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Barello S, Anderson G, Bosio C, Lane DA, Leo DG, Lobban TCA, Trevisan C, Graffigna G. Patient engagement in multimorbidity: a systematic review of patient-reported outcome measures. Front Psychol 2024; 15:1345117. [PMID: 39100568 PMCID: PMC11294995 DOI: 10.3389/fpsyg.2024.1345117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/06/2024] [Indexed: 08/06/2024] Open
Abstract
Background People with multimorbidity are increasingly engaged, enabled, and empowered to take responsibility for managing their health status. The purpose of the study was to systematically review and appraise the psychometric properties of tools measuring patient engagement in adults with multimorbidity and their applicability for use within engagement programs. Methods PubMed, Scopus, Web of Science, and PsycInfo were searched from inception to 1 July 2021. Gray literature was searched using EBSCO host-database "Open dissertation". The reference lists of studies meeting the inclusion criteria were searched to identify additional eligible studies. The screening of the search results and the data extraction were performed independently by two reviewers. The methodological quality of the included studies was evaluated with the COSMIN checklist. Relevant data from all included articles were extracted and summarized in evidence synthesis tables. Results Twenty articles on eight tools were included. We included tools that measure all four dimensions of patient engagement (i.e., engagement, empowerment, activation, and participation). Their psychometric properties were analyzed separately. Most tools were developed in the last 10 years in Europe or the USA. The comparison of the estimated psychometric properties of the retrieved tools highlighted a significant lack of reliable patient engagement measures for people with multimorbidity. Available measures capture a diversity of constructs and have very limited evidence of psychometric properties that are vital for patient-reported measures, such as invariance, reliability, and responsiveness. Conclusion This review clarifies how patient engagement, as operationalized in measures purporting to capture this concept, overlaps with, and differs from other related constructs in adults with multimorbidity. The methodological quality of psychometric tools measuring patient engagement in adults with multimorbidity could be improved. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=259968, identifier CRD42021259968.
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Affiliation(s)
- Serena Barello
- EngageMinds HUB – Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Gloria Anderson
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Caterina Bosio
- EngageMinds HUB – Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Deirdre A. Lane
- Liverpool Centre for Cardiovascular Science and Department of Cardiovascular and Metabolic Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Donato G. Leo
- Liverpool Centre for Cardiovascular Science and Department of Cardiovascular and Metabolic Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | - Caterina Trevisan
- Department of General Psychology, University of Padua, Padua, Italy
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Guendalina Graffigna
- EngageMinds HUB – Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, Cremona, Italy
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Ng QX, Liau MYQ, Tan YY, Tang ASP, Ong C, Thumboo J, Lee CE. A Systematic Review of the Reliability and Validity of the Patient Activation Measure Tool. Healthcare (Basel) 2024; 12:1079. [PMID: 38891154 PMCID: PMC11171848 DOI: 10.3390/healthcare12111079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Patient activation, broadly defined as the ability of individuals to manage their health and navigate the healthcare system effectively, is crucial for achieving positive health outcomes. The Patient Activation Measure (PAM), a popularly used tool, was developed to assess this vital component of health care. This review is the first to systematically examine the validity of the PAM, as well as study its reliability, factor structure, and validity across various populations. Following the PRISMA and COSMIN guidelines, a search was conducted in MEDLINE, EMBASE, and Cochrane Library, from inception to 1 October 2023, using combinations of keywords related to patient activation and the PAM. The inclusion criteria were original quantitative or mixed methods studies focusing on PAM-13 or its translated versions and containing data on psychometric properties. Out of 3007 abstracts retrieved, 39 studies were included in the final review. The PAM has been extensively studied across diverse populations and geographical regions, including the United States, Europe, Asia, and Australia. Most studies looked at populations with chronic conditions. Only two studies applied the PAM to community-dwelling individuals and found support for its use. Studies predominantly showed a high internal consistency (Cronbach's alpha > 0.80) for the PAM. Most studies supported a unidimensional construct of patient activation, although cultural differences influenced the factor structure in some cases. Construct validity was established through correlations with health behaviors and outcomes. Despite its strengths, there is a need for further research, particularly in exploring content validity and differential item functioning. Expanding the PAM's application to more diverse demographic groups and community-dwelling individuals could enhance our understanding of patient activation and its impact on health outcomes.
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Affiliation(s)
- Qin Xiang Ng
- Health Services Research Unit, Singapore General Hospital, Singapore 169608, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Matthias Yi Quan Liau
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Yong Yi Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Ansel Shao Pin Tang
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Clarence Ong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Julian Thumboo
- Health Services Research Unit, Singapore General Hospital, Singapore 169608, Singapore
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- SingHealth Duke-NUS Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Chien Earn Lee
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
- SingHealth Duke-NUS Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore
- SingHealth Office of Regional Health, Singapore 911532, Singapore
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Roesel I, Froehlich D, Joos S, Valentini J, Mauch H, Martus P. The Patient Activation Measure-13 (PAM-13) in an oncology patient population: psychometric properties and dimensionality evaluation. Health Qual Life Outcomes 2024; 22:39. [PMID: 38764032 PMCID: PMC11103863 DOI: 10.1186/s12955-024-02255-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/27/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Accurate assessment and enhancement of health-related skills among oncology patients are pivotal for optimizing cancer care. The Patient Activation Measure (PAM-13), a questionnaire designed to reflect an individual's knowledge, skills, and confidence in self-healthcare management, has been validated across diverse countries and settings. Concerns have been raised regarding the cross-situational applicability, as patients with specific diseases and cultural backgrounds interpret questionnaire items differently. This study aimed to examine the structural validity and psychometric properties of the PAM-13 in an oncological patient cohort. METHODS Baseline data from a longitudinal non-randomized controlled study involving cancer out-patients (n = 1,125) from Comprehensive Cancer Centres in Southern Germany were analysed. The German version of the PAM-13 was employed. With classical test and item response theory methods data quality, reliability, convergent and structural validity, as well as psychometric properties were assessed. Exploratory (EFA) and confirmatory factor analyses (CFA) were employed to investigate the postulated unidimensionality of the underlying construct. With a partial credit model (PCM) we examined item fit, targeting, local independence and differential item functioning. RESULTS Participants were predominantly female (73.0%) with a breast cancer diagnosis (41.3%). While items were generally well-accepted, ceiling effects were observed and a high mean PAM-13 score (69.7, SD = 14.2) was noted, potentially compromising responsiveness to interventions. Reliability was adequate (Cronbach's α = 0.81), person and item separation reliability were good to excellent (0.81 and 0.99, respectively). Explorations of the unidimensionality of the construct (EFA, CFA, PCM) yielded inconclusive results, hinting towards a two-factor solution. Item difficulty rankings deviated from the original. No differential item functioning was identified, and local independence was confirmed. CONCLUSIONS While the PAM-13 serves as a valuable instrument for comprehending and promoting health-related skills in cancer patients, the identification of ceiling effects, disordered item-difficulty rankings, and inconclusive findings regarding unidimensionality contribute to the expanding body of evidence, emphasizing the dependency of PAM-13's validity and reliability on distinctive characteristics within the population under investigation. Future research should prioritize refining or adding PAM-13 items to better capture the specific health-related challenges within diverse populations, paving the way for more effective patient engagement strategies in oncology. TRIAL REGISTRATION NUMBER DRKS00021779.
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Affiliation(s)
- Inka Roesel
- Institute for General Practice and Interprofessional Care, Faculty of Medicine Tuebingen, University Hospital, Tuebingen, Germany.
- Institute for Clinical Epidemiology and Applied Biostatistics, University Hospital of Tuebingen, Tuebingen, Germany.
| | - Daniela Froehlich
- Institute for General Practice and Interprofessional Care, Faculty of Medicine Tuebingen, University Hospital, Tuebingen, Germany
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Care, Faculty of Medicine Tuebingen, University Hospital, Tuebingen, Germany
| | - Jan Valentini
- Institute for General Practice and Interprofessional Care, Faculty of Medicine Tuebingen, University Hospital, Tuebingen, Germany
| | - Holger Mauch
- Institute for General Practice and Interprofessional Care, Faculty of Medicine Tuebingen, University Hospital, Tuebingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biostatistics, University Hospital of Tuebingen, Tuebingen, Germany
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Caballero J, Patel N, Waldrop D, Ownby RL. Patient activation and medication adherence in adults. J Am Pharm Assoc (2003) 2024; 64:102025. [PMID: 38320653 PMCID: PMC11081861 DOI: 10.1016/j.japh.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/02/2024] [Accepted: 01/30/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Patients' level of medication adherence provides conflicting results in its relationship to patient activation. Multiple factors may be contributing to these mixed results. OBJECTIVES The primary purpose was to assess the association of patient activation to medication adherence in adults with chronic health conditions and low health literacy (HL). Secondary objectives were to determine whether age, education, gender, and race were associated with activation. METHODS Participants completed self-report questionnaires regarding chronic disease self-management. Patient activation was measured using Hibbard's Patient Activation Measure (PAM). Self-report of medication adherence was determined using the Gonzalez-Lu adherence questionnaire. Block regressions first assessed the relation of demographic variables and education to adherence and then the added relation of patient activation in a second model. RESULTS The analyses included 301 participants (mean age 58 years; 53% female; mean chronic conditions of 6.6). Some of the most common chronic conditions included hypertension (60%), arthritis (51%), depression (49%), and hyperlipidemia (43%). The relation of older age to greater medication adherence was significant (P < 0.05) in both models. The addition of PAM was significantly related to better adherence (P < 0.001) and also increased the R squared value from 0.04 to 0.09. This change resulted in a moderate effect size (d = 0.50). CONCLUSION Evaluating patient activation at baseline may predict those more likely to be medication adherent in patients with low HL.
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Vall-Vargas A, Constans M, Torà N, Arnau A, Altés A, de Juan Pardo MÁ. Determinants associated with activation in patients with oral anticoagulant treatment: A cross-sectional study. ENFERMERIA CLINICA (ENGLISH EDITION) 2024; 34:148-160. [PMID: 38796107 DOI: 10.1016/j.enfcle.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/16/2024] [Indexed: 05/28/2024]
Abstract
AIMS The terms "patient activation" and "patient empowerment" are used to describe the extent to which individuals are able to manage their own healthcare. Health outcomes and quality of life improve in patients who are more active in health care. The aim of this study was to identify sociodemographic, clinical, sociological and psychological determinants associated with activation in a group of chronically anticoagulated patients. METHODS Cross-sectional study of patients treated with oral antivitamin-k drugs attended at a specialized outpatient anticoagulant unit between November 2021 and June 2022. The main dependent variable was the level of patient activation according to the 13-item Patient Activation Measure (PAM-13). Simple and multiple linear regression models were conducted to identify the determinants associated with PAM-13 score. RESULTS A total of 137 patients who met all the inclusion criteria were recruited for the study. The mean age was 59.6 years (SD 13.8; range 22-86) and 60.6% were male. Sixty per cent presented a level IV of activation according to the PAM-13 scale. Mean patient activation score was 73.9 (SD 15.4). The factors independently associated with significantly lower activation were: emergency department visits in the past 12 months, intermediate social risk, anxiety symptoms, stress symptoms and low self-efficacy. CONCLUSIONS Five determinants were found to be associated with activation. Knowing the factors that modify the level of activation can help to identify subgroups of chronic anticoagulated patients who are less likely to engage in self-management and are therefore candidates for tailored educational interventions.
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Affiliation(s)
- Alba Vall-Vargas
- Department of Hematology, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain; Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain; Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain.
| | - Mireia Constans
- Department of Hematology, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain; Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Núria Torà
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain; Research and Innovation Unit, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Anna Arnau
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain; Research and Innovation Unit, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain; Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain; Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Albert Altés
- Department of Hematology, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain; Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain; Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - M Ángeles de Juan Pardo
- Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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Wong AWK, Tomazin R, Walker K, Heeb Desai R, Hollingsworth H, Newland PK, Morgan KA. Text messaging intervention for fatigue self-management in people with stroke, spinal cord injury, and multiple sclerosis: A pilot study. Disabil Health J 2024; 17:101549. [PMID: 38001005 DOI: 10.1016/j.dhjo.2023.101549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Fatigue negatively impacts the function and quality of life of people with disabilities (PwD). Mobile health (mHealth) platforms are recognized as effective and accessible approaches to delivering health interventions and may show higher satisfaction by tailoring the information toward personalized needs for PwD. OBJECTIVE To evaluate the acceptability, feasibility, and participant engagement with a Short Message Service (SMS) text messaging intervention for fatigue self-management and to explore the pre- and post-score health changes in PwD. METHODS A total of 27 PwD (multiple sclerosis = 9, spinal cord injury = 9, or stroke = 9) experiencing fatigue in their daily lives participated in a 12-week self-management text messaging intervention. Participants completed a demographic survey and health outcome measures, including patient activation, self-efficacy for managing symptoms, fatigue, sleep, and satisfaction with participation in social roles before and after the intervention. Participants also completed a client satisfaction questionnaire after the intervention. We also tracked the program retention and SMS response rates over the 12-week intervention period. RESULTS Twenty-five participants completed the entire intervention (93% retention rate), and the overall SMS response rate was 84.67%, indicating high acceptability and adherence to the intervention. The mean satisfaction score was 3.18, indicating high satisfaction with the intervention. Despite finding a negligible effect on patient activation, we found a small intervention effect on self-efficacy for managing symptoms (η2 = 0.04) and moderate effects on fatigue (η2 = 0.06-0.12), sleep (η2 = 0.11), and satisfaction with participation in social roles (η2 = 0.08). CONCLUSIONS This study provides initial feasibility and health outcome change evidence to support an SMS text messaging intervention to manage fatigue in PwD.
