Patient and Disease Characteristics Associated with Activation for Self-Management in Patients with Diabetes, Chronic Obstructive Pulmonary Disease, Chronic Heart Failure and Chronic Renal Disease: A Cross-Sectional Survey Study

Abstract

A substantial proportion of chronic disease patients do not respond to self-management interventions, which suggests that one size interventions do not fit all, demanding more tailored interventions. To compose more individualized strategies, we aim to increase our understanding of characteristics associated with patient activation for self-management and to evaluate whether these are disease-transcending. A cross-sectional survey study was conducted in primary and secondary care in patients with type-2 Diabetes Mellitus (DM-II), Chronic Obstructive Pulmonary Disease (COPD), Chronic Heart Failure (CHF) and Chronic Renal Disease (CRD). Using multiple linear regression analysis, we analyzed associations between self-management activation (13-item Patient Activation Measure; PAM-13) and a wide range of socio-demographic, clinical, and psychosocial determinants. Furthermore, we assessed whether the associations between the determinants and the PAM were disease-transcending by testing whether disease was an effect modifier. In addition, we identified determinants associated with low activation for self-management using logistic regression analysis. We included 1154 patients (53% response rate); 422 DM-II patients, 290 COPD patients, 223 HF patients and 219 CRD patients. Mean age was 69.6±10.9. Multiple linear regression analysis revealed 9 explanatory determinants of activation for self-management: age, BMI, educational level, financial distress, physical health status, depression, illness perception, social support and underlying disease, explaining a variance of 16.3%. All associations, except for social support, were disease transcending. This study explored factors associated with varying levels of activation for self-management. These results are a first step in supporting clinicians and researchers to identify subpopulations of chronic disease patients less likely to be engaged in self-management. Increased scientific efforts are needed to explain the greater part of the factors that contribute to the complex nature of patient activation for self-management.

Patient Activation in Acute Decompensated Heart Failure

“…The association of activation with age is intriguing but may reflect that older adults with HF frequently have concomitant geriatric syndromes, such as impaired cognition and limitations in functional mobility(29, 30) that can make self-care and disease management more challenging. Several prior studies have noted that patients who are less activated are more likely to have depression(10, 25), consistent with our findings. Symptoms associated with depression such as anhedonia, difficulty concentrating, and insomnia can make it more difficult for patients to feel confident in engaging in their healthcare decisions and management.…”

“…Similar to others, we found that activation was higher in patients who were younger(25, 26), more educated(10, 25, 26), and in those with better health literacy(10). Previous HF literature demonstrates that health literacy is associated with enhanced HF knowledge and better self-care(27, 28), and our results suggest that these patients also have higher activation.…”

“…For example, in a large outpatient primary care population, four out of five patients were in the highest two levels of activation, compared with only two out of five in our study. Patients with chronic disease tend to be less activated(9, 25), though the proportion of patients at the highest activation level in this study (3.0%) was less than has been reported in ambulatory populations. This could reflect that we are capturing a high-risk population, and they may feel a lack of control over their health while in the hospital and over their condition given their acute decompensation.…”

Promoting self-care for the patient with diabetes and depression: an integrative literature review

“…These findings suggest that certain subgroups of patients with diabetes may need additional consideration when constructing a plan of care and further research is warranted for this population. Similar findings were identified by Bos-Touwen et al (2015) in their cross-sectional survey of patients with diabetes, COPD, HF, and chronic renal disease.…”

Brief Report: Patient Activation Among Urban Hospitalized Patients With Heart Failure

“…1 The optimal management of HF relies on patients being able to participate in their own self-care, including being able to manage progressive symptoms of HF. Patient activation entails having knowledge, skills, and confidence to manage ones’ own health, and it positively influences patient outcomes, 2 disease management, 3 and health care utilization. 4 Patient activation has also been described as one’s self-concept of self-management, or the feeling of being in charge of one’s own health.…”