ENABLE: Understanding how health systems shape participation, self-management and healthy behaviours

ENGAGE: Understanding how health systems shape participation, self-management and healthy behaviours

Across Europe, health systems are being challenged by increasing levels of long-term conditions, multimorbidity, population ageing, health inequalities and growing pressure on health and care resources. In response, policy frameworks increasingly emphasise prevention, person-centred care, self-management, community participation and integrated models of care. These ambitions are reflected in major European initiatives including the European Health Union, Europe's Beating Cancer Plan, the EU4Health Programme, and the growing focus on integrated, digitally enabled and community-oriented care within Horizon Europe.

Despite substantial evidence supporting interventions such as physical activity, rehabilitation, self-management support, social prescribing and community-based care, engagement remains highly variable. Many people do not participate in opportunities designed to support their health and wellbeing, while others engage successfully and sustain positive change over time. Existing research has predominantly focused on changing individual behaviour through education, motivation or technology. However, this perspective may overlook a more fundamental question:

How do health systems themselves shape engagement?

Emerging evidence from diverse long-term condition contexts suggests that engagement is not simply an individual characteristic, but an outcome of interactions between people, professionals, organisations and communities. Health systems may unintentionally suppress engagement through fragmented pathways, risk-focused communication, professional boundaries, limited community integration, and service models that prioritise disease management over participation in everyday life. Equally, systems may create conditions that enable engagement through trusted relationships, shared decision-making, personalised support, peer connection, community partnerships and approaches that recognise what matters to people, not simply what is the matter with them.

We propose a new research agenda focused on understanding engagement as a system-level phenomenon. Rather than examining individual behaviours in isolation, we seek to investigate the organisational, relational, cultural and contextual mechanisms through which health systems influence participation in health-promoting activities, rehabilitation, self-management and community life.

This work aims to develop a transferable understanding of how engagement is generated, sustained or suppressed across different populations, conditions and health system contexts. Potential areas of application include rehabilitation, chronic disease management, healthy ageing, mental health, cardiovascular health, diabetes, musculoskeletal conditions and multimorbidity.

By bringing together expertise from health services research, implementation science, behavioural science, rehabilitation, public health, digital health, social care and community organisations, this emerging programme seeks to contribute to the next generation of evidence on how health systems can support people not only to receive care, but to actively participate in creating and maintaining health and wellbeing.

We are interested in connecting with researchers, healthcare organisations, policymakers, municipalities, community organisations and patient groups who share an interest in participation, self-management, integrated care, prevention and health system transformation across Europe.