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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Method
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Method
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Background
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Background
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Method
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Background
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“12 Patient activation is a component of overall “patient engagement.””
Background
Activating Peripheral Arterial Disease Patients to Reduce Cholesterol: A Randomized Trial
McDermott, M. M., Reed, G., Greenland, P., Mazor, K. M., Pagoto, S., Ockene, J. K., Graff, R., Merriam, P. A., Leung, K., Manheim, L. M., et al. (2011) · The American Journal of Medicine · doi:10.1016/j.amjmed.2010.11.032 · Cited by 24
“§Measured by a previously validated investigator questionnaire.(17) Measured by the Brief Medication Questionnaire question about whether participants missed any cholesterol-lowering medication during the previous week.”
BackgroundMethodInfluential
Emerging Trends in Health and Productivity Management
Goetzel, R. Z., Ozminkowski, R. J., Pelletier, K. R., Metz, R. D., & Chapman, L. S. (2007) · American Journal of Health Promotion · doi:10.4278/0890-1171-22.1.tahp-1 · Cited by 24
Patients Receiving Integrative Medicine Effectiveness Registry (PRIMIER) of the BraveNet practice-based research network: study protocol
Dusek, J. A., Abrams, D. I., Roberts, R., Griffin, K. H., Trebesch, D., Dolor, R. J., Wolever, R. Q., McKee, M. D., & Kligler, B. (2015) · BMC Complementary and Alternative Medicine · doi:10.1186/s12906-016-1025-0 · Cited by 24
“Each level addresses a broad array of selfcare behaviors and offers insight into the characteristics that drive health activation [22].”
Background
Low-income Groups and Behaviour Change Interventions: A review of intervention content and effectiveness
Michie, S., Jochelson, K., Markham, & Bridle, C. (2008) · UCL Discovery (University College London) · Cited by 24
Linking Practice Adoption of Patient Engagement Strategies and Relational Coordination to Patient‐Reported Outcomes in Accountable Care Organizations
RODRIGUEZ, H. P., POON, B. Y., WANG, E., & SHORTELL, S. M. (2019) · The Milbank Quarterly · doi:10.1111/1468-0009.12400 · Cited by 21
Oximetry-supported self-management for chronic obstructive pulmonary disease: mixed method feasibility pilot project
MacNab, M., Lee, S. H., McCloughan, L., Hanley, J., McKinstry, B., & Pinnock, H. (2015) · BMC Health Services Research · doi:10.1186/s12913-015-1135-2 · Cited by 21
“…perception of respiratory problems, [18] Hospital Anxiety and Depression Scale (HADS) which assesses anxiety and depression, [19] EuroQol-5D(EQ-5D) a generic measure of health-status, [20] and Patient Activation Measure (PAM) which measures activation in self-management of chronic illness [21, 22].”
Making comparative performance information more comprehensible: an experimental evaluation of the impact of formats on consumer understanding
Damman, O. C., Jong, A. D., Hibbard, J. H., & Timmermans, D. R. M. (2015) · BMJ Quality & Safety · doi:10.1136/bmjqs-2015-004120 · Cited by 23
“39 After calculating mean scores of respondents, the scores were transformed into activation scores and divided into four levels of activation, using the scorecard of Hibbard et al .”
Self-citation
Examining the relationship between therapeutic self-care and adverse events for home care clients in Ontario, Canada: a retrospective cohort study
Sun, W., Doran, D. M., Wodchis, W. P., & Peter, E. H. (2017) · BMC Health Services Research · doi:10.1186/s12913-017-2103-9 · Cited by 23
“proposed that being an engaged and active participant in one’s own care is associated with better health outcomes [38].”
Background
The Effect of Electronic Health Record Use and Patient-Centered Communication on Cancer Screening Behavior: An Analysis of the Health Information National Trends Survey
Totzkay, D., Silk, K. J., & Sheff, S. E. (2017) · Journal of Health Communication · doi:10.1080/10810730.2017.1338801 · Cited by 23
“…behaviors, avoid health-damaging behaviors, are satisfied with clinical interactions, have more out-of-office contact with providers, and are more likely to follow care plans like screening recommendations (Hibbard & Greene, 2013; Hibbard et al., 2004; Jiang & Street, 2016;Wagner et al., 2005).”
