Disparities in Patient Engagement: Insights from the Danish Healthcare Sector

Patient Involvement has become a mandated principle in the governance of Western healthcare systems, including the Nordic welfare states, thereby reshaping the relationships between healthcare professionals and patients. As patients increasingly engage in managing their health—often driven by access to health-related information through the internet and social media—they are asserting greater control over their healthcare decisions and bodily investments. However, this agency is not evenly distributed; it is profoundly influenced by factors such as varying levels of health literacy, types of capital including cultural health capital, and the nature and number of diseases being managed.

This study employs Bourdieu’s concepts of habitus, capital, and field, along with the sociology of expertise, to investigate the complexities of patient involvement within the Danish specialized healthcare system. Our research includes 30+ interviews with patients experiencing both acute and chronic conditions, as well as interviews with 15 healthcare professionals. We focus on how patient responsibility and choice are enacted in hospital settings, analyzing the disparities in patients' forms of capital and the differing investment strategies reported by patients in comparison to the perspectives of health professionals.

Our findings illustrate that healthcare professionals navigate their obligation to adhere to decision-making standards for involvement in various ways. Furthermore, patients have differing opportunities for involvement and often require different forms of engagement. We identify significant gaps between the aspirational goals of patient-centered care and its actual implementation, highlighting the distinct challenges healthcare professionals face in facilitating patient involvement as ideally envisioned. We observe that these dynamics transform the notion of professional expertise when patients are engaged in decisions about the goals of medical intervention, potentially leading to a more co-produced form of medical expertise in healthcare.