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Affiliation(s)
- Alex W K Wong
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA; Department of Physical Medicine and Rehabilitation and Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Rachel Tomazin
- Washington University in St. Louis, School of Medicine, Program in Occupational Therapy, St. Louis, MO, USA
| | - Kim Walker
- Washington University in St. Louis, School of Medicine, Program in Occupational Therapy, St. Louis, MO, USA
| | - Rachel Heeb Desai
- Washington University in St. Louis, School of Medicine, Program in Occupational Therapy, St. Louis, MO, USA.
| | - Holly Hollingsworth
- Washington University in St. Louis, School of Medicine, Program in Occupational Therapy, St. Louis, MO, USA
| | - Pamela K Newland
- Goldfarb School of Nursing at Barnes Jewish College, St. Louis, MO, USA.
| | - Kerri A Morgan
- Washington University in St. Louis, School of Medicine, Program in Occupational Therapy, St. Louis, MO, USA
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Grigolo S, Bruschi B, Di Masi D, Bena C, Armando LG, Cena C. Identification of Barriers for Active Disease Management and of Medication-Related Problems through Therapeutic Patient Education in Older Home-Care Patients. Healthcare (Basel) 2024; 12:231. [PMID: 38255118 PMCID: PMC10815688 DOI: 10.3390/healthcare12020231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Combining therapeutic patient education (TPE) with a medication review service could foster the adoption of appropriate lifestyles by patients and support care-providers in identifying strategies to improve the quality of prescribed care. This study aimed to identify barriers experienced by patients in managing their diseases and medication-related problems. This was a monocentric, case series, observational study involving home-care patients from the Local Health Authority ASL TO4. Patients were enrolled for a TPE intervention where drug therapies and patient habits were collected through narrative interviews. Medication review was performed to identify potentially inappropriate prescriptions (PIPs). Twenty patients (13 females) with a mean age of 74.7 years were enrolled. Patients had an average of 4.3 diseases and 80.0% of them were treated with ≥5 daily medications. The main PIPs involved ibuprofen, furosemide and pantoprazole. The qualitative analysis of the interviews identified seven macro-themes relating to different aspects of medication management: therapy; diseases; patient; patient journey; professionals; family and caregivers; drug information. The results of this study revealed some critical aspects related to the treatment path and healthcare professionals. These results will be used to plan educational interventions for polypharmacy patients to improve medication adherence and the understanding and management of diseases.
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Affiliation(s)
- Sabrina Grigolo
- Department of Philosophy and Education Sciences, University of Turin, Via Sant’Ottavio 20, 10124 Turin, Italy; (S.G.); (B.B.); (D.D.M.)
| | - Barbara Bruschi
- Department of Philosophy and Education Sciences, University of Turin, Via Sant’Ottavio 20, 10124 Turin, Italy; (S.G.); (B.B.); (D.D.M.)
| | - Diego Di Masi
- Department of Philosophy and Education Sciences, University of Turin, Via Sant’Ottavio 20, 10124 Turin, Italy; (S.G.); (B.B.); (D.D.M.)
| | - Carla Bena
- Struttura Semplice Cure Domiciliari di Chivasso, Settimo Torinese, San Mauro Torinese, Via Po 11, 10034 Chivasso, Italy
| | - Lucrezia Greta Armando
- Department of Drug Science and Technology, University of Turin, Via Pietro Giuria 11, 10125 Turin, Italy;
| | - Clara Cena
- Department of Drug Science and Technology, University of Turin, Via Pietro Giuria 11, 10125 Turin, Italy;
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Lin CY, Chung ML, Schuman DL, Biddle MJ, Mudd-Martin G, Miller JL, Hammash M, Schooler MP, Rayens MK, Feltner FJ, Moser DK. Psychometric Properties of the Patient Activation Measure in Family Caregivers of Patients With Chronic Illnesses. Nurs Res 2023; 72:292-300. [PMID: 37011339 PMCID: PMC10330077 DOI: 10.1097/nnr.0000000000000659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND The Patient Activation Measure (PAM) is used clinically and in research to measure an individual's knowledge, skills, and confidence related to their health management engagement. Despite the use of "patient" in the title, the instrument can be used in nonpatient populations. A group at high risk for low activation concerning their own health is family caregivers of patients with chronic illnesses. The psychometric properties of the PAM have not been established in family caregivers. OBJECTIVES This study aimed to examine the psychometric properties of the PAM 10-item version (PAM-10) in a sample of family caregivers of patients with chronic illnesses. Our focus was on family caregivers' health activation of their own healthcare needs. METHODS We evaluated the internal consistency reliability of the PAM-10 in a sample of 277 family caregivers. Item-total correlations and interitem correlations were used to assess item homogeneity. Construct validity of the PAM-10 was examined using exploratory factor analysis and testing hypotheses on known relationships. RESULTS The PAM-10 demonstrated adequate internal consistency. Item-total correlation coefficients and interitem correlation coefficients were acceptable. Construct validity of the instrument was supported. Factor analysis yielded two factors that explained 62.3% of the variance in the model. Lower levels of depressive symptoms were significantly associated with better activation, providing evidence of construct validity. Caregivers with high activation levels were significantly more likely to engage in and adhere to self-care behaviors such as regular exercise, eating a healthy diet, and engaging in stress reduction strategies. DISCUSSION This study demonstrated that the PAM-10 is a reliable and valid measure for family caregivers of patients with chronic illnesses to measure caregivers' health activation of their own healthcare needs.
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Crijns TJ, Segina P, Kortlever JTP, Thomas JE, Ring D, Reichel L, Vagner G, Ramtin S. Moderators and Mediators of the Relationship of Shared Decision-Making and Satisfaction. J Patient Exp 2023; 10:23743735231171563. [PMID: 37138951 PMCID: PMC10150427 DOI: 10.1177/23743735231171563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Background:Evidence suggests that health literacy, perceived availability of information and guidance to adapt to challenges (informational support), and symptoms of depression all have the potential to mediate or moderate the relationship between patient-rated involvement in decisions and satisfaction with care. If so these could be useful targets for improving patient experience. Methods: We prospectively enrolled 130 new adult patients visiting an orthopedic surgeon over a 4-month period. All patients were asked to complete measures of satisfaction with care (21-item Medical Interview Satisfaction Scale), perceived involvement in decisions (9-item Shared Decision-Making Questionnaire), symptoms of depression (the Patient-Reported Outcomes Measurement Information Scale [PROMIS] Depression Computerized Adaptive Test [CAT]), perceived availability of information and guidance to adapt to challenges (PROMIS Informational Support CAT), and the Newest Vital Sign test of health literacy. Results: The strong correlation between satisfaction with care (ρ = 0.60, P < .001) and perceived involvement in decisions was neither mediated nor moderated by health literacy, perceived availability of information and guidance, and symptoms of depression. Conclusions: The observation that patient-rated shared decision-making is strongly related to satisfaction with an office visit, independent of health literacy, perceived support, and symptoms of depression, is consistent with evidence that various measures of patient experience tend to correlate and emphasizes the importance of the patient-clinician relationship. Level of Evidence: Level II, prospective study.
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Affiliation(s)
- Tom J Crijns
- Department of Surgery and
Perioperative Care, Dell Medical School, The University of Texas at Austin,
Austin, TX, USA
| | - Paxton Segina
- Department of Surgery and
Perioperative Care, Dell Medical School, The University of Texas at Austin,
Austin, TX, USA
| | - Joost T P Kortlever
- Department of Surgery and
Perioperative Care, Dell Medical School, The University of Texas at Austin,
Austin, TX, USA
| | - Jacob E Thomas
- Department of Surgery and
Perioperative Care, Dell Medical School, The University of Texas at Austin,
Austin, TX, USA
| | - David Ring
- Department of Surgery and
Perioperative Care, Dell Medical School, The University of Texas at Austin,
Austin, TX, USA
- David Ring, Department of Surgery and
Perioperative Care, Dell Medical School, The University of Texas at Austin,
Health Discovery Building 6.706; 1701 Trinity St., Austin, TX 78712, USA.
| | - Lee Reichel
- Department of Surgery and
Perioperative Care, Dell Medical School, The University of Texas at Austin,
Austin, TX, USA
| | - Gregg Vagner
- Department of Surgery and
Perioperative Care, Dell Medical School, The University of Texas at Austin,
Austin, TX, USA
| | - Sina Ramtin
- Department of Surgery and
Perioperative Care, Dell Medical School, The University of Texas at Austin,
Austin, TX, USA
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Zrubka Z, Vékás P, Németh P, Dobos Á, Hajdu O, Kovács L, Gulácsi L, Hibbard J, Péntek M. Validation of the PAM-13 instrument in the Hungarian general population 40 years old and above. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1341-1355. [PMID: 35102464 PMCID: PMC9550701 DOI: 10.1007/s10198-022-01434-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 01/11/2022] [Indexed: 05/07/2023]
Abstract
BACKGROUND Patient activation comprises the skills, knowledge and motivation necessary for patients' effective contribution to their care. We adapted and validated the 13-item Patient Activation Measure (PAM-13) in the ≥ 40 years old Hungarian general population. METHODS A cross-sectional web survey was conducted among 900 respondents selected from an online panel via quota sampling. After 10 days, the survey was repeated on 100 respondents. The distribution, internal consistency, test-retest reliability, factor structure, convergent, discriminant and known-groups validity of PAM-13 were assessed according to the COSMIN guidelines. RESULTS The sample comprised 779 respondents. Mean (± SD) age was 60.4 ± 10.6 years, 54% were female and 67% had chronic illness. Mean (± SD) PAM-13 score was 60.6 ± 10.0. We found good internal consistency (Cronbach alpha: 0.77), moderate test-retest reliability (ICC: 0.62; n = 75), a single-factor structure and good content validity: PAM-13 showed moderate correlation with the eHealth Literacy Scale (r = 0.40), and no correlation with age (r = 0.02), education (r = 0.04) or income (ρ = 0.04). Higher PAM-13 scores were associated with fewer lifestyle risks (p < 0.001), more frequent health information seeking (p < 0.001), participation in patient education (p = 0.018) and various online health-related behaviours. When controlling for health literacy, sociodemographic factors and health status, the association of higher PAM-13 scores with overall fewer lifestyle risks, normal body mass index, physical activity and adequate diet remained significant. Similar properties were observed in the subgroup of participants with chronic morbidity, but not in the age group 65+. CONCLUSION PAM-13 demonstrated good validity in the general population. Its properties in clinical populations and the elderly as well as responsiveness to interventions warrant further research.
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Affiliation(s)
- Zsombor Zrubka
- University Research and Innovation Center, Óbuda University, Bécsi út 96/b, Budapest, 1034, Hungary.
- Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary.
| | - Péter Vékás
- Institute of Mathematical Statistics and Modelling, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Péter Németh
- Doctoral School of Economics, Business and Informatics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Ágota Dobos
- Centre for Foreign Language Education and Research, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Ottó Hajdu
- Institute of Business Economics, Eötvös Loránd University, Rákóczi út 7, Budapest, 1088, Hungary
| | - Levente Kovács
- University Research and Innovation Center, Óbuda University, Bécsi út 96/b, Budapest, 1034, Hungary
| | - László Gulácsi
- University Research and Innovation Center, Óbuda University, Bécsi út 96/b, Budapest, 1034, Hungary
- Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Judith Hibbard
- Health Policy Research Group, University of Oregon, 1209 University of Oregon, Eugene, OR, 97403-1209, USA
| | - Márta Péntek
- University Research and Innovation Center, Óbuda University, Bécsi út 96/b, Budapest, 1034, Hungary
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11
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Multiple sclerosis disease-related knowledge measurement instruments show mixed performance: a systematic review. J Clin Epidemiol 2022; 149:60-82. [DOI: 10.1016/j.jclinepi.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/02/2022] [Accepted: 05/24/2022] [Indexed: 11/20/2022]
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12
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Magadi W, Lightfoot CJ, Memory KE, Santhakumaran S, van der Veer SN, Thomas N, Gair R, Smith AC. Patient activation and its association with symptom burden and quality of life across the spectrum of chronic kidney disease stages in England. BMC Nephrol 2022; 23:45. [PMID: 35081904 PMCID: PMC8793272 DOI: 10.1186/s12882-022-02679-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 01/13/2022] [Indexed: 12/11/2022] Open
Abstract
Background The knowledge, skills, and confidence to manage one’s own health is termed patient activation and can be assessed using the Patient Activation Measure (PAM). This measure is increasingly recommended for use in chronic kidney disease (CKD), but there is a need to better understand patient activation within this population. This work aimed to explore the association of PAM with patient-reported outcomes, namely symptom burden and health-related quality of life (HRQoL), to understand the relationship between patient activation and outcomes which are of importance to people with CKD. Methods Non-dialysis, dialysis, and kidney transplant patients from 14 renal units across England completed a survey comprising questionnaires assessing patient activation, symptom burden, and HRQoL. Latent class analysis (LCA) was used to determine HRQoL and symptom burden subgroups in the data. Multinomial logistic regression analyses were performed to investigate the associations between patient activation and symptom burden and HRQoL classes separately, adjusting for age, gender, ethnicity, deprivation and treatment modality. Results Three thousand thirteen participants (mean age 61.5 years, 61.8% males, and 47% haemodialysis) were included in the analysis. Patient activation was strongly associated with both the HRQoL and symptom burden classes identified, with highly activated patients more likely to report higher HRQoL (P = < 0.0001; OR 29.2, 95% CI 19.5–43.9) and fewer symptoms (P = < 0.0001; OR 25.9, 95% CI 16.8–40.2). Conclusion Lower activation levels are associated with a higher symptom burden and reduced HRQoL across the trajectory of CKD stages and treatment modalities. Therefore, targeted and holistic self-management support focussing on improving activation may have the potential to improve aspects of health experience which are valued by individuals living with kidney disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02679-w.
