Cited by 2,748Psychometric Methodologies and TestingHealth Education and ValidationPatient-Provider Communication in Healthcare

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Development of the Patient Activation Measure (PAM): Conceptualizing and Measuring Activation in Patients and Consumers

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Hibbard, Judith H., Stockard, Jean, Mahoney, Eldon R., Tusler, Martin·2004·Health Services Research

DOI 10.1111/j.1475-6773.2004.00269.xPMC PMC1361049

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Abstract

Background. Controlling costs and achieving health care quality improvements require the participation of activated and informed consumers and patients. Objectives. We describe a process for conceptualizing and operationalizing what it means to be “activated” and delineate the process we used to develop a measure for assessing “activation,” and the psychometric properties of that measure. Methods. We used the convergence of the findings from a national expert consensus panel and patient focus groups to define the concept and identify the domains of activation. These domains were operationalized by constructing a large item pool. Items were pilot‐tested and initial psychometric analysis performed using Rasch methodology. The third stage refined and extended the measure. The fourth stage used a national probability sample to assess the measure's psychometric performance overall and within different subpopulations. Study Sample. Convenience samples of patients with and without chronic illness, and a national probability sample ( N =1,515) are included at different stages in the research. Conclusions. The Patient Activation Measure is a valid, highly reliable, unidimensional, probabilistic Guttman‐like scale that reflects a developmental model of activation. Activation appears to involve four stages: (1) believing the patient role is important, (2) having the confidence and knowledge necessary to take action, (3) actually taking action to maintain and improve one's health, and (4) staying the course even under stress. The measure has good psychometric properties indicating that it can be used at the individual patient level to tailor intervention and assess changes.

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“Scores are categorised into one of four patient activation levels, where 1 and 4 denote the lowest and highest level of patient activation, respectively [7, 8].”
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“They describe 4 levels of patient activation reflecting: (1) peoples’ beliefs about the importance of the patient role; (2) confidence and knowledge necessary to take action; (3) enacting health behaviors (eg, maintaining lifestyle changes, preventing problems, handling symptoms on one’s own); and (4) behavior mainten…”
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“66 Work disability (n = 535) Yes 109 (20) 57.”
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“The Patient Activation Measure (PAM)(25) is a 22assessment of long-term activation along four domains, specifically: believing that one’s role is important; having the confidence and knowledge necessary to take action; taking action to maintain and improve one’s health; and, staying the course under stress.(25) The PA…”
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“It refers to an individual ’ s knowledge, skill, and con ﬁ dence in managing their health and healthcare [7].”
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“A growing body of research has examined interventions to support self-management or ‘patient activation’ which is the individual’s knowledge, skills and confidence to self-manage their health [45].”
Background
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Self-citation
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Authors: Hibbard, J. H., Stockard, J., Mahoney, E. R., & Tusler, M.
Affiliations: University of Oregon (US)
Corresponding author: Hibbard, Judith H.
ORCID: Hibbard, Judith H.
Stockard, Jean
Venue: Health Services Research
Publisher: Wiley
Published: 2004-06-28
Volume: 39
Issue: 4p1
Pages: 1005-1026
ISSN: 0017-9124 (ISSN-L)
1475-6773
DOI: 10.1111/j.1475-6773.2004.00269.x
PMC: PMC1361049
OpenAlex: W1926404136
Cited by: 2,748
References: 36
Citations by year: 2026: 136 · 2025: 217 · 2024: 227 · 2023: 203 · 2022: 233 · 2021: 235 · 2020: 184 · 2019: 182 · 2018: 186 · 2017: 172 · 2016: 172 · 2015: 147 · 2014: 114 · 2013: 88 · 2012: 65
FWCI: 18.98
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Health Services Research (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Scholars' Bank (University of Oregon) (submittedVersion)
Topics: Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Health Sciences › Nursing › Research and Theory › Health Education and Validation
Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
Keywords: Patient Activation Measure, patient activation, psychometric validation, Rasch analysis, scale development, chronic disease, health behavior change, healthcare quality improvement
MeSH terms: Adult, Aged, Aged, 80 and over, Chronic Disease, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Outcome and Process Assessment, Health Care, Patient Education as Topic, Patient Participation, Pilot Projects, Primary Prevention, Psychometrics, Surveys and Questionnaires, Time Factors, United States, Reproducibility of Results

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Development of the Patient Activation Measure (PAM): Conceptualizing and Measuring Activation in Patients and Consumers

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