BackgroundMethodInfluential
Reducing Barriers to Mental Health Care: Bringing Evidence‐Based Psychotherapy Home
Soo Borson, B., Korpak, A. M., Carbajal‐Madrid, P., Likar, D., Brown, G. A., & Batra, R. (2019) · Journal of the American Geriatrics Society · doi:10.1111/jgs.16088 · Cited by 24
Patient-Reported Outcome Measures and Patient Activation: What Are Their Roles in Orthopedic Trauma?
Moore, M. L. G., Jayakumar, P., Laverty, D. C., Hill, A. D., & Koenig, K. M. (2019) · Journal of Orthopaedic Trauma · doi:10.1097/bot.0000000000001612 · Cited by 23
Implementing Supported Self-Management in Community-Based Stroke Care: A Secondary Analysis of Nurses’ Perspectives
Kidd, L., Booth, J., Lawrence, M., & Rowat, A. M. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9040985 · Cited by 23
“The data for this secondary analysis were originally drawn from an evaluation study which aimed to design, develop and evaluate the feasibility and acceptability of a nurse‐facilitated, intervention, which was delivered to stroke survivors who were up to 12 months post‐stroke, comprised a collaborative, personalized s…”
Method
Measuring engagement in a collaborative learning health system: The case of ImproveCareNow
Hartley, D., Keck, C., Havens, M., Margolis, P. A., & Seid, M. (2020) · Learning Health Systems · doi:10.1002/lrh2.10225 · Cited by 23
Same goals, different challenges: A systematic review of perspectives of people with diabetes and healthcare professionals on Type 2 diabetes care
Catapan, S. D. C., Nair, U., Gray, L., Calvo, M. C. M., Bird, D., Janda, M., Fatehi, F., Menon, A., & Russell, A. W. (2021) · Diabetic Medicine · doi:10.1111/dme.14625 · Cited by 23
Patients with low activation level report limited possibilities to participate in cancer care
Westman, B., Bergkvist, K., Rosenblad, A., Sharp, L., & Bergenmar, M. (2022) · Health Expectations · doi:10.1111/hex.13438 · Cited by 23
“The PAM ‐ 13 ® scale was developed by Hibbard et al. 17,26 and aimed to measure patients' activation levels so that strategies could be tailored to support patients at the different levels to increase their activation by gaining knowledge, skills and confidence in making informed choices.”
Short-term effect of a chronic pain self-management intervention delivered by an easily accessible primary healthcare service: a randomised controlled trial
Nøst, T. H., Steinsbekk, A., Bratås, O., & Grønning, K. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-023017 · Cited by 23
“roles.[11, 39] The baseline PAM score in this study was around 63, which is in the higher 598”
BackgroundMethodInfluential
Multimorbidity and quality of primary care after release from prison: a prospective data-linkage cohort study
Calais‐Ferreira, L., Butler, A., Dent, S., Preen, D. B., Young, J. T., & Kinner, S. A. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08209-6 · Cited by 26
“Validated screening tools administered at baseline included the Hayes Ability Screening Index [15] (HASI - a measure of intellectual disability), Patient Activation Measure [16] (PAM - a measure of confidence in self-managing health conditions), and Enriched Social Support Inventory [17] (ESSI - a measure of perceived…”
Method
Patient activation reduces effects of implicit bias on doctor–patient interactions
Gainsburg, I., Derricks, V., Shields, C. G., Fiscella, K., Epstein, R., Yu, V., & Griggs, J. (2022) · Proceedings of the National Academy of Sciences of the United States of America · doi:10.1073/pnas.2203915119 · Cited by 15
“Using criteria derived from prior research (19, 21, 32, 33), we trained activated SPs to politely ask direct questions, to request information, to ask for clarification, and to redirect when their concerns were not addressed.”
Method
A Web-Delivered, Clinician-Led Group Exercise Intervention for Older Adults With Type 2 Diabetes: Single-Arm Pre-Post Intervention
Kirwan, M., Chiu, C. L., Laing, T., Chowdhury, N., & Gwynne, K. G. (2022) · Journal of Medical Internet Research · doi:10.2196/39800 · Cited by 25
“The Patient Activation Measure (PAM) assesses a person’s self-reported knowledge, skill, and confidence for the self-management of their health or chronic condition [28].”
Do patients’ preferences prevail in hospital selection?: a comparison between discrete choice experiments and revealed hospital choice
Salampessy, B. H., Ikkersheim, D., Portrait, F. R. M., & Koolman, X. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08403-6 · Cited by 23
“Similarly, we lack any information on variables such as patient activation [39].”