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Affiliation(s)
- Winnie Magadi
- UK Renal Registry, Brandon House Building 20A1, Southmead Road, Bristol, BS34 7RR, UK.
| | - Courtney J Lightfoot
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Katherine E Memory
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Shalini Santhakumaran
- UK Renal Registry, Brandon House Building 20A1, Southmead Road, Bristol, BS34 7RR, UK
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Nicola Thomas
- School of Health and Social Care, London South Bank University, London, UK
| | - Rachel Gair
- UK Renal Registry, Brandon House Building 20A1, Southmead Road, Bristol, BS34 7RR, UK
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
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13
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Hussein WF, Bennett PN, Sun SJ, Reiterman M, Watson E, Farwell IM, Schiller B. Patient Activation Among Prevalent Hemodialysis Patients: An Observational Cross-Sectional Study. J Patient Exp 2022; 9:23743735221112220. [PMID: 35924026 PMCID: PMC9340399 DOI: 10.1177/23743735221112220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Patient activation is the product of knowledge, skills, and confidence that
enables a person to manage their own healthcare. It is associated with healthy
behaviors and improved patient outcomes. We surveyed prevalent hemodialysis (HD)
patients at 10 centers using the Patient Activation Measure 13-item instrument
(PAM-13). Activation was reported as scores (0-100) and corresponding levels
(1-4). Of 1149 eligible patients, surveys were completed by 925 patients (92%
response rate). Mean age was 62 ± 14 years, 40% were female, median vintage was
41 (IQR 19-77) months, and 66% had diabetes. Mean PAM score was 56 ± 13, with
14%, 50%, 25%, and 10% in levels 1 to 4, respectively. In adjusted analysis,
older age and having diabetes were associated with lower activation, whereas
higher educational levels and female gender were associated with higher scores.
Significant variation in activation was observed among participants from
different centers even after adjustment for other variables. In conclusion, low
activation is common among prevalent HD patients.
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Affiliation(s)
- Wael F Hussein
- Satellite Healthcare, San Jose, CA, USA
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Paul N Bennett
- Satellite Healthcare, San Jose, CA, USA
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | | | | | | | | | - Brigitte Schiller
- Satellite Healthcare, San Jose, CA, USA
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
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14
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Bloem AEM, Mostard RLM, Stoot N, Custers JWH, Vooijs M, Janssen DJA, van 't Hul AJ, Spruit MA. Patient Activation for Self-Management in Patients with Idiopathic Pulmonary Fibrosis or Sarcoidosis. Respiration 2021; 101:76-83. [PMID: 34515234 DOI: 10.1159/000518216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/30/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Self-management is considered important in the management of patients with idiopathic pulmonary fibrosis (IPF) or sarcoidosis. However, data about the degree of activation for self-management is lacking. OBJECTIVES The aim of the study was to determine the degree of activation for self-management in patients with IPF or sarcoidosis using the Patient Activation Measure (PAM) and to evaluate the association between PAM scores, clinical characteristics, and health-related outcomes. STUDY DESIGN AND METHODS This cross-sectional prospective study assessed besides the PAM also demographics, lung function, dyspnea (modified Medical Research Council [mMRC]), fatigue (Checklist Individual Strength-Fatigue [CIS-Fatigue]), anxiety/depression (Hospital Anxiety and Depression Scale [HADS-A/HADS-D]), and generic health status (EuroQol five-dimensional-five-level [EQ-5D-5L]). RESULTS Mean PAM was 55.0 (9.1) points in patients with IPF (n = 59) and low levels of patient activation for self-management (PAM ≤55.1 points) were present in 56% of the patients. PAM Scores correlated significantly (p < 0.05) with mMRC (ρ = -0.476), HADS-A (ρ = -0.326), HADS-D (ρ = -0.459), and EQ-5D-5L (ρ = 0.393). In patients with sarcoidosis (n = 59), the mean PAM score was 55.7 (11.0) points, and 46% of the patients reported low PAM levels. Significant correlations were found with mMRC (ρ = -0.356), HADS-A (ρ = -0.394), HADS-D (ρ = -0.478), and EQ-5D-5L (ρ = 0.313). CONCLUSION About half of the outpatients with IPF or sarcoidosis have a low degree of activation for self-management, and these patients generally report more dyspnea, anxiety, depression, and a lower health status. Whether patients with a low degree of activation can be successful in self-managing their disease remains to be determined.
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Affiliation(s)
- Ada E M Bloem
- Institute of Movement Studies, University of Applied Sciences Utrecht, Faculty of Health Care, Utrecht, The Netherlands.,Department of Pulmonology, ILD Centre of Excellence, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Rémy L M Mostard
- Department of Respiratory Medicine, Zuyderland Medical Center Heerlen, Heerlen/Sittard-Geleen, The Netherlands
| | - Naomi Stoot
- Department of Respiratory Medicine, Zuyderland Medical Center Heerlen, Heerlen/Sittard-Geleen, The Netherlands
| | - Jan W H Custers
- Institute of Movement Studies, University of Applied Sciences Utrecht, Faculty of Health Care, Utrecht, The Netherlands
| | - Martijn Vooijs
- Institute of Movement Studies, University of Applied Sciences Utrecht, Faculty of Health Care, Utrecht, The Netherlands
| | - Daisy J A Janssen
- Department of Research and Development, Ciro, Horn, The Netherlands.,Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Alex J van 't Hul
- Department of Respiratory Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martijn A Spruit
- Department of Research and Development, Ciro, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Science, Maastricht, The Netherlands
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15
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Lindman A, Handberg C, Olesen G, Duijts S. Health-related quality of life and physical functioning in patients participating in a rehabilitation programme, undergoing non-myeloablative allogeneic haematopoietic stem cell transplantation: Outcomes from a single arm longitudinal study. Eur J Cancer Care (Engl) 2021; 30:e13478. [PMID: 34263492 DOI: 10.1111/ecc.13478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study aims to report HRQOL, patient activation and physical functioning of haematological patients, participating in a 6-month multimodal interdisciplinary rehabilitation programme HAPPY, when undergoing non-myeloablative allogeneic haematopoietic stem cell transplantation (NMA-HSCT). METHODS A prospective single-arm longitudinal design. Outcomes were collected as part of a feasibility study and included: HRQOL (EORTC QLQ-C30), patient activation measure (PAM), cardiorespiratory capacity (VO2peak ), leg extensor power, lean body mass, measured pre-NMA-HSCT at 3-, 6- and 12-month follow-up. RESULTS Thirty (mean age (SD) 64.1 (6.5)) out of 34 patients participated and 18 completed HAPPY. Outcome measures showed large individual differences of decline and improvement during follow-up. Patients rated HRQOL as good (median 70.8; range 33.3-100). Fatigue, dyspnoea, insomnia and appetite loss mainly remained or worsened. PAM stayed in the upper half of range (median 55.6; range 20.5-84.8) with a trend towards improvement at 12-month follow-up. Physical functioning scores were low [i.e. baseline VO2peak , men median 1.5 L/min range (1.0-2.9), women 1.0 L/min (0.8-1.4), leg extensor power men 2.1 Watt/kg range (1.3-3.8), women 1.7 Watt/kg (1.3-2.4), lean body mass men 19.5% (17.6-24.9) and women 17.8% (15.3-21.7)]. CONCLUSION The sustained low level of physical functioning and symptoms 12-month after NMA-HSCT emphasise the need for pre-rehabilitation and long-lasting rehabilitation support in this frail patient group.
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Affiliation(s)
- Astrid Lindman
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Charlotte Handberg
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
| | - Gitte Olesen
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
| | - Saskia Duijts
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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16
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Lightfoot CJ, Wilkinson TJ, Memory KE, Palmer J, Smith AC. Reliability and Validity of the Patient Activation Measure in Kidney Disease: Results of Rasch Analysis. Clin J Am Soc Nephrol 2021; 16:880-888. [PMID: 34117081 PMCID: PMC8216620 DOI: 10.2215/cjn.19611220] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/22/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite the increasing prioritization of the promotion of patient activation in nephrology, its applicability to people with CKD is not well established. Before the Patient Activation Measure is universally adopted for use in CKD, it is important to critically evaluate this measure. The aim of this study was to describe the psychometric properties of the Patient Activation Measure in CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A survey containing the 13-item Patient Activation Measure was completed by 942 patients with CKD, not treated with dialysis. Data quality was assessed by mean, item response, missing values, floor and ceiling effects, internal consistency (Cronbach's alpha and average interitem correlation), and item-rest correlations. Rasch modeling was used to assess item performance and scaling (item statistics, person and item reliability, rating scale diagnostics, factorial test of residuals, and differential item functioning). RESULTS The item response was high, with a small number of missing values (<1%). Floor effect was small (range 1%-5%), but the ceiling effect was above 15% for nine items (range 15%-38%). The Patient Activation Measure demonstrated good internal consistency overall (Cronbach α=0.925, and average interitem correlation 0.502). The difficulty of the Patient Activation Measure items ranged from -0.90 to 0.86. Differential item functioning was found for disease type (item 3) and age (item 12). The person separation index was 9.48 and item separation index was 3.21. CONCLUSIONS The 13-item Patient Activation Measure appears to be a suitably reliable and valid instrument for assessing patient activation in CKD. In the absence of a kidney-specific instrument, our results support the 13-item Patient Activation Measure as a promising measure to assess activation in those with CKD, although consideration for several items is warranted. The high ceiling effect may be a problem when using the 13-item Patient Activation Measure to measure changes over time.
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Affiliation(s)
- Courtney J Lightfoot
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
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17
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Development and evaluation of an interactive web-based decision-making programme on relapse management for people with multiple sclerosis (POWER@MS2)-study protocol for a randomised controlled trial. Trials 2021; 22:139. [PMID: 33583424 PMCID: PMC7882468 DOI: 10.1186/s13063-021-05059-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/20/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Multiple sclerosis is a chronic inflammatory, degenerative disease of the central nervous system manifesting at first with relapses in about 85% of cases. In Germany, intravenous therapy with high-dose corticosteroids is the treatment standard of acute relapses. The treatment leads to a faster reduction of symptoms in about 25 of 100 treated patients but has no proven long-term benefits over placebo treatment. Intravenous treatment is not superior to oral treatment. Therefore, informed decisions on relapse management are required. An earlier randomised controlled trial showed that evidence-based patient information and education on relapse management leads to more informed decisions and more relapses not treated or treated with oral corticosteroids. This study aims to evaluate whether a web-based relapse management programme will positively change relapse management and strengthen autonomy in people with multiple sclerosis. Methods The pragmatic double-blind randomised controlled trial is accompanied by a mixed-methods process evaluation and a health economic evaluation and follows the UK Medical Research Council guidance on developing and evaluating complex interventions. A total of 188 people with possible or relapsing-remitting multiple sclerosis with ≥ 1 relapse within the last year and/or ≥ 2 relapses within the last 2 years will be recruited and randomised using blocks. The intervention group receives a web- and dialogue-based decision aid on relapse management, a nurse-led webinar and access to a monitored chat forum. The control group receives standard information, which will be made available via the same online platform as the intervention. The primary endpoint is the proportion of relapses not treated or treated with oral corticosteroids. Key secondary endpoints are the annualised relapse rate, decision-making, empowerment, quality of life and cost-effectiveness. Facilitators and barriers will be assessed by mixed-methods process evaluation measures. The study ends when 81 relapses have been documented or after 24 months of observation per individual patient. Analyses will follow the intention-to-treat principle. Discussion We hypothesise that the intervention will enhance patient empowerment and have a positive impact on patients’ relapse management. Trial registration ClinicalTrials.govNCT04233970. Registered on 18 January 2020
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18
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Wilkie DD, Solari A, Nicholas RSJ. The impact of the face-to-face consultation on decisional conflict in complex decision-making in multiple sclerosis: A pilot study. Mult Scler J Exp Transl Clin 2020; 6:2055217320959802. [PMID: 33194220 PMCID: PMC7594484 DOI: 10.1177/2055217320959802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/29/2020] [Indexed: 11/24/2022] Open
Abstract
Background The role of face-to-face consultations in medicine is increasingly being
challenged. Disease activity, national guidelines, life goals e.g.
pregnancy, multiple therapies and side effects need to be considered on
starting disease modifying treatments (DMTs) in people with multiple
sclerosis (pwMS). Objectives We studied the impact of a face-to-face consultation on decision making,
using decisional conflict (DC) as the primary outcome. Methods Prospective cohort study of 73 pwMS attending clinics who were making
decisions about DMTs followed for one year. Prerequisites and consultation
features were measured with the SURE scale for DC used as the primary
outcome at baseline and at one year. Results The patient activation measure (PAM) was the only driver prior to the
consultation associated with DC (p = 0.02) showing those less engaged were
more likely to have DC. Overall, 51/73 (70%) of people made their treatment
decision or reinforced a former decision during the consultation. We found
making a treatment decision between the original consultation and the
follow-up was associated with resolving DC (p = 0.008). Conclusions Patient engagement impacts DC but the HCP delivering the optimal Shared
Decision Making (SDM) approach is additionally significant in reducing DC.
