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      Factors associated with patient activation in an Australian population with comorbid diabetes and chronic kidney disease: a cross-sectional study

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          Abstract

          Objective

          To evaluate the extent of patient activation and factors associated with activation in adults with comorbid diabetes and chronic kidney disease (CKD).

          Design

          A cross-sectional study.

          Setting

          Renal/diabetes clinics of four tertiary hospitals across the two largest states of Australia.

          Study population

          Adult patients (over 18 years) with comorbid diabetes and CKD (estimated glomerular filtration rate <60 mL/min/1.73 m 2).

          Main outcome measures

          Patients completed the Patient Activation Measure, the Kidney Disease Quality of Life and demographic and clinical data survey from January to December 2014. Factors associated with patient activation were examined using χ 2 or t-tests and linear regression.

          Results

          Three hundred and five patients with median age of 68 (IQR 14.8) years were studied. They were evenly distributed across socioeconomic groups, stage of kidney disease and duration of diabetes but not gender. Approximately 46% reported low activation. In patients with low activation, the symptom/problem list, burden of kidney disease subscale and mental composite subscale scores were all significantly lower (all p<0.05). On multivariable analysis, factors associated with lower activation for all patients were older age, worse self-reported health in the burden of kidney disease subscale and lower self-care scores. Additionally, in men, worse self-reported health in the mental composite subscale was associated with lower activation and in women, worse self-reported health scores in the symptom problem list and greater renal impairment were associated with lower activation.

          Conclusion

          Findings from this study suggest that levels of activation are low in patients with diabetes and CKD. Older age and worse self-reported health were associated with lower activation. This data may serve as the basis for the development of interventions needed to enhance activation and outcomes for patients with diabetes and CKD.

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          Most cited references56

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          Development and testing of a short form of the patient activation measure.

          Judith Hibbard, Eldon R. Mahoney, Jean Stockard … (2005)
          The Patient Activation Measure (PAM) is a 22-item measure that assesses patient knowledge, skill, and confidence for self-management. The measure was developed using Rasch analyses and is an interval level, unidimensional, Guttman-like measure. The current analysis is aimed at reducing the number of items in the measure while maintaining adequate precision. We relied on an iterative use of Rasch analysis to identify items that could be eliminated without loss of significant precision and reliability. With each item deletion, the item scale locations were recalibrated and the person reliability evaluated to check if and how much of a decline in precision of measurement resulted from the deletion of the item. The data used in the analysis were the same data used in the development of the original 22-item measure. These data were collected in 2003 via a telephone survey of 1,515 randomly selected adults. Principal Findings. The analysis yielded a 13-item measure that has psychometric properties similar to the original 22-item version. The scores for the 13-item measure range in value from 38.6 to 53.0 (on a theoretical 0-100 point scale). The range of values is essentially unchanged from the original 22-item version. Subgroup analysis suggests that there is a slight loss of precision with some subgroups. The results of the analysis indicate that the shortened 13-item version is both reliable and valid.
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            Measuring patient activation in the Netherlands: translation and validation of the American short form Patient Activation Measure (PAM13)

            Jany Rademakers, Jessica Nijman, Lucas van der Hoek … (2012)
            Background The American short form Patient Activation Measure (PAM) is a 13-item instrument which assesses patient (or consumer) self-reported knowledge, skills and confidence for self-management of one’s health or chronic condition. In this study the PAM was translated into a Dutch version; psychometric properties of the Dutch version were established and the instrument was validated in a panel of chronically ill patients. Methods The translation was done according to WHO guidelines. The PAM 13-Dutch was sent to 4178 members of the Dutch National Panel of people with Chronic illness or Disability (NPCD) in April 2010 (study A) and again to a sub sample of this group (N = 973) in June 2010 (study B). Internal consistency, test-retest reliability and cross-validation with the SBSQ-D (a measure for Health literacy) were computed. The Dutch results were compared to similar Danish and American data. Results The psychometric properties of the PAM 13-Dutch were generally good. The level of internal consistency is good (α = 0.88) and item-rest correlations are moderate to strong. The Dutch mean PAM score (61.3) is comparable to the American (61.9) and lower than the Danish (64.2). The test-retest reliability was moderate. The association with Health literacy was weak to moderate. Conclusions The PAM-13 Dutch is a reliable instrument to measure patient activation. More research is needed into the validity of the Patient Activation Measure, especially with respect to a more comprehensive measure of Health literacy.
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              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

              Irene Bos-Touwen, Marieke Schuurmans, Evelyn Monninkhof … (2015)
              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.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2017
                Publication date (Electronic): 22 October 2017
                Volume: 7
                Issue: 10
                Electronic Location Identifier: e017695
                Affiliations
                [1 ] departmentSchool of Public Health and Preventive Medicine , Monash Centre for Health Research and Implementation (MCHRI), Monash University , Melbourne, Victoria, Australia
                [2 ] departmentDepartment of Nephrology , Monash Health , Melbourne, Victoria, Australia
                [3 ] departmentDiabetes and Vascular Medicine Unit , Monash Health , Melbourne, Victoria, Australia
                [4 ] departmentDepartment of Diabetes and Endocrinology , Royal North Shore Hospital , St Leonards, New South Wales, Australia
                [5 ] The George Institute for Global Health, University of Sydney , Sydney, New South Wales, Australia
                [6 ] departmentSydney Medical School, Westmead , University of Sydney , Sydney, New South Wales, Australia
                [7 ] departmentDepartment of General Practice , School of Primary Health and Allied Health Care, Monash University , Melbourne, Victoria, Australia
                [8 ] departmentDepartment of Renal Medicine , Alfred Hospital , Melbourne, Victoria, Australia
                Author notes
                [Correspondence to ] Professor Sophia Zoungas; sophia.zoungas@ 123456monash.edu
                Author information
                http://orcid.org/0000-0002-2423-9193
                Article
                Publisher ID: bmjopen-2017-017695
                DOI: 10.1136/bmjopen-2017-017695
                PMC ID: 5665291
                PubMed ID: 29061622
                SO-VID: c803e356-d5e8-43d7-a782-9daef6f14010
                Copyright © © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 11 May 2017
                Date revision received : 11 September 2017
                Date accepted : 13 September 2017
                Funding
                Funded by: National Health and Medical Research Council, Australia;
                Categories
                Subject: Public Health
                Subject: Research
                Subject: 1506
                Subject: 1724
                Custom metadata
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                ScienceOpen disciplines: Medicine
                Keywords: patient activation,diabetes,chronic kidney disease,self-care,health related quality of life
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: patient activation, diabetes, chronic kidney disease, self-care, health related quality of life

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