serve as a roadmap for administrators and decision-makers, providing guidance to enhance patient engagement on both a national and institutional scale.\u003c/p\u003e","manuscriptTitle":"Unmet Needs and Strategies to Promote Patient Engagement in The Arab World: Experts' Opinion","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-03 20:03:25","doi":"10.21203/rs.3.rs-3825755/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dc19ed4b-20c8-4f76-8982-af82d70254b2","owner":[],"postedDate":"January 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-02-29T05:32:17+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-03 20:03:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3825755","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3825755","identity":"rs-3825755","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}