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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van Overbeeke, E., Hauber, B., Michelsen, S., Peerlinck, K., Lambert, C., Hermans, C. R. J. R., Lê, P.-Q., Goldman, M., Simoens, S., & Huys, I. (2021) · Haemophilia · doi:10.1111/hae.14401 · Cited by 28
Assessing the Implementation and Effectiveness of the Electronic Patient-Reported Outcome Tool for Older Adults With Complex Care Needs: Mixed Methods Study
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“PAM is considered a valid and reliable metric of patient self-management for older adults with multimorbidity [50-52].”
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“In this pilot study, we did not find a significant change in the patient activation measure (PAM-13) [11] in either group, although trends were observed.”
Result
Appointment Length, Psychiatrists’ Communication Behaviors, and Medication Management Appointment Adherence
Cruz, M., ROTER, D. L., Cruz, R. F., Wieland, M. E., Larson, S., Cooper, L. A., & Pincus, H. A. (2013) · Psychiatric Services · doi:10.1176/appi.ps.201200416 · Cited by 29
Patient-Centered Care
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“Providing patients with information has been suggested as an approach to “activate the patient” 17,18 and was also found to be effective by Stone et al’s 15 meta-analysis, with adjusted odds ratios of 1.29 to 1.53 for interventions targeting immunizations and other screening services.”
BackgroundInfluential
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“, screenings), and healthinformation seeking [31] and as a result, have better health, functioning, quality of life, and higher satisfaction with their care [32, 33].”
Background
RETRACTED ARTICLE: Tools for measuring individual self-care capability: a scoping review
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Retracted
The effects of a digital health intervention on patient activation in chronic kidney disease
Lightfoot, C. J., Wilkinson, T. J., Sohansoha, G. K., Gillies, C. L., Vadaszy, N., Ford, E. C., Davies, M. J., Yates, T. E., Smith, A. C., Graham-Brown, M. P. M., et al. (2024) · npj Digital Medicine · doi:10.1038/s41746-024-01296-1 · Cited by 27
Parents' Perspectives on “Keeping Their Children Safe” in the Hospital
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Simulated Conversations With Virtual Humans to Improve Patient-Provider Communication and Reduce Unnecessary Prescriptions for Antibiotics: A Repeated Measure Pilot Study
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“Patient activation was measured for patients with the Patient Activation Measure (PAM) developed by Hibbard et al [35,36].”
MethodSelf-citation
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“[47] in operationalizing a definition of patient engagement.”
Background
A Systematic Review of Outcome Measures Assessing Disability Following Upper Extremity Trauma
Jayakumar, P., Williams, M. A., Ring, D., Lamb, S. E., & Gwilym, S. E. (2017) · JAAOS Global Research and Reviews · doi:10.5435/jaaosglobal-d-17-00021 · Cited by 27
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A SMART design to determine the optimal treatment of chronic pain among military personnel
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David, D., Barnes, D. E., McMahan, R. D., Shi, Y., Katen, M. T., & Sudore, R. L. (2018) · Journal of Palliative Medicine · doi:10.1089/jpm.2018.0096 · Cited by 27
“, ‘‘How strongly do you agree with the statement: Taking an active role in your own healthcare is the most important factor in determining your health and ability to function’’).(4) We used the 13-item PAM version.”
BackgroundMethod
The decline in physical activity in aging people is not modified by gender or the presence of cardiovascular disease
Achttien, R. J., van Lieshout, J., Wensing, M., der Sanden, M. W. G. N., & Staal, J. B. (2019) · European Journal of Public Health · doi:10.1093/eurpub/ckz159 · Cited by 27
Patient Satisfaction Is Improved With Exposure to Trauma Recovery Services
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Frequent Attendance to the Emergency Department after Release from Prison: a Prospective Data Linkage Study
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“The mean PAM-13 Total Score was 55.9 (SD 13.1).”
MethodInfluential
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Implementation of peer specialist services in VA primary care: a cluster randomized trial on the impact of external facilitation
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“…Scale (Maujean et al., 2014) • General Self-Efficacy Scale (Schwarzer & Jerusalem, 1995) • Falls Self-Efficacy Scale (Tinetti et al., 1990) • Patient Activation Measure (Hibbard et al., 2004) International Journal of Telerehabilitation • Vol. 13, No. 1 Spring 2021 • (10.5195/ijt.2021.6379) 9 when…”
Influential
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“Particularly, scientific studies have demonstrated that patients who are more engaged in their care reports better medical results [10], higher quality of life [11], higher satisfaction with their care relationship, healthier behaviors [12], more effective self-management skills [13] and treatment adherence [13].”
Background
Evaluation of a web-based resource to improve menstrual health literacy and self-management in young women
Armour, M., Parry, K. A., Curry, C., Ferfolja, T., Parker, M. A., Farooqi, T., MacMillan, F., Smith, C. A., & Holmes, K. (2022) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2022.111038 · Cited by 27
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“Data collection: Focus groups and interviews with participants and therapists; Patient Activation Measure (PAM), 10-m walk test, Rivermead Mobility Index, self-efficacy, subjective health status, quality of life.”
BackgroundMethodInfluential
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“This involves several stages of development (Hibbard et al., 2004): a.”
Background
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“In developing their conceptualization of activation, Hibbard et al. (2004) reviewed the literature on skills and knowledge needed to manage a chronic illness.”
BackgroundMethodInfluential
Remote Patient Monitoring and Clinical Outcomes for Postdischarge Patients with Type 2 Diabetes
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“Corroborating previous studies showing that more activated patients have better treatment outcomes and better care experiences than patients who are less activated, 23–26 the present study found higher activation scores to be associated with improved HbA1c control.”
Post-discharge intervention in vulnerable, chronically ill patients.
Kansagara, D., Ramsay, R. S., Labby, D., & Saha, S. (2012) · Journal of Hospital Medicine · doi:10.1002/jhm.941 · Cited by 26
Evaluating a Bilingual Patient Navigation Program for Uninsured Women With Abnormal Screening Tests for Breast and Cervical Cancer: Implications for Future Navigator Research
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“…that although the intervention arm with the strongest patient-centered approach was grounded in the principles of patient activation pronounced by Hibbard et al. (2004), the intervention did not provide the field nurses with the patient’s activation score, and the process of choosing and…”
BackgroundMethodInfluential
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“The PAM was developed to determine the activation level of patients and examine the knowledge, skills, and confidence needed to manage an illness.(18) Those with higher activation levels have a lower degree of fatalism about their health.”
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“Patient activation has been defined as an individual's willingness and ability to assume responsibility for their health and health care, with the knowledge, skills and confidence to take independent actions in this regard (Hibbard et al., 2004).”
Background
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“In 2004, the 22-item Patient Activation Measure (PAM22) was developed to measure individual patient activation, to formulate interventions and to assess changes in patient status.(12) In 2005, Hibbard et al.”
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“Missing 6 (10) 48 (15) 75 (17) 129 (16)”

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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