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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BackgroundMethodInfluential
The relationship between patient activation, confidence to self-manage side effects, and adherence to oral oncolytics: a pilot study with Michigan oncology practices
Salgado, T. M., Mackler, E. R., Severson, J. A., Lindsay, J., Batra, P., Petersen, L., & Farris, K. B. (2017) · Supportive Care in Cancer · doi:10.1007/s00520-017-3584-0 · Cited by 53
“In this study, we used the 13-item short form (PAM-13) [24] which showed similar psychometric properties to the original 22-item version [25].”
Method
Collaborative action for person-centred coordinated care (P3C): an approach to support the development of a comprehensive system-wide solution to fragmented care
Lloyd, H. M., Pearson, M., Sheaff, R., Asthana, S., Wheat, H. C., Sugavanam, T., Britten, N., Valderas, J. M., Bainbridge, M., Witts, L., et al. (2017) · Health Research Policy and Systems · doi:10.1186/s12961-017-0263-z · Cited by 54
“practitioner and patient experience [51, 53], patient activation [54], patient well-being [55], morbidity, mortality, cost and organisational processes [41]).”
A Mobile App With Optical Imaging for the Self-Management of Hand Rheumatoid Arthritis: Pilot Study
Mollard, E. K., & Michaud, K. D. (2018) · JMIR mhealth and uhealth · doi:10.2196/12221 · Cited by 54
“Patient activation is an important element of self-management that includes having the skills and confidence to become actively engaged in one’s own health care [16].”
A systematic review and meta-analysis of patient activation in people living with chronic conditions
Cuevas, H. E., Heitkemper, E., Huang, Y., Jang, D. E., García, A. A., & Zuniga, J. A. (2021) · Patient Education and Counseling · doi:10.1016/j.pec.2021.02.016 · Cited by 53
Intervention Mapping as a Guide for the Development of a Diabetes Peer Support Intervention in Rural Alabama
Cherrington, A., Martin, M., Hayes, M., Halanych, J. H., Wright, M. L. A., & Appel, S. J. (2011) · Preventing Chronic Disease · doi:10.5888/pcd9.110053 · Cited by 54
The role of patient activation in frequent attendance at primary care: a population-based study of people with chronic disease.
Donald, M., Ware, R., Ozolins, I. Z., Begum, N., Crowther, R., & Bain, C. (2011) · Patient Education and Counseling · doi:10.1016/j.pec.2010.05.031 · Cited by 63
“1010)’’ [11].”
The Patient Activation Measure: a validation study in a neurological population
Packer, T. L., Kephart, G. C., Ghahari, S., Audulv, Å., Versnel, J., & Warner, G. (2015) · Quality of Life Research · doi:10.1007/s11136-014-0908-0 · Cited by 53
Psychometric Properties of the Korean Version of the “Patient Activation Measure 13” (PAM13-K) in Patients With Osteoarthritis
Ahn, Y. H., Yi, C., Ham, O. K., & Kim, B.-J. (2014) · Evaluation & the Health Professions · doi:10.1177/0163278714540915 · Cited by 53
“The structure of the probabilistic hierarchy of item difficulty showed that it is necessary to ascertain an individual’s position on the activation continuum to increase that person’s activation (Hibbard et al., 2004).”
Factors associated with patient activation in an older adult population with functional difficulties
Gleason, K. T., Tanner, E. K., Boyd, C. M., Saczynski, J. S., & Szanton, S. L. (2016) · Patient Education and Counseling · doi:10.1016/j.pec.2016.03.011 · Cited by 53
Activation and Self-Efficacy in a Randomized Trial of a Depression Self-Care Intervention
McCusker, J., Lambert, S., Cole, M. G., Ciampi, A., Strumpf, E., Freeman, E. E., & Belzile, É. (2016) · Health Education & Behavior · doi:10.1177/1090198116637601 · Cited by 53
“The 13-item Patient Activation Measure (PAM– Chronic Disease version; Hibbard et al., 2004) was administered at baseline and at 6 month follow-up.”
Effect of a Mobile Web App on Kidney Transplant Candidates' Knowledge About Increased Risk Donor Kidneys
Gordon, E. J., Sohn, M., Chang, C.-H., McNatt, G. E., Vera, K., Beauvais, N., Warren, E., Mannon, R. B., & Ison, M. G. (2016) · Transplantation · doi:10.1097/tp.0000000000001273 · Cited by 53
“Scores are trichotomized into low (1-22), medium (23-32), and high (32-40) efficacy.”
