Using Systematic Measurement to Target Consumer Activation Strategies

A review of literature finds that a consumer’s level of engagement in his or her own health care can be measured by a "patient activation measure” (PAM), which is derived from the patient’s responses to a psychometric interview. The patient’s PAM, in turn, is a significant predictor of the extent to which the patient will engage in various self-help health care behaviors.

As health care strategies increasingly depend on consumers to be active managers of their own care, defining and measuring each consumer’s level of engagement, or activation, is important to both evaluate and improve the efficacy of those strategies. The article takes a new approach by mapping desired self-management behaviors into different levels of engagement, and confirming that PAM scores predict those levels of engagement.

Key Findings:

  • Neither financial incentives, nor strategies to improve the information available to consumers, nor models such as chronic care or disease management, have as implemented proven to be successful at changing people’s management of their own health care in the long term.
  • PAM is a valid statistical construct of a patient’s level of engagement in health care self-management behaviors.
  • A person’s PAM score level does predict whether he or she will engage in hypertension self-management behaviors, medical encounter behaviors (such as persistence in asking when one does not understand something the doctor has said), healthy behaviors (such as diet and exercise) and seeking information as a health care consumer.
  • Anecdotal evidence indicates that merely administering the PAM interview tends to increase a patient’s self-awareness and engagement.

Research that assesses how to apply PAM scores to improve outcomes is in its infancy. But the author recommends that health care strategies at the individual, group and community levels should be tailored to increase each consumer’s PAM. The chances for success of such strategies are improved if they are segmented to encourage behaviors that are realistic based on a patient’s current PAM level, in turn bolstering that patient’s level of activation one step at a time with each success.