In complex decisions there is a clear role for face-to-face consultations in
current practice.
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Affiliation(s)
- David Daniel Wilkie
- Centre for Neuroscience, Faculty of Medicine, Imperial College London, London, UK
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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19
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Hamilton CB, Li LC. Measures of Patient Activation and Self-Efficacy. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:645-659. [PMID: 33091240 DOI: 10.1002/acr.24350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/05/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Clayon B Hamilton
- The University of British Columbia, Vancouver, British Columbia, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Linda C Li
- The University of British Columbia, Vancouver, British Columbia, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
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20
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Newland P, Lorenz R, Oliver BJ. Patient activation in adults with chronic conditions: A systematic review. J Health Psychol 2020; 26:103-114. [PMID: 32830587 DOI: 10.1177/1359105320947790] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Patient activation is an important aspect of self-management for adults with chronic non cancerous health conditions (CHC). However, there is limited evidence about which measures of patient activation and healthrelated quality of life are most useful to clinicians. This systematic review examined regarding the types of measures used to evaluate a patient's readiness for self-management including patient activation and healthrelated quality of life (HRQOL). Two such as measurements are the Patient Activation Measure (PAM) and overall PROMIS® Global health. Ten articles were identified which included measurement of patient activation and HRQOL. The results indicate that HRQOL is evaluated with various measurement tools. Most researchers agree that patient activation and the measurement of global HRQOL positively contribute to successful self-management strategies.
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Affiliation(s)
| | | | - Brant J Oliver
- Departments of Community & Family Medicine, Psychiatry, The Dartmouth Institute for Health Policy & Clinical Practice, The Geisel School of Medicine at Dartmouth
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21
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Plow M, Packer T, Mathiowetz VG, Preissner K, Ghahari S, Sattar A, Bethoux F, Finlayson M. REFRESH protocol: a non-inferiority randomised clinical trial comparing internet and teleconference to in-person 'Managing Fatigue' interventions on the impact of fatigue among persons with multiple sclerosis. BMJ Open 2020; 10:e035470. [PMID: 32801193 PMCID: PMC7430436 DOI: 10.1136/bmjopen-2019-035470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system. It is considered a major cause of non-traumatic disability in young adults. One of the most common and disabling symptoms of MS is fatigue. MS fatigue can impact all aspects of quality of life, including physical, mental and social function. Fortunately, fatigue self-management interventions, such as 'Managing Fatigue: A 6 week energy conservation course', can decrease the impact of fatigue and improve health-related quality of life. The purpose of this study is to compare three modes of delivering the Managing Fatigue intervention-two remote delivery formats (teleconference and internet) and one in-person format-on perceptions of fatigue and its impact on physical, mental and social function. METHODS AND ANALYSIS A non-inferiority randomised clinical trial is being conducted to compare the three delivery formats (1:1:1 allocation ratio) among 582 participants with MS living in the Midwestern and Northeastern United States. The hypothesis is that teleconference and internet versions of the intervention are non-inferior to the traditional mode of clinical service delivery (ie, one to one, in person) in terms of the primary outcome of self-reported fatigue impact (ie, Fatigue Impact Scale) and the secondary outcome of health-related quality of life (ie, Multiple Sclerosis Impact Scale). Outcomes are being measured at baseline, 2 months, 3 months and 6 months. The primary analysis tool will be linear mixed effects model. The prespecified inferiority margin for the primary outcome is 10 points. We will also examine whether baseline characteristics (eg, sociodemographic) moderate outcomes of the Managing Fatigue intervention and whether changes in self-efficacy and fatigue self-management behaviours mediate changes in outcomes. ETHICS AND DISSEMINATION The protocol is approved centrally by the institutional review board at Case Western Reserve University. Eligible participants give consent before being enrolled and randomised into the study. The study results will be disseminated through relevant advocacy organisations, newsletters to participants, publication in peer-reviewed journals and presentations at scientific conferences. TRIAL REGISTRATION NUMBER NCT03550170; Pre-results.
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Affiliation(s)
- Matthew Plow
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Tanya Packer
- School of Occupational Therapy and School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Virgil G Mathiowetz
- Program in Occupational Therapy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kathy Preissner
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Abdus Sattar
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Francois Bethoux
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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22
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Cunha CM, da Cunha DCPT, Manzato RDO, Nepomuceno E, da Silva D, Dantas RAS. Validation of the Brazilian Version of the Patient Activation Measure 13. J Nurs Meas 2020; 27:97-113. [PMID: 31068494 DOI: 10.1891/1061-3749.27.1.97] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE To assess the psychometric properties of the PAM13 Brazilian-Portuguese (PAM13-B) among outpatients with chronic diseases. METHODS 513 adults participated, diagnosed with a chronic disease for more than 6 months, under outpatient monitoring. Reliability was tested using internal consistency and test-retest reliability. Construct validity was verified through different techniques (correlation between activation and self-esteem measures, anxiety, depression and health status), known-groups validity and dimensionality by means of confirmatory factor analysis. Significance was set at 0.05. RESULTS The PAM13-B presented appropriate results for internal consistency (α = 0.83) and test-retest reliability (intraclass correlation coefficient [ICC] = 0.81). A moderate correlation was found between activation and self-esteem only (r = 0.43, p < 0.001). The one-dimensional structure was not confirmed in the sample analyzed. CONCLUSIONS In the study sample, the version PAM13-B demonstrated its reliability and validity, but with a two-factor structure.
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Affiliation(s)
| | | | | | - Eliane Nepomuceno
- University of São Paulo at Ribeirão Preto College of Nursing-São Paulo State, Brazil
| | - Dirceu da Silva
- University of Campinas, Faculty of Education, Campinas-São Paulo State, Brazil
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Self-Management, Self-Efficacy, and Health-Related Quality of Life in Children With Chronic Illness and Medical Complexity. J Pediatr Health Care 2020; 34:304-314. [PMID: 32107073 PMCID: PMC8381929 DOI: 10.1016/j.pedhc.2019.11.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/18/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Children with chronic illnesses and medical complexity (CIMC) require frequent health-care use, thereby increasing medical care costs. We evaluated parent-child perceptions of self-management, self-efficacy, and health-related quality of life (HRQOL) in children with CIMC. METHOD Parent-children pairs (n = 32) completed three measures before discharge from the hospital (Patient Activation Measure, Self-Efficacy Scale, and Acute Care-Pediatric Quality of Life for Children 8-12 and 13-17 years). RESULTS Parents (56.3%) and children (40.6%) reported moderate levels of self-management. HRQOL was correlated with both self-management (r = .441, p = .12) and self-efficacy (r = .464, p = .008). At least 25% to 50% reported low PedsQL subscale scores (< 70), which indicate problems with physical, emotional, social, and mental domains. DISCUSSION Our findings support the assessment of not only physical but also mental, emotional, and social needs in children with CIMC. We recommend development and testing strategies promoting self-management and self-efficacy to maximize HRQOL and improve health outcomes in children with CIMC.
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Allen-Philbey K, Middleton R, Tuite-Dalton K, Baker E, Stennett A, Albor C, Schmierer K. Can We Improve the Monitoring of People With Multiple Sclerosis Using Simple Tools, Data Sharing, and Patient Engagement? Front Neurol 2020; 11:464. [PMID: 32655472 PMCID: PMC7325931 DOI: 10.3389/fneur.2020.00464] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 04/29/2020] [Indexed: 12/14/2022] Open
Abstract
Technological innovation is transforming traditional clinical practice, enabling people with multiple sclerosis (pwMS) to contribute health care outcome data remotely between clinic visits. In both relapsing and progressive forms of multiple sclerosis (MS), patients may experience variable disability accrual and symptoms throughout their disease course. The potential impact on the quality of life (QoL) in pwMS and their families and carers is profound. The introduction of treatment targets, such as NEDA (no evidence of disease activity) and NEPAD (no evidence of progression or active disease), that guide clinical decision-making, highlight the importance of utilizing sensitive instruments to measure and track disease activity and progression. However, the gold standard neurological disability tool—expanded disability severity scale (EDSS)—has universally recognized limitations. With strides made in our understanding of MS pathophysiology and DMT responsiveness, maintaining the status quo of measuring disability progression is no longer the recommended option. Outside the clinical trial setting, a comprehensive monitoring system has not been robustly established for pwMS. A 21st-century approach is required to integrate clinical, paraclinical, and patient-reported outcome (PRO) data from electronic health records, local databases, and patient registries. Patient and public involvement (PPI) is critical in the design and implementation of this workflow. To take full advantage of the potential of digital technology in the monitoring and care and QoL of pwMS will require iterative feedback between pwMS, health care professionals (HCPs), scientists, and digital experts.
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Affiliation(s)
- Kimberley Allen-Philbey
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Rod Middleton
- UK MS Register, Swansea University Medical School, Swansea, United Kingdom
| | - Katie Tuite-Dalton
- UK MS Register, Swansea University Medical School, Swansea, United Kingdom
| | - Elaine Baker
- UK MS Register, Swansea University Medical School, Swansea, United Kingdom
| | - Andrea Stennett
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Christo Albor
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Klaus Schmierer
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.,The Blizard Institute (Neuroscience, Surgery & Trauma), Queen Mary University of London, London, United Kingdom
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25
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Eyles JP, Ferreira M, Mills K, Lucas BR, Robbins SR, Williams M, Lee H, Appleton S, Hunter DJ. Is the Patient Activation Measure a valid measure of osteoarthritis self-management attitudes and capabilities? Results of a Rasch analysis. Health Qual Life Outcomes 2020; 18:121. [PMID: 32370751 PMCID: PMC7201682 DOI: 10.1186/s12955-020-01364-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 04/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Patient Activation Measure (PAM-13) was developed using Rasch analysis to assess knowledge, skills and confidence in the management of one's health. Previous studies report positive relationships between PAM-13 scores, self-management behaviours and longitudinal health outcomes in adults with chronic disease. There is little extant measurement property evidence for the use of PAM-13 in specific osteoarthritis (OA) populations. This study tested measurement properties of the PAM-13 in people living with hip and knee OA. METHODS Item response frequency analysis was conducted. Rasch analysis evaluated the fit of the PAM-13 data to the Rasch model. Model-data fit was evaluated using infit and outfit statistics; person/item reliability and person separation indices were computed. Unidimensionality was evaluated using Principal Components Analysis of Rasch residuals and the data were assessed for item redundancy. Differential Item Functioning (DIF) examined bias in respondent subgroups and correlations tested relationships between PAM-13 and other patient-reported outcomes. RESULTS Two-hundred-and-seventeen PAM-13 surveys were completed; there were no missing responses, floor or ceiling effects. Person and item reliability were acceptable (0.98 and 0.87 respectively) with good separation (person separation index 2.58). Unidimensionality was evaluated, with 49.4% of the variance explained by the first eigenvector. There was evidence of potential local response-dependence. The Rasch fit statistics were acceptable (except for item-2). There were some issues identified with targeting of the PAM-13 items to people with higher ability and the item difficulty order was different to that proposed in original cohorts. Significant DIF was identified for sex and educational level for a small number of items. PAM-13 scores were moderately correlated with depressive symptoms on the Depression Anxiety Stress Scale and Assessment of Quality of Life-6D. There were small correlations between PAM-13 and Knee injury and Osteoarthritis Outcome Score pain and activities of daily living scores. CONCLUSIONS This study provides some evidence of adequate person and item reliability, unidimensionality, and construct validity to support the use of PAM-13 to measure patient activation in people living with hip and knee OA. Possible limitations regarding targeting, different item difficulty order, DIF and local response dependence should be investigated in future research.
