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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Newman-Casey, P. A., Killeen, O. J., Miller, S., MacKenzie, C., Niziol, L. M., Resnicow, K., Creswell, J. W., Cook, P. F., & Heisler, M. (2018) · Health Communication · doi:10.1080/10410236.2018.1557357 · Cited by 20
“The PAM score ranges from 1 to 100 with a higher score indicating better patient activation (Hibbard et al., 2004; Hibbard et al., 2005).”
Background
Improving family caregiver and patient outcomes in lung cancer surgery: Study protocol for a randomized trial of the multimedia self-management (MSM) intervention
Sun, V. C.-Y., Raz, D. J., Erhunmwunsee, L., Ruel, N. H., Carranza, J., Prieto, R., FERRELL, B. R., Krouse, R. S., McCorkle, R. C., & Kim, J. Y. (2019) · Contemporary Clinical Trials · doi:10.1016/j.cct.2019.07.002 · Cited by 21
Effects of non-medical health coaching on multimorbid patients in primary care: a difference-in-differences analysis
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The Preferences of Patients With Cancer Regarding Apps to Help Meet Their Illness-Related Information Needs: Qualitative Interview Study
Richards, R., Kinnersley, P., Brain, K. E., Staffurth, J. N., & Wood, F. (2019) · JMIR mhealth and uhealth · doi:10.2196/14187 · Cited by 20
“Suggestions that this type of app might increase users’ knowledge of their condition, and participation in consultations, might indicate that this type of app has the potential to increase patients’ levels of activation [37].”
Background
DIVERT-Collaboration Action Research and Evaluation (CARE) Trial Protocol: a multiprovincial pragmatic cluster randomised trial of cardiorespiratory management in home care
Costa, A. P., Schumacher, C., Jones, A., Dash, D., Campbell, G., Junek, M., Agarwal, G., Bell, C. M., Boscart, V., Bronskill, S. E., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-030301 · Cited by 20
How Do OSCE Cases Activate Learners About Transgender Health?
Greene, R. E., Blasdel, G., Cook, T. E., & Gillespie, C. C. (2020) · Academic Medicine · doi:10.1097/acm.0000000000003704 · Cited by 20
Quality of life in patients with comorbid serious mental illness and chronic diseases: A structural equation model
Chiang, Y., Chang, Y., Liu, Y., & Tzeng, W. (2020) · Journal of Advanced Nursing · doi:10.1111/jan.14663 · Cited by 24
The Mitigating Toxic Stress study design: approaches to developmental evaluation of pediatric health care innovations addressing social determinants of health and toxic stress
McCrae, J. S., Robinson, J. A., Spain, A. K., Byers, K. D., & Axelrod, J. L. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06057-4 · Cited by 19
Mechanisms and Effects of Health Coaching in Patients With Early‐Stage Chronic Kidney Disease: A Randomized Controlled Trial
Lin, M., Cheng, S., Hou, W., Lin, P., Chen, C., & Tsai, P. (2021) · Journal of Nursing Scholarship · doi:10.1111/jnu.12623 · Cited by 20
Knowledge sharing to support long‐term condition self‐management—Patient and health‐care professional perspectives
Brand, S., & Timmons, S. (2021) · Health Expectations · doi:10.1111/hex.13209 · Cited by 19
“Selfmanagement programmes aim to build individuals’ knowledge, skills and confidence both in their condition and the management activities associated with it [8, 9, 10, 11].”
Background
Teach-back of discharge instructions in the emergency department: a pre–post pilot evaluation
Hesselink, G., Sir, Ö., Koster, N., Tolsma, C., Munsterman, M., Rikkert, M. G. M. O., & Schoon, Y. (2021) · Emergency Medicine Journal · doi:10.1136/emermed-2020-210168 · Cited by 20
“33 34 The research team selected four relevant statements from the PAM to minimise response fatigue.”
Patient Activation for Self-Management in Patients with Idiopathic Pulmonary Fibrosis or Sarcoidosis
Bloem, A. E. M., Mostard, R., Stoot, N., Custers, J., Vooijs, M., Janssen, D., Hul, A. V. V. '., & Spruit, M. (2021) · Respiration · doi:10.1159/000518216 · Cited by 13
Co-creating with patients an impact framework across the medicine’s life cycle: a qualitative study exploring patients’ experiences of involvement in and perceptions of impact measures
Gorbenko, O., Cavillon, P., Giles, R. H., Kolarova, T., Marks, M., Cardone, A., Bagga, S. K., & Nolan, C. (2022) · Research Involvement and Engagement · doi:10.1186/s40900-022-00334-0 · Cited by 20
“Workshop advisors echoed this sentiment and agreed on the use of the Patient Activation Measure (PAM) to assess patients’ knowledge and level of confidence with managing their condition before and after the patient support programme [46].”
Method
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Sale, J. E. M. (2022) · BMC Medical Research Methodology · doi:10.1186/s12874-022-01546-4 · Cited by 27
“Drawing from the literature, the term “advocacy” was equated with the theoretical concept of “effective” or “activated” consumer [43, 44].”
