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Patient activation: Health behaviours and clinical outcomes

16/02/17 07:30
COUCH Medcomms



Patient activation is a term that describes a concept concerning health behaviour, and is used to determine how likely a patient is to engage actively in their health care. Going beyond mere understanding of a medical condition, patient activation also determines a patient’s motivation and level of confidence in managing their health

Studies have found that people with long-term conditions are more likely to take a positive attitude towards their health, and work effectively and competently in managing their own health conditions. They not only understand their role in the process, they are confident they have the skills to fulfil that role.

Measuring for success

As in other areas of healthcare, effective measuring is necessary to determine success, and patient activation is no different. The Patient Activation Measure (PAM) assesses activation through a series of 13 statements. These statements delve into areas of:

  • Self belief
  • Confidence to manage health-related tasks
  • Self-assessed knowledge of the condition

From the answers given, healthcare providers assign each patient a score between zero and 100. These are often then subdivided into four groups that determine an individual’s level of activation. HCPs can then offer the correct level and type of support depending on whether activation is low or high. 

Other concepts around healthcare relate to such things as self-efficacy, health literacy, or a readiness to change. Patient activation is a more generalised concept, with another big difference to differentiate it from other constructs: individual patient activation levels can change.

The concept is founded on a development model. It measures a person’s willingness and ability to change as well as self-efficacy, and includes motivational elements. It is understood that patients not only need certain skills with regard to health literacy, they also need the right attitude and mindset that empowers them to take action.

Setting patients up for success

Understanding the patient’s level of activation helps healthcare providers meet patients’ needs more effectively. Extra support can be given, for instance, to those who have experienced failure in managing their health in the past, or those who feel overwhelmed by multiple health conditions. 

For some patients, making lifestyle changes such as to diet or increasing exercise is complicated, with many barriers to success. Often when asked to make multiple changes, the inability to succeed in every area fosters an attitude of failure. They give up and make no changes at all.

For patients with limited self-management skills or scepticism regarding their ability to learn those skills, measuring activation levels helps care providers devise programmes that guide them step by step towards more effective self-management.

Demographics make no difference

Whilst there is some correlation between socio-economic status and patient activation, studies have shown that income levels, gender, age, culture or education accounts for no more than 6% of activation variation. It is a mistake to assume that those with higher socio-economic status are naturally more activated.

All patients can, however, learn self-management skills and progress towards a better health outcome, regardless of their socio-economic status. As patients move to higher levels of activation, they become more proactive in their own healthcare. Further, studies of the relationship between activation and clinical outcomes has demonstrated that those with high activation levels are more likely to have:

  • Normal blood sugar levels
  • Normal blood pressure
  • Normal cholesterol levels
  • Normal body mass index

Amongst HIV patients, patients who could increase their activation scores had better adherence to drug regimens and viral suppression.

Studies have also found that it’s not just physical disorders. Patients suffering from post-traumatic stress disorder, schizophrenia, bipolar disorder and depression also have more positive outcomes with higher activation levels.


Behaviour Change


Topics: Behaviour Change

COUCH Medcomms

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