Levels and Correlates of Patient Activation in Health Center Settings: Building Strategies for Improving Health Outcomes

Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education, The City College of New York, Manhattan, New York, NY 10031, USA.
Journal of Health Care for the Poor and Underserved (Impact Factor: 1.1). 08/2010; 21(3):796-808. DOI: 10.1353/hpu.0.0350
Source: PubMed


Patient activation refers to people's ability to engage in self-management of their health and health care. We assessed the performance of the Patient Activation Measure (PAM) for patients attending three inner-city health centers and compared resultant scores with those of the general U.S. adult population. We approached 801 patients and 527 (65.8%) participated; the majority were Latino(a) or African American/Black. No differences in activation were seen according to age. Males and more educated patients were more activated (p<.05) and patients with better self-rated health and adequate health literacy were more activated than their counterparts (p<.001). Patterns of scores resembled those of the U.S. general population for educational attainment and self-rated health but not for gender and age. Compared with the general population, more patients were characterized as level 1 (least activated). Developing strategies that enhance patient activation is critical to improving health outcomes, particularly in less advantaged populations.

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    • "The correlation between the means of the PAM13-D and the GSE was significant, providing evidence for the construct validity of the instrument. According to both our expectations and previous study results, we observed a positive association between self-reported health status and patient activation [26]–[28]. "
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    ABSTRACT: The patients' active participation in their medical care is important for patients with chronic diseases. Measurements of patient activation are needed for studies and in clinical practice. This study aims to validate the Patient Activation Measure 13 (PAM13-D) in German-speaking primary care patients. This international cross-sectional multicentre study enrolled consecutively patients from primary care practices in three German-speaking countries: Germany, Austria, and Switzerland. Patients completed the PAM13-D questionnaire. General Self-Efficacy scale (GSE) was used to assess convergent validity. Furthermore Cronbach's alpha was performed to assess internal consistency. Exploratory factor analysis was used to evaluate the underlying factor structure of the items. We included 508 patients from 16 primary care practices in the final analysis. Results were internally consistent, with a Cronbach's alpha of 0.84. Factor analysis revealed one major underlying factor. The mean values of the PAM13-D correlated significantly (r = 0.43) with those of the GSE. The German PAM13 is a reliable and valid measure of patient activation. Thus, it may be useful in primary care clinical practice and research.
    PLoS ONE 09/2013; 8(9):e74786. DOI:10.1371/journal.pone.0074786 · 3.23 Impact Factor
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    • "In some studies the relative contribution of health literacy and patient activation was examined in relation to a number of health related behaviours and choices [7-9]. Two studies showed that the association between patient activation and measures of health literacy was weak, indicating that these are two distinct concepts [7,8]. The other study distinguished between numeracy, literacy and activation [9]. "
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    ABSTRACT: Background The American short form Patient Activation Measure (PAM) is a 13-item instrument which assesses patient (or consumer) self-reported knowledge, skills and confidence for self-management of one’s health or chronic condition. In this study the PAM was translated into a Dutch version; psychometric properties of the Dutch version were established and the instrument was validated in a panel of chronically ill patients. Methods The translation was done according to WHO guidelines. The PAM 13-Dutch was sent to 4178 members of the Dutch National Panel of people with Chronic illness or Disability (NPCD) in April 2010 (study A) and again to a sub sample of this group (N = 973) in June 2010 (study B). Internal consistency, test-retest reliability and cross-validation with the SBSQ-D (a measure for Health literacy) were computed. The Dutch results were compared to similar Danish and American data. Results The psychometric properties of the PAM 13-Dutch were generally good. The level of internal consistency is good (α = 0.88) and item-rest correlations are moderate to strong. The Dutch mean PAM score (61.3) is comparable to the American (61.9) and lower than the Danish (64.2). The test-retest reliability was moderate. The association with Health literacy was weak to moderate. Conclusions The PAM-13 Dutch is a reliable instrument to measure patient activation. More research is needed into the validity of the Patient Activation Measure, especially with respect to a more comprehensive measure of Health literacy.
    BMC Public Health 07/2012; 12(1):577. DOI:10.1186/1471-2458-12-577 · 2.26 Impact Factor
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    ABSTRACT: To evaluate the impact of a patient activation intervention (PAI) focused on building question formulation skills that was delivered to patients in community health centers prior to their physician visit. Level of patient activation and patient preferred role were examined using the patient activation measure (PAM) and the patient preference for control (PPC) measure. More of the 252 patients evaluated were at lower levels of activation (PAM levels 1 or 2) than U.S. population norms before the intervention. Paired-samples t-test revealed a statistically significant increase from pre-intervention to post-visit PAM scores. One-third of participants moved from lower levels of activation to higher levels (PAM levels 3 or 4) post-intervention. Patients preferring a more passive role had lower initial PAM scores and greater increases in their post-intervention PAM scores than did those who preferred a more active role. Patients exposed to the PAI demonstrated significant improvement on a measure of activation. The PAI may be useful in helping patients prepare for more effective encounters with their physicians. The PAI was feasible to deliver in the health center setting and may be a useful method for activating low-income, racial/ethnic minority patient populations.
    Patient Education and Counseling 08/2011; 84(2):257-60. DOI:10.1016/j.pec.2010.07.026 · 2.20 Impact Factor
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