Study: Consumers’ health skills vary widely

WASHINGTON – A national study by the Center for Studying Health System Change has found that the level of “patient activation” – people’s ability to manage their health and health care – varies considerably in the U.S. population.
Less than half of adults, 41.4 percent, were found to be at the highest level, which is associated with lower levels of unmet need for medical care and greater support from health care providers for self-management of chronic conditions.
Younger, more-educated and higher-income people – and those with private health insurance – tended to have higher activation levels, while people with lower incomes and/or less education, Medicaid beneficiaries and those with only Medicare coverage had lower levels.
Racial and ethnic differences in activation were also found, with Hispanics having much lower activation levels compared with other groups.
The study also found that sicker people are often less engaged than healthier counterparts. Overall, people with chronic conditions had lower levels of activation – about 26 percent in Level 1 or 2, compared with 18 percent for people without any chronic conditions.
People with chronic conditions who are at lower activation levels are much more likely to report unmet medical needs, to delay care and to have unmet prescription drug needs, and they are also somewhat less likely to have a usual source of care, according to the study.
Conversely, people with chronic conditions who are more activated appear to get more support from their providers in managing their health. For example, 83.6 percent of those at the highest activation level reported that their health care provider helped them to set goals to improve their diet, compared with 48.3 percent at the lowest activation level.
The Patient Activation Measure (PAM) uses a 13-item scale to assess people’s skill, knowledge and confidence in managing their health. Prior research using the PAM has relied on relatively small samples or groups, such as health plan enrollees, Medicaid enrollees in several local areas, and older adults with chronic conditions.
The center’s 2007 Health Tracking Household Survey is the first large nationally representative survey – covering 13,500 adults – to use the PAM to assess the level of activation in the U.S. population. The survey and the PAM analysis were funded by the Robert Wood Johnson Foundation, a backer of the nonpartisan health policy research center.
In a news release about the study, co-author Judith Hibbard, of the University of Oregon, noted that previous research has linked patient activation levels to “important outcomes” such as seeking care, seeking information, and changing behavior.
“Because activation is changeable, it is a potentially important lever for change in the health care system,” Hibbard said.
“It appears that when there’s a good relationship between patients and their doctors, the patients are more engaged, and more likely to receive high-quality health care,” said Anne F. Weiss, senior program officer and team leader for the Robert Wood Johnson Foundation’s Quality/Equality strategy. “Doctors need to talk with their patients about setting goals for their health and how to monitor their conditions. And since we know that activated patients fare better and ultimately cost less, policy makers should consider encouraging health systems to find ways to activate their patients.”
The PAM assigns each person a score based on the 13 measures, and based on that score, people are classified in four groups: At the first or lowest level, people tend to be passive and may not feel confident enough to play an active role in their own health. At the second level, people may lack basic knowledge and confidence in their ability to manage their health.
At the third level, people appear to be taking some action but may still lack confidence and skill to support all necessary behaviors. At the fourth level, people have adopted many of the behaviors to support their health but may not be able to maintain them in the face of life stressors.
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and improve health care policy. Based in Washington, D.C., it is funded in part by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research Inc. For more information – including the research brief “How Engaged Are Consumers in Their Health and Health Care, and Why Does It Matter?,” which details the results of the new study – go to www.HSChange.org.