Therapeutic engagement across acute care patient journeys: motivational insights on young adults

Purpose This study aims to conceptualize therapeutic adherence as a manifestation of patient engagement. It examines how motivational drivers shape engagement across successive stages of the acute patient journey among young adults. Design/methodology/approach A scenario-based survey was conducted with 359 university students exposed to a three-stage acute patient journey (consultation, treatment initiation and treatment continuation). Drawing on Protection Motivation Theory (PMT), the authors assessed how threat and coping appraisals predict engagement intentions at each stage. Findings Engagement varies significantly across stages. Entry into care represents a critical activation threshold, largely driven by perceived solution efficacy. Engagement intensifies at treatment initiation, where coping appraisals dominate. It declines at treatment continuation as perceived threat decreases. Therapeutic engagement thus emerges as a stage-dependent reconfigured process. Research limitations/implications The use of a hypothetical scenario and self-reported intentions limits behavioral generalizability. Future research should examine longitudinal and field-based engagement processes across diverse healthcare contexts and vulnerability profiles. Practical implications It provides insights for healthcare providers, universities and public institutions seeking to design coordinated, stage-sensitive interventions that activate, reinforce and stabilize young adults’ engagement across the acute patient journey. These findings can also inform public health policies aimed at improving access to care, therapeutic adherence and health engagement during emerging adulthood. Social implications This article addresses an important issue for public policymakers: the prevention of therapeutic nonadherence through the development of health-related services. Originality/value By applying PMT to a patient journey within a service perspective, this study advances a novel view of therapeutic engagement shaped by evolving perceptions of threat and efficacy across the three stages of acute care.