Abstract
Background: People with chronic conditions are better able to self-manage if they are more engaged, informed, and confident. Healthcare providers are increasingly offering support for self-management, and there is interest in improving the efficacy of these efforts by tailoring them to a person’s knowledge, skill, and confidence to self-manage — so-called ‘activation.’
Objective: To explore how people with chronic conditions at different levels of ‘activation’ (as measured by the Patient Activation Measure) understand successful self-management, what barriers to self-management they face, and what strategies they employ to manage their condition and to cope with stress.
Methods: Face-to-face semi-structured interviews were conducted with a stratified convenience sample of respondents with at least one chronic condition (n = 27) who were non-faculty staff at the University of Oregon (Eugene, OR, USA). Stratification was performed using the level of patient activation. Interviews took place in February and March 2006 in a private office on the university campus.
Results: Those people lower in activation tended to see successful self-management as compliance whereas those at higher activation levels saw it as being in control. People with lower activation levels indicated that lack of knowledge and lack of confidence were barriers for them. Both the high and low activated could be derailed by stress. People with lower activation levels talked about a more limited number of strategies for coping but both the high and low activated had learned strategies from professionals and by trial and error.
Conclusions: Some aspects of self-management support may need to be tailored for people at different levels of activation to ensure that differences in their understanding, knowledge, and confidence are addressed. However, there are also likely to be some types of self-management support such as stress-coping strategies and problem-solving skills that are beneficial for all patients with chronic conditions regardless of activation level.
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Notes
The PAM is a theoretical 0–100 measure, with most people falling in the 39–90 range.
Survey participants were recruited using a flyer distributed to all non-faculty staff. Participants were paid $US15 and the survey took approximately 20 minutes to complete.
Some examples of these conditions were given (e.g. high cholesterol, high blood pressure, arthritis, asthma, allergies, and diabetes).
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Acknowledgments
Judith Hibbard and Martin Tusler have ownership interests in, and are consultants to, Insignia Health LLC, which holds licensing rights to the PAM. No sources of funding were used to assist in the preparation of this study. Support was provided by the Commonwealth Fund. The views presented here are those of the authors and should not be attributed to the Commonwealth Fund or its directors, officers, or staff.
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Dixon, A., Hibbard, J. & Tusler, M. How do People with Different Levels of Activation Self-Manage their Chronic Conditions?. Patient-Patient-Centered-Outcome-Res 2, 257–268 (2009). https://doi.org/10.2165/11313790-000000000-00000
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DOI: https://doi.org/10.2165/11313790-000000000-00000