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Affiliation(s)
- J P Eyles
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. .,Department of Rheumatology, Royal North Shore Hospital , Sydney, Australia. .,Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia.
| | - M Ferreira
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Rheumatology, Royal North Shore Hospital , Sydney, Australia
| | - K Mills
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - B R Lucas
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
| | - S R Robbins
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Rheumatology, Royal North Shore Hospital , Sydney, Australia
| | - M Williams
- Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
| | - H Lee
- Rehabilitation Department, Hunters Hill Private Hospital, Sydney, Australia
| | - S Appleton
- Physiotherapy Department, Mount Wilga Private Hospital, Sydney, Australia
| | - D J Hunter
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Rheumatology, Royal North Shore Hospital , Sydney, Australia
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Allen S, Rogers SN, Harris RV. Socio-economic differences in patient participation behaviours in doctor-patient interactions-A systematic mapping review of the literature. Health Expect 2019; 22:1173-1184. [PMID: 31398772 PMCID: PMC6803421 DOI: 10.1111/hex.12956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 12/15/2022] Open
Abstract
Background The degree to which patients participate in their care can have a positive impact on health outcomes. This review aimed to map the current literature on patient participation behaviours in interactions with physicians and the extent to which differences in these behaviours can be explained by socio‐economic status (SES). Search strategy Four electronic databases were searched from 1980 onwards using key words related to socio‐economic status and patient participation behaviours. Study selection Titles, abstracts and full texts were screened by two reviewers, with the second reviewer screening 20% of all entries. Data extraction Data on year of publication, country, patient population, setting, patient participation behaviour studied, and SES measure used were extracted. Main results Forty‐nine studies were included in the review. Most studies were conducted in the United States, and the most commonly studied patient participation behaviour was involvement in decision making. Most studies measured SES using education as an indicator, with very few studies using occupation as a measure. Many studies did not report on participants’ medical condition or study setting. Patient participation in their health‐care appointment increased with increasing SES in 24 studies, although in 27 studies no significant association was found. Discussion and conclusions Current literature was found to be mainly US‐centric. Many studies did not specify participants’ medical condition or in what setting the study was undertaken. More studies are needed on less commonly studied patient participation behaviours. It would be helpful for further studies to also include a wider range of SES indicators.
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Affiliation(s)
- Sarah Allen
- Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Simon N Rogers
- Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK.,Consultant Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK
| | - Rebecca V Harris
- Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
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Barnes EL, Long MD, Kappelman MD, Martin CF, Sandler RS. High Patient Activation Is Associated With Remission in Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:1248-1254. [PMID: 30590700 PMCID: PMC6939681 DOI: 10.1093/ibd/izy378] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND High levels of patient activation (having the knowledge, skills, and confidence to effectively manage one's care), have been associated with improved outcomes in many chronic conditions. There have been few studies of the effects of activation in patients with inflammatory bowel disease (IBD). We performed a large, prospective Internet-based study to assess the relationship between patient activation level and clinical remission in patients with Crohn's disease or ulcerative colitis. METHODS We administered the Patient Activation Measure (Insignia Health) to 1486 cohort participants. Patients completed a follow-up survey within 13 months (median, 189 days). We collected demographic and clinical data; anxiety and depression were assessed using Patient-Reported Outcomes Measurement Information System instruments. We used bivariate analyses and multivariable logistic regression to identify characteristics associated with low or high patient activation and to evaluate the association between levels of patient activation and subsequent disease activity. RESULTS Higher anxiety (adjusted odds ratio [aOR], 0.32; 95% confidence interval [CI], 0.29-0.36) and depression (aOR, 0.33; 95% CI, 0.29-0.37) scores were associated with a decreased odds of high patient activation. After we adjusted for education status, smoking, medication use, and other confounders, we found that patients with high activation at baseline were more likely to be in clinical remission during the follow-up period (aOR, 1.71; 95% CI, 1.20-2.45). CONCLUSIONS In a large, prospective Internet-based cohort of patients with IBD, we found a strong association between patient activation and clinical remission. These findings suggest that patient activation affects disease outcomes.
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Affiliation(s)
- Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Address correspondence to: Edward L. Barnes, MD, MPH, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Bioinformatics Building, CB #7080, Chapel Hill, NC 27599-7080 ()
| | - Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael D Kappelman
- Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Division of Pediatric Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christopher F Martin
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Robert S Sandler
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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McCusker J, Lambert SD, Haggerty J, Yaffe MJ, Belzile E, Ciampi A. Self-management support in primary care is associated with improvement in patient activation. PATIENT EDUCATION AND COUNSELING 2019; 102:571-577. [PMID: 30497799 DOI: 10.1016/j.pec.2018.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/11/2018] [Accepted: 10/13/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To examine: 1) whether patient characteristics predict perceived self-management support (usefulness of information and collaborative care planning) by primary care providers after six months, and 2) the association between perceived self-management support and patient activation at 6 months METHODS: We conducted a secondary analysis among 120 primary care patients aged 40 and over with a chronic physical condition and comorbid depressive symptoms who participated in a randomized controlled trial of a coaching intervention for depression self-management. Activation was measured at baseline (T0) and 6 months (T1). Self-management support was captured at T1 for physical and mood problems. RESULTS The sample of analysis was 120 patients who completed all relevant measures. At T1, the perceived usefulness of information for mood self-management was independently associated with activation. More severe depressive symptoms at T0 predicted lower perceived usefulness of chronic condition self-management information at T1. Lower T0 mental health-related quality of life predicted lower perceived usefulness of mood self-management information at T1. CONCLUSIONS Perceived informational support for mood self-management may contribute to increased activation. Patients with more severe mental health symptoms or impairment perceive that they receive less useful self-management information from their care team. PRACTICE IMPLICATIONS Care teams should determine whether patients with mood problems need greater self-management support.
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Affiliation(s)
- Jane McCusker
- St. Mary's Research Centre, Hayes Pavilion, 3830 Avenue Lacombe, Suite 4720, H3T 1M5, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pin. Avenue, H3A 1A2, Montreal, Quebec, Canada.
| | - Sylvie D Lambert
- St. Mary's Research Centre, Hayes Pavilion, 3830 Avenue Lacombe, Suite 4720, H3T 1M5, Montreal, Quebec, Canada; Ingram School of Nursing, McGill University, McGill University, 680 Sherbrooke Street West, Suite 1800, H3A 2M7, Montreal, Quebec, Canada.
| | - Jeannie Haggerty
- St. Mary's Research Centre, Hayes Pavilion, 3830 Avenue Lacombe, Suite 4720, H3T 1M5, Montreal, Quebec, Canada; Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, 3rd Floor, H3S 1Z1, Montreal, Quebec, Canada.
| | - Mark J Yaffe
- St. Mary's Research Centre, Hayes Pavilion, 3830 Avenue Lacombe, Suite 4720, H3T 1M5, Montreal, Quebec, Canada; Family Medicine Centre, St. Mary's Hospital Center, 3830, H3T 1M5, Montreal, Quebec, Canada; Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, 3rd Floor, H3S 1Z1, Montreal, Quebec, Canada.
| | - Eric Belzile
- St. Mary's Research Centre, Hayes Pavilion, 3830 Avenue Lacombe, Suite 4720, H3T 1M5, Montreal, Quebec, Canada.
| | - Antonio Ciampi
- St. Mary's Research Centre, Hayes Pavilion, 3830 Avenue Lacombe, Suite 4720, H3T 1M5, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pin. Avenue, H3A 1A2, Montreal, Quebec, Canada.
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29
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Kessler D, Hauteclocque J, Grimes D, Mestre T, Côtéd D, Liddy C. Development of the Integrated Parkinson’s Care Network (IPCN): using co-design to plan collaborative care for people with Parkinson’s disease. Qual Life Res 2019; 28:1355-1364. [DOI: 10.1007/s11136-018-2092-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
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Azulay R, Valinsky L, Hershkowitz F, Magnezi R. Is the patient activation measure associated with adherence to colonoscopy after a positive fecal occult blood test result? Isr J Health Policy Res 2018; 7:74. [PMID: 30577883 PMCID: PMC6303990 DOI: 10.1186/s13584-018-0270-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 12/10/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a major cause of morbidity and mortality worldwide, but these can be reduced significantly with population screening using annual fecal occult blood tests (FOBT)A positive FOBT requires timely follow-up with colonoscopy to maximize screening benefits.. Several barriers to follow-up have been identified, with patient health behaviors and choices comprising a significant part of these. The Patient Activation Measure (PAM) assesses knowledge, skills, beliefs, and confidence in managing health. Increased patient activation is related to positive health outcomes. The aim of this study is to examine the association between patient empowerment, as reflected in the PAM, and follow-up colonoscopy within 90 days of a positive FOBT result. METHODS This case-control study included 429 patients with a positive FOBT, 174 who had a colonoscopy within 90 days, and 255 who did not.. Participants completed a PAM telephone questionnaire (Cronbach's α = 0.785). We used both univariate and multivariate analyses to examine the effect of the PAM score as on the likelihood of undergoing colonoscopy, after adjusting for the independent variables. RESULTS In this study we did not find a significant association between PAM and adherence to colonoscopy, using both univariate and multivariate analyses (p = .334 and p = .697, whether PAM was defined as a continuous or as categorical, respectively). CONCLUSIONS This study was the first to examine the association between patient empowerment, as reflected in the patient activation measure, and adherence to colonoscopy after a positive FOBT. The findings did not support such an association. Further examination is required to clarify the relation between patient empowerment and activation and personal healthcare in general, and in the Israeli population in particular. Future policy should include specific, technical interventions to improve FOBT follow-up among all groups, until the patient-related barriers are better understood. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02534142 https://clinicaltrials.gov/ct2/show/NCT02534142.
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Affiliation(s)
- Revital Azulay
- Department of Management, MHA Program, Bar Ilan University, Ramat Gan, Israel. .,Central Laboratory, Meuhedet Health Care, 5 Pesach lev, Lod, Israel.
| | - Liora Valinsky
- Quality Department, Meuhedet Health Care, 124 Eben Gvirol, Tel Aviv, Israel
| | | | - Racheli Magnezi
- Department of Management, MHA Program, Bar Ilan University, Ramat Gan, Israel
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31
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Weiland TJ, De Livera AM, Brown CR, Jelinek GA, Aitken Z, Simpson SL, Neate SL, Taylor KL, O'Kearney E, Bevens W, Marck CH. Health Outcomes and Lifestyle in a Sample of People With Multiple Sclerosis (HOLISM): Longitudinal and Validation Cohorts. Front Neurol 2018; 9:1074. [PMID: 30619037 PMCID: PMC6299875 DOI: 10.3389/fneur.2018.01074] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/26/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: To report the methodology and summary data of the Health Outcomes and Lifestyle In a Sample of people with Multiple sclerosis (HOLISM) longitudinal and validation cohorts. We report (1) data on participation, socio-demographics, disease characteristics, medication use, modifiable lifestyle risk factor exposures, and health outcomes of the HOLISM longitudinal cohort 2.5-years post enrolment; (2) attrition at this 2.5-year wave; and (3) baseline characteristics of the associated HOLISM validation cohort. Methods: The HOLISM longitudinal study recruited people internationally with self-reported diagnosed multiple sclerosis (MS) through web 2.0 platforms and MS society newsletters. Participants, first recruited in 2012, were invited 2.5-years later to participate in a follow-up survey. At both time points, participants completed a comprehensive online questionnaire of socio-demographics, modifiable lifestyle exposures, and health outcomes using validated and researcher-designed tools. The same methodology was used to recruit a new sample: the HOLISM validation cohort. Characteristics were explored using summary measures. Results: Of 2,466 people with MS at baseline, 1,401 (56.8%) provided data at 2.5-year follow-up. Attrition was high, likely due to limited amount of contact information collected at baseline. Completion of the 2.5-year wave was associated with healthier lifestyle, and better health outcomes. Participants completing follow-up had diverse geographical location, were predominantly female, married, unemployed or retired. At 2.5-year follow-up, nearly 40% were overweight or obese, most were physically active, non-smokers, consumed little alcohol, used vitamin D/omega-3 supplements, and 42% reported current disease-modifying drug use. Thirty percentage of reported cane or gait disability, while 13% relied on major mobility supports (Patient Determined Disease Steps). Approximately half the respondents reported a comorbidity, 63% screened positive for clinically significant fatigue (Fatigue Severity Scale), and 22% screened positive for depression (Patient Health Questionnaire-9). The validation cohort's characteristics were mostly consistent with previously reported HOLISM baseline data. Conclusions: Exploring prospective associations of modifiable environmental/behavioral risk factors with health outcomes in this international longitudinal sample of people with MS will be beneficial to MS research. Impacts of attrition and selection bias will require consideration. The validation cohort provides opportunity for replication of previous findings, and also for temporal validation of predictive models derived from the HOLISM cohort.