Electronic Quality of Life Assessment Using Computer-Adaptive Testing
Sidey-Gibbons, C. J., Bower, P., Lovell, K., Valderas, J. M., & Skevington, S. M. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.6053 · Cited by 54
“Such patient-centered metrics include satisfaction [7], activation [8], and subjective QoL [9].”
Background
Patient engagement and self-management in pulmonary arterial hypertension
Graarup, J., Ferrari, P., & Howard, L. (2016) · European Respiratory Review · doi:10.1183/16000617.0078-2016 · Cited by 53
Feasibility of personalised remote long-term follow-up of people with cochlear implants: a randomised controlled trial
Cullington, H. E., Kitterick, P. T., Weal, M. J., & Gromada, M. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-019640 · Cited by 53
Is telephone health coaching a useful population health strategy for supporting older people with multimorbidity? An evaluation of reach, effectiveness and cost-effectiveness using a ‘trial within a cohort’
Panagioti, M., Reeves, D., Meacock, R., Parkinson, B., Lovell, K., Hann, M., Howells, K., Blakemore, A., Riste, L., Coventry, P. A., et al. (2018) · BMC Medicine · doi:10.1186/s12916-018-1051-5 · Cited by 53
“The PAM is a self-report measure of patient knowledge, skills and confidence in selfmanagement for long-term conditions [22, 36, 41].”
Background
Electronic Communications and Home Blood Pressure Monitoring (e-BP) study: Design, delivery, and evaluation framework
Green, B. B., Ralston, J. D., Fishman, P. A., Catz, S. L., Cook, A. J., Carlson, J., Tyll, L. T., Carrell, D., & Thompson, R. S. (2007) · Contemporary Clinical Trials · doi:10.1016/j.cct.2007.09.005 · Cited by 53
“0001) compared to the PAM.”
MethodInfluential
The Audit of Diabetes-Dependent Quality of Life 19 (ADDQoL): feasibility, reliability and validity in a population-based sample of Australian adults
Ostini, R., Dower, J., & Donald, M. (2012) · Quality of Life Research · doi:10.1007/s11136-011-0043-0 · Cited by 51
Effects of Music Therapy on Drug Therapy of Adult Psychiatric Outpatients: A Pilot Randomized Controlled Study
Stefani, M. D., & Biasutti, M. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01518 · Cited by 53
“Several health care institutions at the forefront of policies support the promotion of a patient-centered perspective (Hibbard et al., 2004; Barello et al., 2012).”
Educational group visits for the management of chronic health conditions: A systematic review
Quiñones, A. R., Richardson, J., Freeman, M., Fu, R., O'Neil, M. E., Motu’apuaka, M. L., & Kansagara, D. L. (2014) · Patient Education and Counseling · doi:10.1016/j.pec.2013.12.021 · Cited by 54
“We chose to examine this set of outcomes because there are validated tools [8,9], and these metrics were commonly reported.”
Method
The quest for engaging AmI: Patient engagement and experience design tools to promote effective assisted living
Triberti, S., & Barello, S. (2016) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2016.08.010 · Cited by 52
“For instance, the Patient Activation Measure, developed by Hibbard and colleagues [44] is a well-known instrument speciﬁcally aimed at assessing the patient behaviors when approaching his/her healthcare journey both in term of disease/treatment management and information seeking.”
Background
A Concept Analysis of Patient Participation in Intermediate Care
Kvæl, L. A. H., Debesay, J., Langaas, A. G., Bye, A., & Bergland, A. (2018) · Patient Education and Counseling · doi:10.1016/j.pec.2018.03.005 · Cited by 56
Supporting Collaborative Health Tracking in the Hospital
Mishra, S. R., Miller, A., Haldar, S., Khelifi, M., Eschler, J., Elera, R. G., Pollack, A. H., & Pratt, W. (2018) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3173574.3174224 · Cited by 53
“Most definitions of patient engagement emphasize patients’ awareness of their health status, understanding of their health care needs, or performance of particular behaviors (e.g. [ 15,18,21,40]).”
