Assessing Clinicians' Endorsement of Patient Activation in Health Management

Monday, 30 October 2017

Demetra Bastas-Bratkic, MSN, MPH
California State University of Fullerton, Fullerton, CA, USA


To conduct a quality improvement project to determine the impact that a tailored training will have on influencing a clinician’s role in patient activation.


Living and managing chronic medical conditions presents a multitude of challenges to the afflicted individuals, as well as the health care delivery system they have to navigate. The consequences are burdens that impact our nation’s emotional, social, physical and fiscal health. The management of chronic conditions in the U.S. requires new strategies to more efficiently mobilize patients to be active partners in their health. While not a new concept, the struggle continues with ways to actually enhance patient activation. There is one such validated psychometric tool developed in 2004, known as the Patient Activation Measure (PAM). This tool has demonstrated positive predictive properties, thus becoming advantageous for clinicians, as a participant’s score can serve as a guide for tailoring disease specific interventions. It has been demonstrated that departures from traditional patient-clinician roles are positively correlated with higher patient activation, but the success of this dynamic relies on the initial clinician’s motivation for patient engagement. However, traditional training does not incorporate these notions or strategies for partnering with patients. A relatively new and reliable measure to assess and differentiate between clinicians who support patient self-management, and therefore activation, is called the Clinician Support for Patient Activation Measure (CS-PAM). Few studies have examined actual clinician beliefs concerning patient self-management and the degree a clinician’s belief in supporting patient activation has on the patient.

Undertaking/best practice/approach/methods/process

The process included the development of a training educational module for primary care providers through a complete review of the literature, attending PAM conference(s), and developing a training module that was reviewed by content and education experts. The deployment of the developed training module is currently underway, with a goal of 50 participants. A pre and post-test will be conducted to assess knowledge readiness and then acquisition. Clinician readiness for the role of patient activation will be measured before the training with the CS-PAM and then at one-month post intervention for evaluation to determine if there is a change in clinician attitude and behavior.

Outcomes achieved/documented

Expert review of the developed clinician-training module and of the pre and post-tests has been successfully obtained. As the implementation of the training is currently underway, it is anticipated that by the time for presentation, the expected outcomes will include numeric findings about clinician’s value of patient activation and impact of the training. To best display the findings, tables and figures will be used accordingly.


Although clinical use of PAM is well supported through the research, there are still gaps in the research literature to demonstrate that clinicians can reliably assess patient activation and then engage the patient within the time constraints of a clinical encounter. Additionally, there have been minimal published reports on CS-PAM training via key strategies and assessing what links exists between PCP behavior, patient activation and patient outcomes. Herein lies the gap this project is attempting to fill.