Background
Addressing Barriers to Mental Health Wellness: Prescriptions for Marketing
Kemp, E., Davis, C. D., & Porter, M. (2022) · Journal of Public Policy & Marketing · doi:10.1177/07439156221140787 · Cited by 23
“Machin, Jane E., Teri Brister, Robert M. Bossarte, Jane Drenten, Ronald P. Hill, Deborah L. Holland, et al. (2022), “Conversations About Conducting Marketing Research in Mental Health,” Journal of Consumer Marketing, 39 (6), 569–78.”
BackgroundInfluential
Patient activation among Medicare beneficiaries
Williams, S. S., & Heller, A. (2007) · International Journal of Pharmaceutical and Healthcare Marketing · doi:10.1108/17506120710818210 · Cited by 23
“Adopting a multi-dimensional approach to health care consumer segmentation, Maibach et al. (2006) developed a simple ten-item tool to segment health care consumers based on two dimensions, degree of engagement (active vs passive) and degree of decision making independence (independent vs doctor dependent), into four s…”
Background
Perceptions of Physicians in Civilian Medical Practice on Veterans’ Issues Related to Health Care
Fredricks, T. R., & Nakazawa, M. (2015) · Journal of Osteopathic Medicine · doi:10.7556/jaoa.2015.076 · Cited by 23
Health Coaching and Genomics—-Potential Avenues to Elicit Behavior Change in those at Risk for Chronic Disease: Protocol for Personalized Medicine Effectiveness Study in Air Force Primary Care
Vorderstrasse, A. A., Ginsburg, G. S., Kraus, W. E., Maldonado, M. C. J., & Wolever, R. Q. (2013) · Global Advances in Health and Medicine · doi:10.7453/gahmj.2013.035 · Cited by 23
Effect on motivation, perceived competence, and activation after participation in the ‘‘Ready to Act’’ programme for people with screen-detected dysglycaemia: A 1-year randomised controlled trial, Addition-DK
Maindal, H. T., Sandbæk, A., Kirkevold, M., & Lauritzen, T. (2011) · Scandinavian Journal of Public Health · doi:10.1177/1403494811402721 · Cited by 23
“87 showing good internal consistency [22].”
Method
Evaluation of a peer-led hypertension intervention for veterans: impact on peer leaders
Mosack, K. E., Patterson, L., Brouwer, A. M., Wendorf, A. R., Ertl, K., Eastwood, D. C., Morzinski, J. A., Fletcher, K., & Whittle, J. (2013) · Health Education Research · doi:10.1093/her/cyt004 · Cited by 23
Acupuncture and chiropractic care for chronic pain in an integrated health plan: a mixed methods study
DeBar, L., Elder, C. R., Ritenbaugh, C., Aickin, M. G., Deyo, R. A., Meenan, R. T., Dickerson, J. F., Webster, J., & Yarborough, B. J. H. (2011) · BMC Complementary and Alternative Medicine · doi:10.1186/1472-6882-11-118 · Cited by 24
“We will assess general preventive behavior [105,106] by collecting data on self-management behaviors including physical activity practices.”
Method
Patients’ confidence in coping with arthritis after nurse-led education; a qualitative study
Grønning, K., Midttun, L., & Steinsbekk, A. (2016) · BMC Nursing · doi:10.1186/s12912-016-0150-x · Cited by 23
“It further refers to patients’ understanding of their roles, knowledge, skills and confidence to manage their health [24].”
