PE in their own health care is desirable because it can improve patient knowledge, relationship with providers, health service use, satisfaction with health care, adherence to recommended treatment and other desirable lifestyle behaviours, and clinical outcomes . However, numerous factors challenge PE. For example, patients may not be familiar or comfortable with PE , and physicians may experience role tension between PE and delivering clinical care . Consequently, many patients do not experience desired levels of PE , and experts have advocated for improved PE implementation [10, 11].