Begin with a person’s purpose
Engagement starts with something a person wants to understand, decide, or do. A caregiver may want to know whom to call about a change. A participant may want to choose an activity. A care team may need to agree on who follows up. Each is more specific than “increase engagement,” and each suggests a different way to offer support.
We use research to ask better questions about these situations. A useful framework can make a barrier visible, but it does not establish that the resulting service or technology works. That next step requires observation and evaluation in the setting where people will use it.
Four ways to understand participation
Carman and colleagues’ engagement framework (opens in a new tab) describes participation ranging from consultation to partnership, across individual care, organizational decisions, and policy. It helps a team ask how much influence people actually have.
COM-B and the Behaviour Change Wheel (opens in a new tab) organize behavior around capability, opportunity, and motivation. The original 2011 paper developed a framework; it did not test a family care app.
Self-determination theory (opens in a new tab) considers autonomy, competence, and relatedness in motivation. These are conceptual lenses for understanding experience, rather than interchangeable scores or a recipe that guarantees change.
Cohen and Wills’ social-support buffering review (opens in a new tab) distinguishes the broad value of social integration from support that may help when a person faces stress. It directs attention to whether useful help is available when needed. A larger contact list alone does not establish that someone receives that support.
A team can use these lenses together while keeping their jobs distinct. They ask who has a voice, what makes action possible, how an experience supports motivation, and whether useful help is available during stress. None makes it reasonable to assume that a person who does not respond lacks motivation.
A practical example
Imagine a home care agency offering a short orientation to family caregivers. This is a hypothetical design example, not a genusConnect customer result.
The agency initially plans to send three reminders. In a conversation, a caregiver explains that the orientation arrives during work and that its examples do not match the task she is preparing for. A second caregiver can open the page but cannot comfortably read the small text. A third already knows the material and wants a way to ask one specific question.
The next design decision should follow those differences. The agency could offer a choice of time, a clearer format, and a direct route to the relevant question. It could also ask caregivers to help choose the examples. More reminders alone would leave the original problems unresolved.
Turn a broad ambition into a useful question
For a first improvement cycle, we recommend naming the activity and the intended benefit before selecting a metric:
- What does the person want to accomplish?
- What makes that difficult in this situation?
- What support can the organization realistically provide?
- Can the person choose another route or decline?
- What observation would tell us whether the support helped?
These are proposed design questions, not a validated assessment instrument. A team should review the answers with the people affected, including those who stop using the service.
Keep understanding visible
A completed lesson can show that a person reached its end. It cannot tell us everything they understood or whether the next step was possible. The AHRQ health literacy toolkit (opens in a new tab) offers practical approaches to clearer information, follow-up, and checking understanding.
For genusConnect, this literature informs the questions we bring to engagement design. carePhysics is our product and design framework. It should be presented alongside its research foundations with clear attribution, while the effectiveness of any particular genusConnect implementation remains a separate question to investigate.
Compare their roles
| Foundation | Question it helps ask | Limit |
|---|---|---|
| Carman engagement framework | How much influence do people have in decisions? | Participation levels are not proof of better health outcomes. |
| COM-B | Is capability, opportunity, or motivation making an action difficult? | A diagnosis of barriers does not validate the chosen intervention. |
| Self-determination theory | Does the experience support autonomy, competence, and relatedness? | These needs are not interchangeable with app activity measures. |
| Social-support buffering | Is the right support available when stress occurs? | More connections do not automatically mean useful support. |
These frameworks explain different aspects of behavior and relationships. A delivery model such as CMS GUIDE defines how a program operates, while carePhysics describes genusConnect’s design approach. Neither should be presented as equivalent to these foundational theories.