Bridging individual and population perspectives: a qualitative inquiry into health activation with population health experts.

backgroundPopulation health activation is thought to extend beyond individual patient engagement, emphasising community-wide participation in health management. This contrasts with the original patient activation measure developed by Hibbard and colleagues in 2010. This qualitative study thus investigates how population health experts conceptualise health activation on a population level.

methodsAdopting a critical realist epistemology, semi-structured interviews were conducted with experts from health policy, health care systems, and community health across various institutions in Singapore. Purposive sampling was used to recruit experts with over five years of relevant experience. Interviews, lasting approximately 60 min each, were audio-recorded, transcribed verbatim, and analysed inductively using reflexive thematic analysis, following Braun and Clarke's framework.

resultsA total of 18 population health experts were interviewed. No new ideas or concepts emerged after the 15th interview; an additional three interviews were conducted to ensure saturation. Based on the findings, three major themes were generated: (1) Health activation is dynamic and influenced by external life circumstances such as competing responsibilities; (2) Emotional readiness and psychological resilience are critical prerequisites for meaningful health activation, beyond mere knowledge or skills; and (3) Social support networks and health care system structures are important in enabling or inhibiting health activation. Based on these insights, we propose a preliminary conceptual framework for health activation interventions that integrates emotional, social, and systemic dimensions.

conclusionIn summary, the findings advance the understanding of population health activation by proposing a broader and more dynamic conceptualisation, and they highlight the need for flexible adaptable strategies in population health, where engagement must be maintained over time and across diverse subpopulations. By focusing on emotional resilience, psychological preparedness and external support structures, health care systems can better promote and sustain individual health activation. Future research should empirically test this and incorporate additional perspectives from the public and patients.