Relationship between patient activation measurement and self-rated health in patients with chronic diseases

Nina Tusa, Hannu Kautiainen, Pia Elfving, Sanna Sinikallio, Pekka Mäntyselkä, Nina Tusa, Hannu Kautiainen, Pia Elfving, Sanna Sinikallio, Pekka Mäntyselkä

Abstract

Background: In the aging population, chronic diseases and multimorbidity are common. Therefore, it is important to engage patients in their self-care. The aim of this study was to analyze the relationship between activity in self-care and self-rated health among primary care patients with chronic diseases.

Methods: The data of the present study were derived from a research project on the Participatory Patient Care Planning in Primary Care (4PHC). A total of 605 patients were recruited in the Siilinjärvi Health Center from those patients who were being monitored due to the treatment of hypertension, ischemic heart disease or diabetes. We evaluated the level of patient's activity in self-care with the Patient Activation Measurement (PAM). Self-rated health (SRH) was measured with the 5-item Likert scale. An adjusted hypothesis of linearity across categories of PAM and self-rated health was estimated using analysis of covariance (ANCOVA).

Results: It was found that 76 patients had low activity, 185 had moderate while 336 patients had high activity as measured with PAM. Patients with the highest activity were younger, less depressed, had a lower body mass index and a higher level of physical activity than those with the lower activity. Correspondingly, good SRH was perceived by 29, 45 and 67% of the patients in these three PAM groups adjusted with sex, age, depressive symptoms (BDI) and number of diseases. There was a significant linear trend (adjusted with age, number of diseases and depressive symptoms) between SRH and PAM, p < 0.001.

Conclusions: Activity in self-care had an independent, linear relationship with the self-rated health. The present findings suggest that Patient Activation Measurement has the potential to categorize the patients according to their perceived health and their needs related to their disease management and self-care. The present results warrant longitudinal studies on the impact of promoting patient activation levels.

Trial registration: ClinicalTrials.gov Identifier: NCT02992431 . Registered 14 December 2016 https://ichgcp.net/clinical-trials-registry/NCT02992431.

Keywords: Aging population; Chronic diseases; Patient activation measurement; Primary health care; Self-rated health.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Distribution of the Patient activation measurement (PAM) total score. Box-and-whiskers plot shows median with IQR, and whiskers indicate 5th and 95th percentiles. The dotted lines show the four PAM categories (activation levels): Level 1: Not taking an active role; Level 2: Gaining confidence and knowledge to take action; Level 3: Taking action and Level 4: Maintaining behaviors and pressing ahead
Fig. 2
Fig. 2
Patient activation measurement (PAM) score according to self-rated health (SRH), adjusted by sex, age, BDI (Beck depression index) index and the number of diseases. Whiskers represent 95% confidence intervals. SRH category I means excellent health and V poor health, respectively. Hatched lines represent the four PAM categories

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