Background
Examining the Impact of a Web-Based Intervention to Promote Patient Activation in Chemotherapy-Induced Peripheral Neuropathy Assessment and Management
Knoerl, R., Lee, D., Yang, J. J., Bridges, C. M., Kanzawa-Lee, G. A., Smith, G., & Smith, E. (2017) · Journal of Cancer Education · doi:10.1007/s13187-017-1200-0 · Cited by 23
Contingent engagement: What we learn from patients with complex health problems and low socioeconomic status
Komaromy, M. S., Madden, E. F., Zurawski, A., Kalishman, S. G., Barker, K. K., O’Sullivan, P., Jurado, M., & Arora, S. (2017) · Patient Education and Counseling · doi:10.1016/j.pec.2017.08.019 · Cited by 23
Understanding patient activation and adherence to nebuliser treatment in adults with cystic fibrosis: responses to the UK version of PAM-13 and a think aloud study
Gao, J., Arden, M. A., Hoo, Z. H., & Wildman, M. J. (2019) · BMC Health Services Research · doi:10.1186/s12913-019-4260-5 · Cited by 23
Assessing Patient Preferences for Treatment Decisions for New Direct Acting Antiviral (DAA) Therapies for Chronic Hepatitis C Virus Infections
Welzel, T. M., Yang, M. H., Sajeev, G., Chen, Y. J., Pinsky, B. W., Bao, Y., Wu, E. Q., & Dieterich, D. T. (2019) · Advances in Therapy · doi:10.1007/s12325-019-01012-6 · Cited by 23
Studying the impact of a medication use evaluation by the community pharmacist (Simenon): Patient-reported outcome measures
Wuyts, J., Maesschalck, J., Wulf, I. D., Lepeleire, J. D., & Foulon, V. (2020) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2020.01.017 · Cited by 23
Study on advance care planning in care dependent community-dwelling older persons in Germany (STADPLAN): protocol of a cluster-randomised controlled trial
Schnakenberg, R., Silies, K., Berg, A., Kirchner, Ä., Langner, H., Chuvayaran, Y., Köberlein–Neu, J., Haastert, B., Wiese, B., Meyer, G., et al. (2020) · BMC Geriatrics · doi:10.1186/s12877-020-01537-4 · Cited by 23
Patient competence in the context of cancer: its dimensions and their relationships with coping, coping self-efficacy, fear of progression, and depression
Giesler, J. M., & Weis, J. (2020) · Supportive Care in Cancer · doi:10.1007/s00520-020-05699-0 · Cited by 25
Engaging Patients in Atrial Fibrillation Management via Digital Health Technology: The Impact of Tailored Messaging
Toscos, T., Coupe, A., Wagner, S., Ahmed, R., Roebuck, A. E., Flanagan, M., Drouin, M. A., & Mirro, M. J. (2020) · Journal of Innovations in Cardiac Rhythm Management · doi:10.19102/icrm.2020.110802 · Cited by 23
A Pilot Study Assessing the Impact of a Learner-Centered Adult Asthma Self-Management Program on Psychological Outcomes
Tousman, S., Zeitz, H., & Taylor, L. D. (2009) · Clinical Nursing Research · doi:10.1177/1054773809354290 · Cited by 23
The addition of STEPPS in the treatment of patients with bipolar disorder and comorbid borderline personality features: a protocol for a randomized controlled trial
Riemann, G., Weisscher, N., Goossens, P. J. J., Draijer, N., Apenhorst-Hol, M., & Kupka, R. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-172 · Cited by 25
“Hibbard JH, Stockard J, Mahoney ER, Tusler M: Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers.”
Method
An AIDS-Denialist Online Community on a Russian Social Networking Service: Patterns of Interactions With Newcomers and Rhetorical Strategies of Persuasion
Meylakhs, P. A., Rykov, Y. G., Koltsova, O. Y., & Koltcov, S. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.3338 · Cited by 23
“This finding is in accordance with the popular, or even dominant, consumerist ideology of health care, according to which patients are informed consumers that critically assess medical advice before accepting or rejecting it [3,31,34,35].”
Development and psychometric evaluation of the Decisional Engagement Scale (DES-10): A patient-reported psychosocial survey for quality cancer care.
Hoerger, M. P., Chapman, B. P., Mohile, S. G., & Duberstein, P. R. (2016) · Psychological Assessment · doi:10.1037/pas0000294 · Cited by 24
“…et al., 2010; Chewning et al., 2012; Degner et al., 1997; Edwards et al., 2003; Farin et al., 2011; Gagnon et al., 2006; Goldstein et al., 2005; Hibbard et al., 2004; Hubbard et al., 2008; Kriston et al., 2010; Légaré et al., 2010; Mack et al., 2008; Maly, Frank, Marshall, DiMatteo, & Reuben,…”
Background
Patient navigation and activation interventions for elderly patients with cancer: A systematic review
van Ee, B., Hagedoorn, M., Slaets, J. P. J., & Smits, C. H. M. (2016) · European Journal of Cancer Care · doi:10.1111/ecc.12621 · Cited by 23
Barriers to technology use among older heart failure individuals in managing their symptoms after hospital discharge
Nguyen, L., Keshavjee, K., Archer, N., Patterson, C., Gwadry-Sridhar, F., & Demers, C. (2017) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2017.06.001 · Cited by 22
Planning and designing the care transitions innovation (C‐Train) for uninsured and Medicaid patients
Englander, H. L., & Kansagara, D. L. (2012) · Journal of Hospital Medicine · doi:10.1002/jhm.1926 · Cited by 21

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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