The role of Patient Health Engagement Model (PHE-model) in affecting patient activation and medication adherence: A structural equation model

Abstract

Background: Increasing bodies of scientific research today examines the factors and interventions affecting patients' ability to self-manage and adhere to treatment. Patient activation is considered the most reliable indicator of patients' ability to manage health autonomously. Only a few studies have tried to assess the role of psychosocial factors in promoting patient activation. A more systematic modeling of the psychosocial factors explaining the variance of patient activation is needed.

Objective: To test the hypothesized effect of patient activation on medication adherence; to test the the hypothesized effects of positive emotions and of the quality of the patient/doctor relationship on patient activation; and to test the hypothesized mediating effect of Patient Health Engagement (PHE-model) in this pathway.

Material and methods: This cross-sectional study involved 352 Italian-speaking adult chronic patients. The survey included measures of i) patient activation (Patient Activation Measure 13 -short form); ii) Patient Health Engagement model (Patient Health Engagement Scale); iii) patient adherence (4 item-Morinsky Medication Adherence Scale); iv) the quality of the patients' emotional feelings (Manikin Self Assessment Scale); v) the quality of the patient/doctor relationship (Health Care Climate Questionnaire). Structural equation modeling was used to test the hypotheses proposed.

Results: According to the theoretical model we hypothesized, research results confirmed that patients' activation significantly affects their reported medication adherence. Moreover, psychosocial factors, such as the patients' quality of the emotional feelings and the quality of the patient/doctor relationship were demonstrated to be factors affecting the level of patient activation. Finally, the mediation effect of the Patient Health Engagement model was confirmed by the analysis.

Conclusions: Consistently with the results of previous studies, these findings demonstrate that the Patient Health Engagement Model is a critical factor in enhancing the quality of care. The Patient Health Engagement Model might acts as a mechanism to increase patient activation and adherence.

Fig 1. The a priori model tested in the current study.

This is a path diagram describing the hypothesized effects of positive emotions and of the ability of the healthcare professionals to support patients’ autonomy on patient activation and medication adherence; it also describes the hypothesized mediating effect of patient engagement in this pathway. Unidirectional straight arrows indicate the predicted direction of the hypothesized effect. Note: HCCQ: Health Care Climate Questionnaire, PHE-s: Patient Health Engagement Scale, SAM: Self-Assessment Manikin Scale, PAM-13: Patient Activation Measure-short form, MMAS-4: 4 item-Morinsky Medication Adherence Scale.

Fig 2. Significant pathways of the final model.

Circles indicate unobserved latent variables, while rectangles represent observed variables. Significant paths with their estimated parameter are shown by solid lines. Standardized path coefficients are presented at the midpoint of the unidirectional arrow paths. Not significant paths are shown by dashed lines.