Why do some people sail out of surgery or childbirth, seemingly back to ordinary life in a matter of weeks, while others take months or even years to recover?
Researchers have long been interested in why some people respond better than others after health events.
Judith Hibbard, PhD, MPH, professor emerita at the University of Oregon and a senior researcher at the university’s Health Policy Research Group, studies this issue. One factor, Hibbard has found, has to do with what she calls “patient activation” — or how proactive a person is about their own health.
In a 2004 publication, she and several co-authors proposed a way of measuring this hard-to-pin-down trait, calling it the patient activation measure, or PAM. The authors identified four levels of activation:
In 2005, the same group was able to shorten their original 22-item questionnaire gauging patient activation to 13 items without losing reliability. The questions address knowledge, confidence, and the ability to act on health issues, such as when to take medications or get needed medical care. Over the past decade, the measure has been increasingly studied in a number of environments — and its effects may surprise you.
Those who are most “activated,” or engaged in their own health, do better on a broad range of measures — they have better health outcomes and better overall health numbers (such as blood pressure or cholesterol levels). They even have better relationships with their doctors.
So where are you on the health activation scale? And what can you do to raise your numbers?
If you’re often confused by the amount of information you receive from your doctors, you may be a level 1 or 2 on the scale. “I think too often we give people a list of things to change about their life, and it's overwhelming,” Hibbard says. “And the upshot of that is that they usually don't do any of it.”
If that’s you, simply paying attention to your habits is a good way to start. Hibbard suggests asking yourself: “How much am I actually moving around? How much am I actually eating in a week?” That sort of paying attention — often called mindfulness — is a helpful first step.
Next, ask your doctor to help you prioritize — an easy way to help filter complex health information. “For any given situation, you really can become overwhelmed with the amount of information and instructions and things that need to be done,” Hibbard says. Your doctor can help you by saying, “If you only do two things, do these two things.”
Starting with small steps and experiencing success have also both been shown to help people move to the next level of activation, which involves making behavior changes. “Breaking things down into smaller steps, building up a foundation of skills like self-awareness, and then helping … develop small habits that when they add up over time are going to be good health behaviors” are all important, Hibbard says.
Finally, anticipate challenges. Ask your healthcare providers to help you think through what to do if you encounter a health issue. What if your work schedule doesn’t allow for a complex medication or dietary regimen, or you’re not sure how to get in enough physical activity each day? Your doctors can help you think through problems like these.
If you’re higher on the activation scale — levels 3 and 4 — you’re ready to make specific changes, such as exercising three times a week or ensuring you get three to five servings of fruits and veggies every day. At this level, the health benefits become apparent, according to Hibbard’s research. Not only that, but people who are more activated are more satisfied with their healthcare. “I think that's because they have more realistic expectations,” she says. “They know what they want, so they're more satisfied, they have better communication with their doctors, and they also have better medical outcomes and lower costs.”
The good news? Activation levels can change — and when they do, health outcomes improve, too.
What’s more, doctors themselves can help raise activation levels, Hibbard says — which doesn’t just happen naturally. “Clinicians need to understand where their patients are coming from and respond appropriately,” she says. “So if they're less activated, they need to not pile on the changes or the information, and break things down into smaller steps. For more activated patients, they need to work with them to meet them where they are by being more inclusive in how they communicate and work with those patients.”
As part of the Affordable Care Act, hospitals are now penalized for high readmission rates. Hibbard’s patient activation questionnaire is one tool that’s helping them. In at least 40 states, she says, hospitals are now using PAM to identify patients who need additional support. Patients with lower activation — who are about twice as likely to be readmitted after a discharge — may receive phone calls or even home visits to help them transition to life at home.
September 01, 2016
Janet O’Dell, RN