The following is taken from the King’s Fund report: Supporting People to Manage their Health: An introduction to patient activation by Judith Hibbard and Helen Giburt 2014
What is patient activation?
Patient activation is a behavioural concept. It captures a number of core components of patient involvement, each of which is important for active engagement and participation. It is defined as ‘an individual’s knowledge, skill, and confidence for managing their health and health care’ (Hibbard et al 2005).
Patients with high levels of activation understand their role in the care process and feel capable of fulfilling that role. Individuals with long-term conditions who are more highly activated are more likely to engage in positive health behaviours and to manage their health conditions more effectively.
Between 25 and 40 per cent of the population have low levels of activation. Individuals with low levels of activation are more likely to:
- feel overwhelmed with the task of managing their health
- have little confidence in their ability to have a positive impact on their health
- misunderstand their role in the care process
- have limited problem-solving skills
- have had substantial experience of failing to manage their health, and have become passive in managing their health
- say that they would rather not think about their health
Of course, these are all major barriers to an individual’s ability to manage their own health. If a patient feels overwhelmed, has little confidence and has experience of failing to manage their health, imagine how they will respond when a doctor tells them that, because of a new diagnosis, they need to make multiple changes to their lifestyle – changing their diet, increasing their physical activity and managing new medications. They may try to make these changes, but when they cannot make all of them, they will most likely make none. By not understanding that a patient like this has limited self-management skills, their doctor has set them up for failure.
Measuring patient activation
In health care, it is commonly understood that measurement is a necessary first step in effectively improving care. The Patient Activation Measure (PAM) is the most commonly used measure of activation. Like patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs), the PAM is a measure that patients complete themselves, although they can be supported in this process. The PAM contains a series of 13 statements designed to assess the extent of a patient’s activation. These statements are about beliefs, confidence in the management of health-related tasks and self-assessed knowledge. Patients are asked to rate the degree to which they agree or disagree with each statement. These answers are combined to provide a single score of between 0 and 100, which represents the person’s concept of themselves as an active manager of their health and health care.
See this link for the items contained in PAM https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361231/table/tbl1/#
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