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Affiliation(s)
- Tracey J. Weiland
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Alysha M. De Livera
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Biostatistics Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Chelsea R. Brown
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - George A. Jelinek
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Zoe Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Steve L. Simpson
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Disability and Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Sandra L. Neate
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Keryn L. Taylor
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Emily O'Kearney
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - William Bevens
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Claudia H. Marck
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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Nelson RG, Pankratz VS, Ghahate DM, Bobelu J, Faber T, Shah VO. Home-Based Kidney Care, Patient Activation, and Risk Factors for CKD Progression in Zuni Indians: A Randomized, Controlled Clinical Trial. Clin J Am Soc Nephrol 2018; 13:1801-1809. [PMID: 30442864 PMCID: PMC6302341 DOI: 10.2215/cjn.06910618] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/28/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The burden of CKD is greater in ethnic and racial minorities and persons living in rural communities, where access to care is limited. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A 12-month clinical trial was performed in 98 rural adult Zuni Indians with CKD to examine the efficacy of a home-based kidney care program. Participants were randomized by household to receive usual care or home-based care. After initial lifestyle coaching, the intervention group received frequent additional reinforcement by community health representatives about adherence to medicines, diet and exercise, self-monitoring, and coping strategies for living with stress. The primary outcome was change in patient activation score, which assesses a participant's knowledge, skill, and confidence in managing his/her own health and health care. RESULTS Of 125 randomized individuals (63 intervention and 62 usual care), 98 (78%; 50 intervention and 48 usual care) completed the 12-month study. The average patient activation score after 12 months was 8.7 (95% confidence interval, 1.9 to 15.5) points higher in the intervention group than in the usual care group after adjusting for baseline score using linear models with generalized estimating equations. Participants randomized to the intervention had 4.8 (95% confidence interval, 1.4 to 16.7) times the odds of having a final activation level of at least three ("taking action") than those in the usual care group. Body mass index declined by 1.1 kg/m2 (P=0.01), hemoglobin A1c declined by 0.7% (P=0.01), high-sensitivity C-reactive protein declined by 3.3-fold (P<0.001), and the Short-Form 12 Health Survey mental score increased by five points (P=0.002) in the intervention group relative to usual care. CONCLUSIONS A home-based intervention improves participants' activation in their own health and health care, and it may reduce risk factors for CKD in a rural disadvantaged population.
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Affiliation(s)
- Robert G. Nelson
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona
| | - V. Shane Pankratz
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico; and
| | - Donica M. Ghahate
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico; and
| | - Jeanette Bobelu
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico; and
| | - Thomas Faber
- Indian Health Service, Zuni Comprehensive Care Center, Zuni, New Mexico
| | - Vallabh O. Shah
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico; and
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Barnard E, Brown CR, Weiland TJ, Jelinek GA, Marck CH. Understanding barriers, enablers, and long-term adherence to a health behavior intervention in people with multiple sclerosis. Disabil Rehabil 2018; 42:822-832. [PMID: 30375258 DOI: 10.1080/09638288.2018.1510550] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: The optimal management strategy for multiple sclerosis (MS), and many other chronic diseases, likely involves health behavior modification. Multimodal behavioral interventions may be most effective, but little is known about long-term adherence in people with MS.Methods: This qualitative study assessed barriers and enablers to long-term adherence by people with MS who self-selected for a 5-day health behavior intervention 3-5 years prior. Thirteen women and five men participated in semi-structured phone interviews, which were transcribed and thematically analyzed.Results: The experience was described as useful for information gathering, decision making, and practical strategies regarding health behaviors. The majority still followed supplementation and dietary recommendations most of the time, although consuming non-recommended food while eating out was common. Support at home, ability and enjoyment in food preparation, and ability to resist unhealthy foods were both barriers and enablers. Adherence to "time-consuming" exercise and meditation recommendations were less common and episodic. Many reported competing interests on time from work and family; and barriers including injuries and symptoms, weather, financial or geographical barriers, and lack of person-centred support and motivation. Increased fitness and mobility, weight loss, and a sense of accomplishment and control were advantages and motivators. Practical and attitudinal strategies employed included planning, tailoring activities to ability and preference, and self-monitoring.Conclusion: While most people attempted to engage with all components of the intervention initially, only some still engaged with all components, and none to the recommended levels. These data can inform future quantitative studies and health behavior interventions.Implications for rehabilitationA multimodal group lifestyle intervention may be useful to assist people with multiple sclerosis in information gathering, decision making, attitudinal changes, and practical strategies regarding health behaviors; as well as providing a sense of hope for the future and control over wellbeing.While participants are unlikely to engage with all components of a multimodal intervention to the recommended level, they are likely to make improvements to one or more health behaviors.Experiential learning, including going through recipes and ingredient lists, and practicing meditation and physical exercises, is helpful to instigate behavior change.The initiation and maintenance of behavior change was assisted by support from family, friends, and health practitioners; and practical strategies employed by participants, including planning, self-monitoring, and tailoring activities to ability and preference.
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Affiliation(s)
- Emma Barnard
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Chelsea R Brown
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Tracey J Weiland
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - George A Jelinek
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Claudia H Marck
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Sturt J, Dliwayo TR, Forjaz V, Hamilton K, Bryce C, Fraser J, Griffiths F. Eliciting the Impact of Digital Consulting for Young People Living With Long-Term Conditions (LYNC Study): Cognitive Interviews to Assess the Face and Content Validity of Two Patient-Reported Outcome Measures. J Med Internet Res 2018; 20:e268. [PMID: 30309832 PMCID: PMC6231804 DOI: 10.2196/jmir.9786] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/30/2018] [Accepted: 06/18/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Digital consulting, using email, text, and Skype, is increasingly offered to young people accessing specialist care for long-term conditions. No patient-reported outcome measures (PROMs) have been evaluated for assessing outcomes of digital consulting. Systematic and scoping reviews, alongside patient involvement, revealed 2 candidate PROMs for this purpose: the patient activation measure (PAM) and the physician's humanistic behaviors questionnaire (PHBQ). PAM measures knowledge, beliefs, and skills that enable people to manage their long-term conditions. PHBQ assesses the presence of behaviors that are important to patients in their physician-patient interactions. OBJECTIVE This study aimed to assess the face and content validity of PAM and PHBQ to explore whether they elicit important outcomes of digital consulting and whether the PROMs can isolate the digital consultation component of care. METHODS Participants were drawn from 5 clinics providing specialist National Health Service care to 16- to 24-year-olds with long-term health conditions participating in the wider LYNC (Long-Term Conditions, Young People, Networked Communications) study. Overall, 14 people undertook a cognitive interview in this substudy. Of these, 7 participants were young people with either inflammatory bowel disease, cystic fibrosis, or cancer. The remaining 7 participants were clinicians who were convenience sampled. These included a clinical psychologist, 2 nurses, 3 consultant physicians, and a community youth worker practicing in cancer, diabetes, cystic fibrosis, and liver disease. Cognitive interviews were transcribed and analyzed, and a spreadsheet recorded the participants' PROM item appraisals. Illustrative quotes were extracted verbatim from the interviews for all participants. RESULTS Young people found 11 of the PAM 13 items and 7 of the additional 8 PAM 22 items to be relevant to digital consulting. They were only able to provide spontaneous examples of digital consulting for 50% (11/22) of the items. Of the 7 clinicians, 4 appraised all PAM 13 items and 20 of the PAM 22 items to be relevant to evaluating digital consulting and articulated operationalization of the items with reference to their own digital consulting practice with greater ease than the young people. Appraising the PHBQ, in 14 of the 25 items, two-thirds of the young people's appraisals offered digital consulting examples with ease, suggesting that young people can detect and discern humanistic clinician behaviors via digital as well as face-to-face communication channels. Moreover, 17 of the 25 items were appraised as relevant by the young people. This finding was mirrored in the clinician appraisals. Both young people and the clinicians found the research task complex. Young participants required considerably more researcher prompting to elicit examples related to digital consulting rather than their face-to-face care. CONCLUSIONS PAM and PHBQ have satisfactory face and content validity for evaluating digital consulting to warrant proceeding to psychometric evaluation. Completion instructions require revision to differentiate between digital and face-to-face consultations.
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Affiliation(s)
- Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | | | - Vera Forjaz
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Kathryn Hamilton
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Carol Bryce
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | | | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
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Cunha CM, Nepomuceno E, Manzato RDO, Cunha DCPTD, Silva DD, Dantas RAS. Cultural adaptation and validation of the Brazilian Version of the Patient Activation Measure-22 items. Rev Bras Enferm 2018; 71:1891-1898. [PMID: 30156674 DOI: 10.1590/0034-7167-2016-0470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 07/23/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To adapt and validate the Patient Activation Measure (PAM22) in a sample of Brazilians with chronic diseases under outpatient monitoring. METHOD Adaptation process comprises translation, back translation, analysis by a committee of judges, semantic analysis, and pre-test. Psychometric validation was performed with 513 individuals. Construct validity was analyzed through Pearson's correlation, Student's t-test and Structural Equation Modeling; reliability was assessed by the intraclass correlation coefficient and Cronbach's Alpha. RESULTS The internal consistency was adequate and test-retest reliability was low to moderate (p < 0.05). Validity evidence was found on the convergent construct, with statistically significant correlations between measures of activation, self-esteem, anxiety, depression, and health status. The one-dimensionality of the theoretical model was not confirmed in the adapted version. CONCLUSION Results have shown that the adapted version is reliable and valid, although the theoretical model cannot be explained in a single dimension.
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Affiliation(s)
- Cristiane Martins Cunha
- Universidade de São Paulo, School of Nursing of Ribeirão Preto. Ribeirão Preto, São Paulo, Brazil
| | - Eliane Nepomuceno
- Universidade de São Paulo, School of Nursing of Ribeirão Preto. Ribeirão Preto, São Paulo, Brazil
| | | | | | - Dirceu da Silva
- Universidade de Campinas, Faculty of Education. Campinas, São Paulo, Brazil
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English AF, Dickinson LM, Zittleman L, Nease DE, Herrick A, Westfall JM, Simpson MJ, Fernald DH, Rhyne RL, Dickinson WP. A Community Engagement Method to Design Patient Engagement Materials for Cardiovascular Health. Ann Fam Med 2018; 16:S58-S64. [PMID: 29632227 PMCID: PMC5891315 DOI: 10.1370/afm.2173] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE EvidenceNOW Southwest is a cluster-randomized trial evaluating the differential impact on cardiovascular disease (CVD) care of engaging patients and communities in practice transformation in addition to standard practice facilitation support. The trial included development of locally tailored CVD patient engagement materials through Boot Camp Translation (BCT), a community engagement process that occurred before practice recruitment but after cluster randomization. METHODS We introduce a cluster randomization method performed before recruitment of small to medium-size primary care practices in Colorado and New Mexico, which allowed for balanced study arms while minimizing contamination. Engagement materials for the enhanced study arm were developed by means of BCT, which included community members, practice members, and public health professionals from (1) metropolitan Denver, (2) rural northeast Colorado, (3) Albuquerque, and (4) rural southeast New Mexico. Outcome measures were messages and materials from BCTs and population characteristics of study arms after using geographic-based covariate constrained randomization. RESULTS The 4 BCTs' messages and materials developed by the BCT groups uniquely reflected each community and ranged from family or spiritual values to early prevention or adding relevance to CVD risk. The geographic-based covariate of a cluster randomization method constrained randomization-assigned regions to study arms, allowing BCTs to precede practice recruitment, reduce contamination, and balance populations. CONCLUSIONS Cluster-randomized trials with community-based interventions present study design and implementation challenges. The BCTs elicited unique contextual messages and materials, suggesting that interventions designed to help primary care practices decrease CVD risk may not be one size fits all.
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Affiliation(s)
- Aimee F English
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - L Miriam Dickinson
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Linda Zittleman
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Donald E Nease
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Alisha Herrick
- Department of Family Medicine, University of New Mexico, Albuquerque, New Mexico
| | - John M Westfall
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Matthew J Simpson
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Douglas H Fernald
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Robert L Rhyne
- Department of Family Medicine, University of New Mexico, Albuquerque, New Mexico
| | - W Perry Dickinson
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
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Eneanya ND, Winter M, Cabral H, Waite K, Henault L, Bickmore T, Hanchate A, Wolf M, Paasche-Orlow MK. Health Literacy and Education as Mediators of Racial Disparities in Patient Activation Within an Elderly Patient Cohort. J Health Care Poor Underserved 2018; 27:1427-40. [PMID: 27524777 DOI: 10.1353/hpu.2016.0133] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The Patient Activation Measure (PAM) assesses facets of patient engagement to identify proactive health behaviors and is an important predictor of health outcomes. Health literacy and education are also important for patient participation and successful navigation of the health care system. Because health literacy, education, and patient activation are associated with racial disparities, we sought to investigate whether health literacy and education would mediate racial differences in patient activation. Participants were 265 older adults who participated in a computer-based exercise interventional study. Health literacy was assessed using the Test of Functional Health Literacy in Adults (TOFHLA). Of 210 eligible participants, 72% self-identified as Black and 28% as White. In adjusted analyses, education and health literacy each significantly reduced racial differences in patient activation. These findings are especially important when considering emerging data on the significance of patient activation and new strategies to increase patient engagement.