Method
Associations Between Severity of Depression, Lifestyle Patterns, and Personal Factors Related to Health Behavior: Secondary Data Analysis From a Randomized Controlled Trial
Aguilar‐Latorre, A., Serrano-Ripoll, M. J., Oliván‐Blázquez, B., Gervilla, E., & Navarro, C. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.856139 · Cited by 20
‘Self-Management Intervention through Lifestyle Education for Kidney health’ (the SMILE-K study): protocol for a single-blind longitudinal randomised controlled trial with nested pilot study
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The effect of a novel, digital physical activity and emotional well-being intervention on health-related quality of life in people with chronic kidney disease: trial design and baseline data from a multicentre prospective, wait-list randomised controlled trial (kidney BEAM)
Walklin, C., Young, H. M. L., Asghari, E., Bhandari, S., Billany, R. E., BISHOP, N. C., Bramham, K., Briggs, J., Burton, J. O., Campbell, J. A., et al. (2023) · BMC Nephrology · doi:10.1186/s12882-023-03173-7 · Cited by 25
“The PAM-13 consists of 13 items which assess a person’s knowledge, skills and confidence in managing their own health [39, 40].”
Background
Patient activation in adults attending appointments in general practice: a cross-sectional study
Hernar, I., Graue, M., Igland, J., Richards, D. A., Riise, H. K. R., Haugstvedt, A., & Kolltveit, B. H. (2023) · BMC Family Practice · doi:10.1186/s12875-023-02102-9 · Cited by 20
“We used the generic Patient Activation Measure® (PAM-13) to assess the participant’s knowledge, skills and confidence in managing their health and preventing health problems [22, 23].”
Method
A Mobile App for Chronic Disease Self-Management for Individuals with Low Health Literacy: A Multisite Randomized Controlled Clinical Trial
Ownby, R. L., Waldrop‐Valverde, D., Davenport, R., Simonson, M. R., Caballero, J., Purcell, D. J., Purcell, D. J., Ayala, V., González, J., Patel, N., et al. (2024) · Journal of Ageing and Longevity · doi:10.3390/jal4020005 · Cited by 20
“Assessments of CDSM programs have focused on several outcomes, and in this project, we focused on four that we judged were most relevant to the effects of a CDSM-J targeting intervention and that would allow us to compare our results with those of other researchers.”
Does preoperative narcotic use adversely affect outcomes and complications after spinal deformity surgery? A comparison of nonnarcotic- with narcotic-using groups
Mesfin, A., Lenke, L. G., Bridwell, K. H., Akhtar, U., Jupitz, J. M., Fogelson, J. L., Hershman, S. H., Kim, H. J., & Koester, L. A. (2014) · The Spine Journal · doi:10.1016/j.spinee.2014.03.049 · Cited by 20
Exploring the interaction of patient activation and message design variables: Message frame and presentation mode influence on the walking behavior of patients with type 2 diabetes
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Diabetes Health Coaching Improves Medication Adherence: A Pilot Study
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“The Patient Activation Measure (PAM) was developed by Judith Hibbard based on her work in conceptualizing, defining, and testing attributes of an activated consumer.(29) This 13-item questionnaire measures activation, which is the extent of a person’s knowledge, skill, and confidence for self-management of his or her…”
Method
Patient Activation in Schizophrenia: Insights from Stories of Illness and Recovery
Salyers, M. P., Matthias, M. S., Sidenbender, S., & Green, A. (2012) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-012-0435-7 · Cited by 21
A family-centered intervention for the transition to living with multiple myeloma as a chronic illness: A pilot study.
