Do increases in patient activation result in improved self-management behaviors?

Abstract

Objective: The purpose of this study is to determine whether patient activation is a changing or changeable characteristic and to assess whether changes in activation also are accompanied by changes in health behavior.

Study methods: To obtain variability in activation and self-management behavior, a controlled trial with chronic disease patients randomized into either intervention or control conditions was employed. In addition, changes in activation that occurred in the total sample were also examined for the study period. Using Mplus growth models, activation latent growth classes were identified and used in the analysis to predict changes in health behaviors and health outcomes.

Data sources: Survey data from the 479 participants were collected at baseline, 6 weeks, and 6 months.

Principal findings: Positive change in activation is related to positive change in a variety of self-management behaviors. This is true even when the behavior in question is not being performed at baseline. When the behavior is already being performed at baseline, an increase in activation is related to maintaining a relatively high level of the behavior over time. The impact of the intervention, however, was less clear, as the increase in activation in the intervention group was matched by nearly equal increases in the control group.

Conclusions: Results suggest that if activation is increased, a variety of improved behaviors will follow. The question still remains, however, as to what interventions will improve activation.

Figure 1

Changes in Activation Scores by Intervention and Control Group, ^***F = 13.442, p = 0.000

Figure 2

Estimated Marginal Means of Activation by Wave by Activation Growth Class

Figure 3

Estimated Marginal Means of Depression by Wave by Activation Growth Class