OBJECTIVES : Many decision points for patients exist throughout the duration of clinical care such as choosing to see a doctor, choosing what to communicate with health care providers, choosing a plan of treatment, and how to participate in managing their health. For patients to actively participate in these types of decisions, they need to feel empowered to act. However, it is unclear what constitutes empowerment, especially for patients who are economically disadvantaged. Therefore, this study examines perceptions of patients who are un- or underinsured in order to understand what empowerment means in terms of being an active participant in health care and communicating with their health care provider.

METHODS : As part of a prospective, qualitative research study, subjects were asked during semi-structured interviews to describe empowerment by explaining what phrases like "taking an active role in your health care" and " taking an active role in communicating with your doctor" meant. Interviews were completed in an internal medicine clinical setting between April and October 2019 with patients above the age of 45 presenting for a scheduled office visit. A grounded theory approach was used to identify major themes emerging from the responses.

RESULTS : A purposive sample of 18 subjects (3 males, 15 females) with a mean age of 52.83 (+8.03) participated. Subjects described taking an active role in their health care as being in control of their health, citing specific actions such as exercise and taking medicines to improve their health status. Subjects described taking an active role in communicating with their doctor as expressing concerns and asking questions, in addition to the doctor listening to them.

CONCLUSIONS : Economically disadvantaged patients described empowerment by delineating differences between actively participating in health care and actively participating in communicating with their doctor. Interventions aimed at empowering these patients should consider these differences for successful implementation.