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Overbeek A, Rietjens JAC, Jabbarian LJ, Severijnen J, Swart SJ, van der Heide A, Korfage IJ. Low patient activation levels in frail older adults: a cross-sectional study. BMC Geriatr 2018; 18:7. [PMID: 29304752 PMCID: PMC5756388 DOI: 10.1186/s12877-017-0696-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 12/19/2017] [Indexed: 11/26/2022] Open
Abstract
Background Frail older adults are increasingly expected to self-manage their health and healthcare. We assessed the extent to which this group is able to take up this responsibility by measuring their level of activation as patients (i.e. their knowledge, skills and confidence to self-manage their health and healthcare). Further, we studied which characteristics of older adults were associated with patient activation. Methods In this cross-sectional study 200 frail, competent adults (median age 87 years) participated. Participants were community-dwelling adults who received home care and residents of care homes. Data were collected via personal interviews in participants’ homes. The main outcome measure was patient activation assessed by the short version of the Patient Activation Measure (PAM-13; range: 0–100). The PAM distinguishes four levels of increasing activation with level 1 indicating poor patient activation and level 4 adequate patient activation. Other studied variables were: multimorbidity, type of residency, frailty (Tilburg Frailty Index), mental competence (Mini Mental State Examination), health-related quality of life (SF-12), satisfaction with healthcare (subscale Patient Satisfaction Questionnaire) and personal characteristics (age, gender, marital status, educational level). Regression analyses were performed to investigate which variables were associated with patient activation. Results Participants had a median PAM score of 51. Thirty-nine percent had level 1 activation, 31% level 2, 26% level 3 and 5% level 4. Fifty-nine percent of community dwelling adults had level 1 or 2 activation versus 81% of care home residents (p = 0.007). Mental competence (Effect: 0.52, CI: 0.03–1.01, p = 0.04) and health-related quality of life (Effect: 0.15, CI: 0.01–0.30, p = 0.04 for physical health; Effect: 0.20, CI: 0.07–0.34, p = 0.003 for mental health) were positively associated with patient activation. Frailty (Effect: -1.06, CI: -1.75 – -0.36, p = 0.003) was negatively associated with patient activation. Conclusions The majority of this frail and very old study population, especially those with a lower health-related quality of life, may be unable to self-manage their health and healthcare to the level expected from them. The increasing population of frail older adults may need help in managing their health and healthcare.
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Affiliation(s)
- Anouk Overbeek
- Department of Public Health, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
| | - Judith A C Rietjens
- Department of Public Health, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Lea J Jabbarian
- Department of Public Health, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | | | | | - Agnes van der Heide
- Department of Public Health, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, the Netherlands
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Key attributes of patient centered medical homes associated with patient activation of diabetes patients. BMC FAMILY PRACTICE 2018; 19:4. [PMID: 29304742 PMCID: PMC5755130 DOI: 10.1186/s12875-017-0704-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/20/2017] [Indexed: 12/04/2022]
Abstract
Background Approximately 24 million Americans are living with diabetes. Patient activation among individuals with diabetes is critical to successful diabetes management. The Patient Centered Medical Home (PCMH) model holds promise for increasing patient activation in managing their health. However, what is not well understood is the extent to which individual components of the PCMH model, such as the quality of physician-patient interactions and organizational features of care, contribute to patient activation. This study’s objective is to determine the relative importance of the PCMH constructs or domains to patient activation among individuals living with diabetes. Methods This study is a cross-sectional analysis of 1253 primary care patients surveyed with type II diabetes. The dependent variable, patient activation, was assessed using the Patient Activation Measure (PAM). Independent variables included 7 PCMH domains- organizational access, integration of care, comprehensive knowledge, office staff helpfulness, communication, interpersonal treatment and trust. Ordered logistic regression was performed to determine whether each PCMH domain was independently associated with patient activation, followed by a final ordered logistic regression that included all the PCMH domains in a single adjusted model. Results Using the full adjusted model, the odds of patients reporting higher activation scores (PAM) were found to be significant in the domains that represented organizational access (OR 1.56, 95% CI 1.31–1.85) and comprehensive knowledge (OR 1.44, 95% CI 1.13–1.85). Conclusions Many practices have struggled with the challenge to develop fully functional patient-centered medical homes. In an effort to become more patient-centered, this study aimed to address what factors activated diabetic patients to adhere to diabetes management plan. Understanding these factors can help identify PCMH attributes that practices can prioritize and improve upon to assist their patients in improving health outcomes. Trial registration Study was not a clinical trial; therefore it was not registered.
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Moreno-Chico C, González-de Paz L, Monforte-Royo C, Arrighi E, Navarro-Rubio MD, Gallart Fernández-Puebla A. Adaptation to European Spanish and psychometric properties of the Patient Activation Measure 13 in patients with chronic diseases. Fam Pract 2017; 34:627-634. [PMID: 28379415 DOI: 10.1093/fampra/cmx022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The 13-item Patient Activation Measure (PAM-13) is an instrument that assesses people's knowledge, skills and confidence for self-management of their health and health care. Scores on the PAM-13 have been shown to predict adherence to health behaviours, health-related outcomes and health care costs. OBJECTIVES To develop a European Spanish adaptation of the original PAM-13 and to examine its psychometric properties in a sample of chronic patients. METHODS The PAM-13 was forward-backward translated and then completed by chronic patients attending a primary health care centre. Data were analysed with a Rasch model. We assessed the functioning of the rating scale, its reliability, the item goodness-of-fit, differential item functioning (DIF), local dependence, unidimensionality and correlation analysis. RESULTS A total of 208 patients (80%) completed the questionnaire. Data showed a fit to the Rasch model. More than 50% of patients endorsed all the items. Item rank for the Spanish sample was similar to the original, with few differences. We found significant differences (P < 0.05) in PAM-13 measures according to adherence to prescribed medicines and positive correlations with self-efficacy and physical quality of life. CONCLUSIONS The European Spanish PAM-13 is a reliable and valid instrument for assessing activation in patients with chronic disease in Spain. We suggest adding new items to the instrument so as to examine patients with higher activation levels in the future. Further studies are needed to evaluate the usefulness of this new Spanish PAM-13 in different settings and populations, as well as to examine the relationship between PAM-13 scores and other health-related outcomes.
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Affiliation(s)
- Cibeles Moreno-Chico
- Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.,Rambla Mutua de Terrassa Primary Healthcare Centre, Terrassa, Barcelona, Spain
| | - Luis González-de Paz
- Public Health and Epidemiology Unit, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.,Consorci d'Atenció Primària Esquerra de l'Eixample, Transverse Group for Research in Primary Care, IDIBAPS, Barcelona, Spain
| | - Cristina Monforte-Royo
- Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Emilia Arrighi
- Albert J. Jovell Institute for Public Health and Patients, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - M Dolores Navarro-Rubio
- Public Health and Epidemiology Unit, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.,Albert J. Jovell Institute for Public Health and Patients, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Alberto Gallart Fernández-Puebla
- Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
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Graffigna G. Is a Transdisciplinary Theory of Engagement in Organized Settings Possible? A Concept Analysis of the Literature on Employee Engagement, Consumer Engagement and Patient Engagement. Front Psychol 2017; 8:872. [PMID: 28729843 PMCID: PMC5499260 DOI: 10.3389/fpsyg.2017.00872] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/12/2017] [Indexed: 11/29/2022] Open
Abstract
Organizations are experiencing increased competition, disruptive innovation, and continuous changes in their social and economic context. Furthermore, the decrease of resources (economic and human) in such a demanding context make it imperative for organizations to find new models and strategies to make their service delivery more sustainable at the economic, environmental and psychological levels. In such a complex scenario the concept of engagement of the individuals involved in organized settings (either as service providers or as final receivers) is a promising lever for innovation. However, despite the number of studies on the matter, the debate on engagement is still very fragmented because the corpus of literature addressing the different areas of engagement is divided and diverse in its nature. In this paper, we discuss the results of a conceptual analysis of the literature conducted in order to investigate overlapping features and areas of divergence among three different areas of investigation and application of the engagement phenomenon in organized settings: the domains of employee engagement, consumer engagement, and patient engagement. These are deliberately selected as prototypical of the phenomenon of engagement along the "inside/outside" of organizational settings. The analysis consisted in a qualitative conceptual survey? Of the scholarly literature indexed with the key terms "employee engagement," "consumer engagement," and "patient engagement." We performed a key-word based survey? Of the literature in the Scopus database. A total of 163 articles were selected and analyzed. The analysis cast light on the following areas of conceptual overlap among employee, consumer and patient engagement: (1) engagement is different from empowerment and activation; (2) engagement is a multi-componential psychological experience; (3) engagement is a self-transformative experience; (4) engagement develops within a relational context; (5) engagement is a systemic phenomenon. These findings, although preliminary and in need of further investigation, suggest the feasibility of promoting a transdisciplinary reflection on the phenomenon of engagement in organized settings.
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Titova E, Salvesen Ø, Bentsen SB, Sunde S, Steinshamn S, Henriksen AH. Does an Integrated Care Intervention for COPD Patients Have Long-Term Effects on Quality of Life and Patient Activation? A Prospective, Open, Controlled Single-Center Intervention Study. PLoS One 2017; 12:e0167887. [PMID: 28060921 PMCID: PMC5218408 DOI: 10.1371/journal.pone.0167887] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 11/18/2016] [Indexed: 12/13/2022] Open
Abstract
Background Implementation of the COPD-Home integrated disease management (IDM) intervention at discharge after hospitalizations for acute exacerbations of COPD (AECOPD) led to reduced hospital utilization during the following 24 months compared to the year prior to study start. Aims To analyze the impact of the COPD-Home IDM intervention on health related quality of life, symptoms of anxiety and depression, and the degree of patient activation during 24 months of follow-up and to assess the association between these outcomes. Methods A single center, prospective, open, controlled clinical study. Changes in The St. George Respiratory Questionnaire (SGRQ), the Hospital anxiety (HADS-A) and depression (HADS-D) and the patient activation measure (PAM) scores were compared between the patients in the integrated care group (ICG) and the usual care group (UCG) 6, 12 and 24 months after enrolment. Results The questionnaire response rate was 80–96%. There were no statistically significant differences in the change of the SGRQ scores between the groups during follow up. After 12 months of follow-up there was a trend towards a reduction in the mean HADS–A score in the ICG compared to the UCG. The HADS-D scores remained stable in the ICG compared with an increasing trend in the UCG. Clinically significant difference in the PAM score was achieved only in the ICG, 6.7 (CI95% 0.7 to 7.5) compared to 3.6 (CI95% -1.4 to 8.6) in the UCG. In a logistic regression model a higher HADS-D score and current smoking significantly increased the odds for a low PAM score. Conclusion The COPD–Home IDM intervention did not result in any statistically significant changes in mean SGRQ, HADS-A, HADS- D or PAM scores during the 24 months of follow-up. Trial registration The ID number for the study in the Clinical.Trials.gov registration system is 17417. ClinicalTrials.gov Identifier: NCT 00702078
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Affiliation(s)
- Elena Titova
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Thoracic and Occupational Medicine, Trondheim University Hospital, Trondheim, Norway
- * E-mail:
| | - Øyvind Salvesen
- The Faculty of medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Synnøve Sunde
- Department of Thoracic and Occupational Medicine, Trondheim University Hospital, Trondheim, Norway
| | - Sigurd Steinshamn
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Thoracic and Occupational Medicine, Trondheim University Hospital, Trondheim, Norway
| | - Anne Hildur Henriksen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Thoracic and Occupational Medicine, Trondheim University Hospital, Trondheim, Norway
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Potter MA, Wilson C. Applying Bureaucratic Caring Theory and the Chronic Care Model to Improve Staff and Patient Self-Efficacy. Nurs Adm Q 2017; 41:310-320. [PMID: 28858999 DOI: 10.1097/naq.0000000000000256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Patient activation and engagement can be powerful enablers for health outcomes that are just as important as staff engagement and satisfaction. The authors applied the Bureaucratic Caring Theory and the Chronic Care Model to a process improvement project designed to link activation, engagement, satisfaction, and health outcomes. Twenty-two adults with diabetes and 7 staff members caring for them participated in a 12-week process improvement project that incorporated a time-based element of longitudinal care with skill-based competencies to provide collaborative, team-based care to patients with type 2 diabetes. Patients completed satisfaction surveys at the end of their clinical encounters. Staff members completed satisfaction surveys pre- and postimplementation. The authors analyzed hemoglobin A1C levels pre- and postimplementation. As engagement and activation increased for both staff and patients, hemoglobin A1C levels decreased. The clinical implication is that the use of Bureaucratic Caring Theory may foster caring while broad application of the Chronic Care Model may improve self-efficacy, create healthier populations, and reduce health care costs.
