Patient Engagement, Chronic Illness, and the Subject of Health Care Reform

In the United States, in the wake of health care reform, health care systems have been subject to intensifying demands to increasepatient engagement, a term that refers broadly to participation in care. We draw from ethnographic research in urban health care safety-net settings in California to examine efforts to increase patient engagement among chronically ill, marginalized patients who have long been disconnected from outpatient care. We suggest that the work of engagement in this context involved getting people to accept the norms of biomedicine while also reworking these norms to account for the complex circumstances of their lives.