Background
Symptoms of depression are associated with physical inactivity but not modified by gender or the presence of a cardiovascular disease; a cross-sectional study
Achttien, R. J., van Lieshout, J., Wensing, M., der Sanden, M. W. G. N., & Staal, J. B. (2019) · BMC Cardiovascular Disorders · doi:10.1186/s12872-019-1065-8 · Cited by 59
Personalised care planning for adults with chronic or long-term health conditions
Coulter, A., Entwistle, V. A., Eccles, A., Ryan, S., Shepperd, S., & Perera, R. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010523 · Cited by 52
Effectiveness of a telerehabilitation intervention using ReCOVery APP of long COVID patients: a randomized, 3-month follow-up clinical trial
Samper-Pardo, M., León-Herrera, S., Oliván‐Blázquez, B., Méndez-López, F., García, M. D., & Sánchez‐Recio, R. (2023) · Scientific Reports · doi:10.1038/s41598-023-35058-y · Cited by 52
Psychometric assessment of the patient activation measure short form (PAM-13) in rural settings
Hung, M., Carter, M., Hayden, C. L., Dzierzon, R., Morales, J., Snow, L. A., Butler, J. M., Bateman, K. A., & Samore, M. H. (2012) · Quality of Life Research · doi:10.1007/s11136-012-0168-9 · Cited by 51
“The patient activation measure short form (PAM-13) [1] consists of 13 items measuring patients’ self-reported knowledge, motivation, and skills for health management (Appendix 1).”
Background
Racial disparities in patient activation: Evaluating the mediating role of health literacy with path analyses
Gwynn, K. B., Winter, M. R., Cabral, H., Wolf, M. S., Hanchate, A. D., Henault, L. E., Waite, K. R., Bickmore, T., & Paasche‐Orlow, M. K. (2016) · Patient Education and Counseling · doi:10.1016/j.pec.2015.12.020 · Cited by 51
“The PAM is a 21-item questionnaire that is scored on a scale of 0–100, 0 = the lowest possible activation and 100 = the highest possible activation [1].”
BackgroundMethodInfluential
A Couples’ Based Self-Management Program for Heart Failure: Results of a Feasibility Study
TRIVEDI, R. B., Slightam, C. A., Fan, V. S., Rosland, A.-M. M., Nelson, K. M., Timko, C., Asch, S. M., Zeliadt, S. B., Heidenreich, P. A., Hebert, P. L., et al. (2016) · Frontiers in Public Health · doi:10.3389/fpubh.2016.00171 · Cited by 51
“org August 2016 | Volume 4 | Article 171 to self-manage chronic illness, collaborate with health-care providers, maintain function, monitor symptoms, and access appropriate care (29).”
Background
L’émergence du patient-acteur dans la sécurité des soins en France : une revue narrative de la littérature entre sciences sociales et santé publique
Mougeot, F., Robelet, M., Rambaud, C., Occelli, P., Buchet-Poyau, K., Touzet, S., & Michel, P. (2018) · Santé Publique · doi:10.3917/spub.181.0073 · Cited by 51
“Prévenir et détecter les évènements indésirables / les erreurs liées aux soins [22, 46, 55-59]”
BackgroundInfluential
Efficacy of a self-management education programme on patients with type 2 diabetes in primary care: A randomised controlled trial
Moreno, E. G., Mateo‐Abad, M., García, L. O. D. R., Vrotsou, K., Pena, E. D. C., Sánchez, Á., Carazo, C. M., Ortiz, J. C. A., Portu, M. Á. R., Elorriaga, K. P., et al. (2018) · Primary care diabetes · doi:10.1016/j.pcd.2018.10.001 · Cited by 56
Relationship between patient activation measurement and self-rated health in patients with chronic diseases
Tusa, N., Kautiainen, H., Elfving, P., Sinikallio, S., & Mäntyselkä, P. T. (2020) · BMC Family Practice · doi:10.1186/s12875-020-01301-y · Cited by 51
Considerations for Community-Based mHealth Initiatives: Insights From Three Beacon Communities
Abebe, N. A., Capozza, K. L., Des Jardins, T. R., Kulick, D. A., Rein, A. L., Schachter, A. A., & Turske, S. A. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2803 · Cited by 46
“Patient activation is assessed with the Patient Activation Measure (PAM), a valid, highly reliable scale that reflects a developmental model of patient and consumer activation [35].”
Method
Tensions and opportunities in social prescribing. Developing a framework to facilitate its implementation and evaluation in primary care: a realist review
Calderón‐Larrañaga, S., Milner, Y., Clinch, M., Greenhalgh, T., & Finer, S. (2021) · BJGP Open · doi:10.3399/bjgpo.2021.0017 · Cited by 51
“Our findings could help to explain why evaluative approaches that conceptualize and measure effectiveness in terms of reduced service utilization (as a proxy for patients’ activation(88)) often fail to prove the value and potential impact of SP.”