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Affiliation(s)
- Marcia A Potter
- Malcolm Grow Medical Clinics & Surgery Center, Joint Base Andrews, Maryland
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A Randomised Controlled Trial of Efficacy of Cognitive Rehabilitation in Multiple Sclerosis: A Cognitive, Behavioural, and MRI Study. Neural Plast 2016; 2016:4292585. [PMID: 28116167 PMCID: PMC5223046 DOI: 10.1155/2016/4292585] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/29/2016] [Accepted: 11/17/2016] [Indexed: 12/18/2022] Open
Abstract
Aim. To explore the efficacy of home-based, computerised, cognitive rehabilitation in patients with multiple sclerosis using neuropsychological assessment and advanced structural and functional magnetic resonance imaging (fMRI). Methods. 38 patients with MS and cognitive impairment on the Brief International Cognitive Assessment for MS (BICAMS) were enrolled. Patients were randomised to undergo 45 minutes of computerised cognitive rehabilitation using RehaCom software (n = 19) three times weekly for six weeks or to a control condition (n = 19). Neuropsychological and MRI data were obtained at baseline (time 1), following the 6-week intervention (time 2), and after a further twelve weeks (time 3). Cortical activations were explored using fMRI and microstructural changes were explored using quantitative magnetisation transfer (QMT) imaging. Results. The treatment group showed a greater improvement in SDMT gain scores between baseline and time 2 compared to the control group (p = 0.005). The treatment group exhibited increased activation in the bilateral prefrontal cortex and right temporoparietal regions relative to control group at time 3 (p < 0.05FWE corrected). No significant changes were observed on QMT. Conclusion. This study supports the hypothesis that home-based, computerised, cognitive rehabilitation may be effective in improving cognitive performance in patients with MS. Clinical trials registration is ISRCTN54901925.
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Ngooi BX, Packer TL, Warner G, Kephart G, Koh KWL, Wong RCC, Lim SP. How adults with cardiac conditions in Singapore understand the Patient Activation Measure (PAM-13) items: a cognitive interviewing study. Disabil Rehabil 2016; 40:587-596. [PMID: 27973921 DOI: 10.1080/09638288.2016.1261413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Validation studies of the PAM-13 have found differences in scale performance, suggesting that health beliefs embedded in different cultures and/or self-management needs of different client groups influence how people respond to the items. The purpose of this study was to examine how adults with cardiac conditions in Singapore interpreted and responded to the PAM-13, to investigate possible reasons for differences in responses and to propose solutions to overcome them. METHODS We conducted retrospective cognitive interviews with 13 participants in an out-patient heart center. Interviews were transcribed and analyzed based on the framework approach to qualitative analysis. The four stages from Tourangeau's cognitive model were used as a framework to index the data from each item. RESULTS There was variation in comprehension of questions leading to variation in responses. Comprehension issues were due to terms perceived by participants to be vague and the use of English terms uncommon in Singapore. Cultural influences impacted decision processes and problems with response processes of the self-rating Likert scale surfaced. CONCLUSIONS This study reinforces the need to culturally adapt the tool, even when language translation is not necessary. Providing Likert scales with a larger number of may widen the relevance of PAM-13 in Singapore. Implications for rehabilitation Need to culturally adapt assessment tool, even when language translation is not necessary. Consider using Likert scales with a larger number of categories when using in Asian countries such as Singapore. Caution must be taken when using PAM-13 levels to decide interventions for each individual.
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Affiliation(s)
- Bi Xia Ngooi
- a Department of Rehabilitation , National University Hospital , Singapore , Singapore.,b School of Occupational Therapy, Dalhousie University , Halifax , NS , Canada
| | - Tanya L Packer
- b School of Occupational Therapy, Dalhousie University , Halifax , NS , Canada
| | - Grace Warner
- b School of Occupational Therapy, Dalhousie University , Halifax , NS , Canada
| | - George Kephart
- c Department of Community Health and Epidemiology , Dalhousie University , Halifax , NS , Canada
| | - Karen Wei Ling Koh
- d Department of Nursing , National University Hospital , Singapore , Singapore
| | | | - Serene Peiying Lim
- a Department of Rehabilitation , National University Hospital , Singapore , Singapore
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Prey JE, Qian M, Restaino S, Hibbard J, Bakken S, Schnall R, Rothenberg G, Vawdrey DK, Masterson Creber R. Reliability and validity of the patient activation measure in hospitalized patients. PATIENT EDUCATION AND COUNSELING 2016; 99:2026-2033. [PMID: 27422339 PMCID: PMC5121059 DOI: 10.1016/j.pec.2016.06.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/24/2016] [Accepted: 06/26/2016] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The purposes of this paper are to describe the internal consistency reliability and construct validity of the PAM-13 for hospitalized cardiology and oncology patients and to examine the predictors of low patient activation in the same population. METHODS We evaluated the internal consistency reliability of the PAM-13 in the inpatient setting. Construct validity of the PAM-13 was then assessed using two approaches: expected known-groups differences between patients with planned and unplanned admissions PAM-13 levels and convergence of PAM-13 levels with other measures. RESULTS The PAM demonstrated adequate internal consistency overall (Cronbach α=0.81). Patients with unplanned admissions were more likely to have low activation than patients with planned admissions (adjusted OR=5.7, p=0.008). The PAM-13 was modestly correlated (p<0.001) with each of the PROMIS Global Health components used in this study (global, physical and mental health). CONCLUSION This study demonstrates the PAM-13 is a reliable and valid measure for use in the inpatient hospital setting and that type of admission (planned versus unplanned) is an important predictor of patient activation. PRACTICE IMPLICATIONS By measuring patient activation with the PAM-13, clinicians and researchers can provide tailored communication and care strategies to meet patient's needs.
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Affiliation(s)
- Jennifer E Prey
- Department of Biomedical Informatics, Columbia University, New York, NY, USA.
| | - Min Qian
- Department of Biostatistics, Columbia University, New York, NY, USA
| | | | - Judith Hibbard
- Institute for Policy Research and Innovation, University of Oregon, Eugene, OR, USA
| | - Suzanne Bakken
- Department of Biomedical Informatics, Columbia University, New York, NY, USA; School of Nursing, Columbia University, New York, NY, USA
| | | | | | - David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, NY, USA; NewYork-Presbyterian Hospital, New York, NY, USA
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Zimmerman L, Wilson FA, Schmaderer MS, Struwe L, Pozehl B, Paulman A, Bratzke LC, Moore K, Raetz L, George B. Cost-Effectiveness of a Care Transition Intervention Among Multimorbid Patients. West J Nurs Res 2016; 39:622-642. [DOI: 10.1177/0193945916673834] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this pilot study was to assess the cost-effectiveness of four different doses (based on patients’ level of cognition and activation) of a home-based care transitions intervention compared with usual care at 2 and 6 months after hospital discharge to home for 126 adult patients with three or more chronic diseases. Health care utilization was measured, and a cost-effectiveness analysis was used to estimate incremental costs and quality-adjusted life-years associated with each intervention arm. At 6 months, results from this pilot study are very promising and support cost-effectiveness for Group 2-low cognition/high activation, Group 3-normal cognition/low activation, and Group 4-normal cognition/high activation patients. However, Group 1-low cognition/low activation needs a more intensive treatment than what was provided in the intervention, because of their low cognition and activation levels. Our intervention strategies provided to the groups would be scalable to a larger patient population and across different facilities.
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Affiliation(s)
| | | | | | - Leeza Struwe
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Bunny Pozehl
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | - Kim Moore
- CHI Health St. Elizabeth, Lincoln, NE, USA
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Ngooi BX, Packer TL, Kephart G, Warner G, Koh KWL, Wong RCC, Lim SP. Validation of the Patient Activation Measure (PAM-13) among adults with cardiac conditions in Singapore. Qual Life Res 2016; 26:1071-1080. [PMID: 27645458 DOI: 10.1007/s11136-016-1412-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE The Patient Activation Measure (PAM-13) measures patients' knowledge, skill, and confidence in chronic condition self-management. The purpose of this study was to assess the validity of PAM-13 (English version) among English-speaking adults with cardiac conditions in Singapore. METHODS A cross-sectional study was conducted in a convenient sample of 270 heart clinic patients. Using the unitary concept of validity, evidence of (1) internal structure via data quality, unidimensionality, differential item functioning, and internal consistency, (2) response process through item difficulty and item fit using Rasch modeling, and (3) relationship to other variables via correlations with depression and self-efficacy were examined. RESULTS The item response was high with only one missing answer. All items had a small floor effect, but nine out of 13 items had a ceiling effect larger than 15 %. Cronbach's α was 0.86, and average inter-item correlations was 0.324. Results suggested unidimensionality; however, differences in item difficulty ranking were found. A low, negative correlation was found with depression, while a moderate, positive correlation was found with self-efficacy. CONCLUSION Evidence in all three areas of validity were mixed. Caution should be exercised when using categorical activation "level" to inform clinical decisions.
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Affiliation(s)
- Bi Xia Ngooi
- Department of Rehabilitation, National University Hospital, 5 Lower Kent Ridge Road, Main Building 1, Level 1, Singapore, 119074, Singapore. .,School of Occupational Therapy, Dalhousie University, Room 214 Forrest Building, 5869 University Ave, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Tanya L Packer
- School of Occupational Therapy, Dalhousie University, Room 214 Forrest Building, 5869 University Ave, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada
| | - George Kephart
- Department of Community Health and Epidemiology, Dalhousie University, Centre for Clinical Research, Room 416, 5790 University Ave, Halifax, NS, B3H 1V7, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Room 214 Forrest Building, 5869 University Ave, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada
| | - Karen Wei Ling Koh
- Department of Nursing, National University Hospital, 5 Lower Kent Ridge Wing, Singapore, 119074, Singapore
| | - Raymond Ching Chiew Wong
- Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Wing, Singapore, 119074, Singapore
| | - Serene Peiying Lim
- Department of Rehabilitation, National University Hospital, 5 Lower Kent Ridge Road, Main Building 1, Level 1, Singapore, 119074, Singapore
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Campbell J, Rashid W, Cercignani M, Langdon D. Cognitive impairment among patients with multiple sclerosis: associations with employment and quality of life. Postgrad Med J 2016; 93:143-147. [PMID: 27512050 DOI: 10.1136/postgradmedj-2016-134071] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 07/05/2016] [Accepted: 07/13/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To explore the relationship between cognitive impairment and conventional measures of disability in multiple sclerosis (MS), quality of life (QOL) and employment status using the brief international cognitive assessment for multiple sclerosis (BICAMS) in the routine outpatient clinic. METHODS 62 patients with MS were assessed on the BICAMS test battery for cognitive impairment. Data were obtained on employment status and a number of questionnaires completed including fatigue severity score, multiple sclerosis neuropsychological questionnaire, hospital anxiety and depression scale, the functional assessment of multiple sclerosis (FAMS) as well as on the EuroQOL five dimension questionnaire (EQ-5D). Other assessments include the patient activation measure and unidimensional self-efficacy scale for multiple sclerosis. RESULTS Cognitive assessment revealed 44 subjects (65%) had evidence of cognitive impairment on formal testing. In comparison with patients without evidence of cognitive impairment, cognitively impaired patients exhibited significantly higher rates of unemployment (p=0.009). The symbol digits modalities test was the most significant predictor of unemployment. Cognitive impairment was associated with lower QOL scores on the FAMS (p=0.001) and EQ-5D (p<0.001). CONCLUSIONS BICAMS provides a sensitive and easy to administer screening test for cognitive impairment within the outpatient setting. Cognitive impairment is common in our cohort of patients with MS attending outpatients and appears to be associated with increased rates of unemployment and lower measures of QOL.
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Affiliation(s)
- J Campbell
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Falmer, UK
| | - W Rashid
- Department of Neurology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - M Cercignani
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Falmer, UK
| | - D Langdon
- Department of Neuropsychology, Royal Holloway, University of London, Egham, Surrey, UK
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Schmaderer MS, Zimmerman L, Hertzog M, Pozehl B, Paulman A. Correlates of Patient Activation and Acute Care Utilization Among Multimorbid Patients. West J Nurs Res 2016; 38:1335-53. [PMID: 27245080 DOI: 10.1177/0193945916651264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient activation and self-management have been associated with improved patient outcomes, including decreased re-hospitalization; however, little research has identified factors that predict patient activation in the multimorbid hospitalized patient. This descriptive correlational study included 200 patients with three or more chronic diseases discharged to home post-hospitalization. Standard multiple regression was used to identify correlates of patient activation. Multimorbid patients with lower activation scores had more acute care utilization (re-hospitalization and emergency department visits) 30 days post-discharge than patients with higher activation scores. Predictors of patient activation were health literacy (p = .013), satisfaction with social role (p = .014), and involvement in chronic illness care (p = .001). Care transition programs focusing on health literacy, role satisfaction, and promoting patient-centered care may improve patient outcomes for multimorbid patients.
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Affiliation(s)
| | | | | | - Bunny Pozehl
- University of Nebraska Medical Center, Lincoln, USA
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