Patient participation and its determinants based on the Social Ecological Model: a cross-sectional study in North China

Grounded in the Social Ecological Model, this study aimed to assess the current status of patient participation in healthcare, identify its associated factors, and quantify the relative contribution of each factor to inform targeted interventions. A cross-sectional survey was conducted from May to October 2024 using convenience sampling at five tertiary hospitals in North China. A total of 573 patients were recruited. Data were collected through structured questionnaires, including the General Information Questionnaire, the Patient Participation Scale, the Patient Participation Competence Scale, the Patient Participation Attitude Scale, the Facilitation of Patient Involvement Scale, the Family APGAR Index, and the MacArthur Scale of Subjective Social Status. The mean patient participation score was 3.56 ± 0.57, indicating a moderate overall level. Multilevel factors across the microsystem, mesosystem, and macrosystem influenced participation, with the microsystem exerting the strongest impact. Participation competence and attitude were the most influential determinants, followed by educational level, facilitation of participation, and family support. Additional factors included patients’ disease knowledge, socioeconomic status, residence, self-rated health, financial burden, age, and communication with healthcare providers. Patient participation in healthcare remains moderate, shaped predominantly by competence and attitudes. These findings highlight the need for healthcare policies and practices that empower patients with the skills, confidence, and supportive environments required for active engagement. Strengthening competence and attitudes, while addressing disparities related to education, socioeconomic status, and health literacy, may foster more equitable and participatory models of care.