Patient Perception, Preference and Participation
Measuring self-management of patients’ and employees’ health: Further validation of the Patient Activation Measure (PAM) based on its relation to employee characteristics

https://doi.org/10.1016/j.pec.2009.02.018Get rights and content

Abstract

Objective

Evaluate the Patient Activation Measure (PAM) in relation to personal characteristics in employed populations. Further validate the PAM for use in improving clinical or employer-based health-intervention programs.

Methods

Data for analysis were taken from baseline survey information and health screenings collected during a randomized, controlled trial testing two different health promotion programs. Study population included 625 employees (predominantly white collar) from two companies in the northern Midwest of the United States: a large, integrated health care system and a national airline.

Results

PAM's psychometric properties are robust in two employed populations. Activation is directly related not only to health status, but also to job performance measures. The strong positive relationship of PAM to measures of healthy behavior, health information-seeking and readiness-to-change further validate the measure. Commonly, a difference of 5 points on the PAM separated healthy from less healthy behaviors.

Conclusion

Activation can be understood in a broader population health context and need not be restricted to people with chronic illnesses. The study provides guidance on how to interpret PAM scores.

Practice implications

The PAM can be used as part of any health-intervention program designed to improve patients’ or employees’ self-management skills, whether the program is clinic-based or employer-based.

Introduction

The burden of chronic illness is well documented [1], [2] and has been the focus of widespread efforts to redesign the primary care system [3]. In this context, attention to motivating patients to self-manage their chronic conditions has expanded and new models of health care delivery focus on teaching patients with chronic illnesses self-management skills [4], [5], [6].

Behind this chronic illness burden, however, lies an even greater pool of people with increasing health risks. In 2007, 72% of adults in the United States did not have 20 or more minutes of vigorous physical activity three or more days per week [7] and 63% were overweight or obese [8]. Such risks foreshadow an even greater level of disease morbidity in the years to come. To make progress in the battle to reduce the morbidity associated with chronic conditions, it is not sufficient to restrict our understanding of self-management to those who already have chronic disease [9]. Self-management is key not only for chronic conditions but for all the behaviors that can lead to, or can counteract, the likelihood of developing chronic illness.

In health care as in other industries, what gets measured gets managed [10]. To help predict the degree to which patients or employees are activated to manage their health and health care and to assess progress of interventions designed to increase activation, clinicians and employers need new measures. The concept of patient activation is not a new one [11], [12], but the concept has not been supported with a validated measure until 2004.

The recently developed Patient Activation Measure (PAM) is based on work in conceptualizing, defining and testing attributes of an activated health consumer [13]. The tool measures the skills, knowledge, beliefs and behaviors that combine to create an activated patient. The PAM has been validated in older populations with chronic conditions [13], [14], [15], [16]. Little is known, however, about the relationship of PAM scores to personal characteristics in employed populations and those at risk for developing chronic conditions in the future. Its validation with other healthy behaviors also has been limited.

To date, PAM scores have been positively associated with key process measures and health outcome measures in several studies of older adults with chronic conditions [13], [15], [16], [17]. New initiatives such as ours seek to use the PAM to assess activation in high-risk individuals, not just those who already have chronic conditions. These expanding applications of PAM indicate a need to understand how activation relates to identifying and engaging individuals within varied populations, especially employed populations.

In this study, we examine employee activation in two industries. We assess the relationship of activation to employee characteristics as well as to enrolling and remaining in health-promotion coaching programs. To further validate the measure, we investigate the relationship of PAM scores to engaging in healthy behaviors, seeking health information, and readiness-to-change.

Section snippets

Study design and subjects

Data for this analysis were taken from baseline survey information collected during a randomized, controlled trial in Spring 2005 [18]. The trial involved testing two different health-promotion programs. Participants included employees recruited from two companies: a large, integrated health care system and a national airline. We mailed invitations, consent forms and questionnaires to employees at their worksite (n = 1628: 832 health care workers, 796 airline reservationists). We gave employees a

Demographic results

Most participants were women (87%) and white (90%), with an average age of 45 years. The overall educational level was high, with 44% having at least a four-year college degree. Participants considered themselves to be in good health: 57% reported that their health was very good or excellent. Only 10% reported smoking either cigars or cigarettes. However, being overweight or obese was common. Sixty-five percent of the participants were either overweight (BMI between 25 and 29) or obese (BMI 30

Discussion

The findings from this study expand the scope of PAM from older populations with chronic disease to employed populations with health risks. We demonstrate that the PAM's psychometric characteristics remain robust in this younger population.

The overall mean score for the employed populations in our study (68.6) was higher than it was for those previously reported (61.9) in a national sample of individuals ages 45–97 years with at least one chronic disease [14]. This difference is undoubtedly

Acknowledgements

This work was funded by grant #1 R01 DP000104-01 from the Centers for Disease Control and Prevention.

Judith Hibbard has ownership interest in and is a consultant for Insignia Health LLC, which owns the licensing rights for the PAM.

The authors wish to thank Penny Marsala for detailed literature reviews; Susan Adlis for preliminary analyses; Larry Kitzman, Kiralee Camp and Sheila Buffie for database support; and Ruth Taswell for editing.

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