Background
Outcome of a Randomized Study of a Mental Health Peer Education and Support Group in the VA
Eisen, S. V., Schultz, M. R., Mueller, L. N., Degenhart, C., Clark, J. A., Resnick, S. G., Christiansen, C. L., Armstrong, M., Bottonari, K. A., Rosenheck, R. A., et al. (2012) · Psychiatric Services · doi:10.1176/appi.ps.201100348 · Cited by 50
The Relationship Between Cancer Survivors’ Socioeconomic Status and Reports of Follow-up Care Discussions with Providers
DiMartino, L., Birken, S. A., & Mayer, D. K. (2016) · Journal of Cancer Education · doi:10.1007/s13187-016-1024-3 · Cited by 50
“, understand one’s own role in the care process and possessing the knowledge, skills, and confidence to take on that role) [18], and as such, providers may consider them as targets for intervention by initiating follow-up care discussions.”
The Trauma Collaborative Care Study (TCCS)
Wegener, S. T., Pollak, A. N., Frey, K. P., Hymes, R. A., Archer, K. R., Jones, C. B., Seymour, R. B., O’Toole, R. V., Castillo, R. C., Huang, Y., et al. (2017) · Journal of Orthopaedic Trauma · doi:10.1097/bot.0000000000000792 · Cited by 50
“Never married 372 (41) 192 (40) 180 (43)”
The impact of patient education and shared decision making on hospital readmissions for COPD
Collinsworth, A. W., Brown, R. M., James, C. S., Stanford, R. H., Alemayehu, D., & Priest, E. L. (2018) · International Journal of COPD · doi:10.2147/copd.s154414 · Cited by 53
“Get Ready and Empowered About Treatment” (GREAT) Study: a Pragmatic Randomized Controlled Trial of Activation in Persons Living with HIV
Carroll, J. K., Tobin, J. N., Luque, A. E., Farah, S., Sanders, M., Cassells, A. N., Fine, S. M., Cross, W. F., Boyd, M., Holder, T., et al. (2019) · Journal of General Internal Medicine · doi:10.1007/s11606-019-05102-7 · Cited by 50
Levels and determinants of health literacy and patient activation among multi-morbid COPD people in rural Nepal: Findings from a cross-sectional study
Yadav, U. N., Lloyd, J. E., Hosseinzadeh, H., Baral, K. P., Bhatta, N., & Harris, M. (2020) · PLoS ONE · doi:10.1371/journal.pone.0233488 · Cited by 55
“Hibbard and colleagues developed a comprehensive scale to measure activation of patients for managing their health known as the Patient Activation Measure (PAM) [13].”
Background
Contributors to patient engagement in primary health care: perceptions of patients with obesity
Forhan, M. A., Risdon, C., & Solomon, P. E. (2012) · Primary Health Care Research & Development · doi:10.1017/s1463423612000643 · Cited by 50
“Patient outcomes associated with engagement in primary health care include increased participation in health-promoting behaviors, such as disease prevention and screening, improved selfefficacy for self-management of health conditions (Hibbard et al., 2004; Coulter and Ellins, 2007) and improved satisfaction with care…”
Background
Patient Activation in Acute Decompensated Heart Failure
Dunlay, S. M., Griffin, J. M., Redfield, M. M., & Roger, V. L. (2016) · The Journal of Cardiovascular Nursing · doi:10.1097/jcn.0000000000000367 · Cited by 49
“Activation was measured using the validated 13-item Patient Activation Measure (PAM).(17,18) According to the developers of the PAM,(18) patients who are activated believe that patients have important roles in maintaining their health, know how to manage their condition and prevent health decline, and have the skills…”
Method
Patient-centered care and the electronic health record: exploring functionality and gaps
Butler, J. M., Gibson, B., Lewis, L., Reiber, G. E., Kramer, H., Rupper, R., Herout, J., Long, B., Massaro, D., & Nebeker, J. R. (2020) · JAMIA Open · doi:10.1093/jamiaopen/ooaa044 · Cited by 52
“The PCC functions identified as least available in the 6 EHR systems were the ability to record and display patient-specific needs for education and healthrelated motivation, which could include assessments of health literacy(35) or patient activation.(36) Clinician users reported on the usefulness of the PCC function…”
Method
Determinants of patient activation and its association with cardiovascular disease risk in chronic kidney disease: A cross‐sectional study
Wilkinson, T. J., Memory, K. E., Lightfoot, C. J., Palmer, J., & Smith, A. C. (2021) · Health Expectations · doi:10.1111/hex.13225 · Cited by 49
“Major CVD risk factors were defined as either traditional [(1) age (older than median total sample 71.0 years), (2) male sex, (3) current smoker, (4) excessive alcohol intake, (>14.3 g/day); (5) hypertension (systolic blood pressure ≥ 130 mm Hg or diastolic ≥ 85 mm Hg, (6) diabetes, (7) dyslipidaemia (TG ≥ 150 mg/dL (…”
Influential

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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