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Diabetes Nurse Case Management in a Canadian Tertiary Care Setting: Results of a Randomized Controlled Trial
Li, D., Elliott, T., Klein, G., Ur, E., & Tang, T. S. (2017) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2016.10.012 · Cited by 20
Facilitating primary care provider use in a patient-centered medical home intervention study for chronic hemodialysis patients
Chukwudozie, I. B., Fitzgibbon, M., Schiffer, L. A., Berbaum, M. L., Gilmartin, C., David, P., Ekpo, E., Fischer, M. J., Porter, A. C., Aziz-Bradley, A., et al. (2018) · Translational Behavioral Medicine · doi:10.1093/tbm/iby021 · Cited by 20
Knowledge, Skill, and Confidence in People Attending Pulmonary Rehabilitation: A Cross-Sectional Analysis of the Effects and Determinants of Patient Activation
McNamara, R. J., Kearns, R., Dennis, S. M., Harris, M., Gardner, K., & McDonald, J. (2018) · Journal of Patient Experience · doi:10.1177/2374373518778864 · Cited by 20
“Patient activation was measured using the Patient Activation Measure (PAM; Insignia Health, LLC, Portland, OR, Demographics Sex, age, primary language, suburb of residence, Aboriginality Medical history Primary respiratory or cardiac diagnosis, past medical history, smoking status, home oxygen therapy Pulmonary functi…”
BackgroundInfluential
eRAPID electronic patient self-Reporting of Adverse-events: Patient Information and aDvice: a pilot study protocol in pelvic radiotherapy
on behalf of the eRAPID radiotherapy work group, Holch, P., Pini, S. A., Henry, A. M., Davidson, S. E., Routledge, J., Brown, J. M., Absolom, K. L., Gilbert, A., Franks, K., et al. (2018) · Pilot and Feasibility Studies · doi:10.1186/s40814-018-0304-6 · Cited by 20
“The Patient Activation Measure [66] (PAM, completed at”
Background
Efficacy of a Preference-Based Decision Tool on Treatment Decisions for a First-Time Anterior Shoulder Dislocation: A Randomized Controlled Trial of At-Risk Patients
Hutyra, C. A., Smiley, S. P., Taylor, D. C., Orlando, L. A., & Mather, R. C. “. (2019) · Medical Decision Making · doi:10.1177/0272989x19832915 · Cited by 20
Evaluation of the clinical effectiveness of a work-based mentoring programme to develop clinical reasoning on patient outcome: A stepped wedge cluster randomised controlled trial
Williams, A., Rushton, A. B., Lewis, J. J., & Phillips, C. J. (2019) · PLoS ONE · doi:10.1371/journal.pone.0220110 · Cited by 20
“being likely to influence outcome [69, 90, 91]); and other patient factors (initial PSFS, EQ5D index, sex, age, ethnicity) [87].”
Response to diagnosis of pre-diabetes in socioeconomically deprived areas: a qualitative study
Twohig, H., Hodges, V., Hobbis, C., & Mitchell, C. A. (2019) · BJGP Open · doi:10.3399/bjgpopen19x101661 · Cited by 19
“Patient activation Patient activation is a term used to describe a person’s knowledge, skills, and confidence to manage their own health.(13) It became apparent during the analysis that this was a key concept in understanding participants’ attitudes and responses to being told they were pre-diabetic.”
Method
Conception and development of Sexual Health indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project
Elliott, S., Jeyathevan, G., Hocaloski, S., O’Connell, C. M., Gulasingam, S., Mills, S., Farahani, F., Kaiser, A., Alavinia, M., Omidvar, M., et al. (2019) · Journal of Spinal Cord Medicine · doi:10.1080/10790268.2019.1612642 · Cited by 20
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Employee Engagement Factors that Affect Enrollment Compared with Retention in Two Coaching Programs—The ACTIVATE Study
Terry, P. E., Fowles, J. B., & Harvey, L. (2010) · Population Health Management · doi:10.1089/pop.2009.0040 · Cited by 20
“Health care employees scored signiﬁcantly higher on the PAM than airline employees (mean PAM score 72 vs. 65, respectively) and had better risk scores (mean PWP score 48 vs. 40, respectively).”
Influential
A Patient-Reported Spectrum of Adverse Health Care Experiences
Wasson, J. H. (2013) · Journal of Ambulatory Care Management · doi:10.1097/jac.0b013e3182955b22 · Cited by 20
“Patient Self-Reported Health Confidence on a Single Measure Compared to Scored Health Confidence Using 6 Items The Table below compares 131 patient reports of their health confidence using a single item versus a computation based on 6 items described by Hibbard et al (2004).”
Method
Framework for Evaluating and Implementing Inpatient Portals: a Multi-stakeholder Perspective
Walker, D. M., Hefner, J. L., Sieck, C. J., Huerta, T. R., & McAlearney, A. S. (2018) · Journal of Medical Systems · doi:10.1007/s10916-018-1009-3 · Cited by 20
Increased Patient Activation Is Associated with Fewer Emergency Room Visits and Hospitalizations for Pain in Adults with Sickle Cell Disease
Cronin, R. M., Dorner, T. L., Utrankar, A., Allen, W., Rodeghier, M., Kassim, A. A., Jackson, G. P., & DeBaun, M. R. (2018) · Pain Medicine · doi:10.1093/pm/pny194 · Cited by 20
Effect of digital monitoring and counselling on self-management ability in patients with rheumatoid arthritis: a randomised controlled trial
LI, L. C., Xie, H. W., Feehan, L. M., Shaw, C., Lu, N., Ramachandran, S., Wang, E., Therrien, S., Mucha, J., Hoens, A. M., et al. (2023) · Rheumatology · doi:10.1093/rheumatology/kead709 · Cited by 22
A Mobile App for Chronic Disease Self-Management: Protocol for a Randomized Controlled Trial
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“Primary outcome measures will be health literacy (FLIGHT/VIDAS), self-reported general health (Medical Outcomes Study 36-item Short Form; SF-36 [95]), health self-efficacy (Chronic Disease Self-Efficacy Scale [96]), patient activation (Patient Activation Measure [97]), and treatment adherence.”
Patient Engagement in VA Health Care: Does Gender Play a Role?
Etingen, B., Miskevics, S. A., Malhiot, A., & LaVela, S. L. (2018) · Defence and Peace Economics · doi:10.1080/10242694.2018.1465676 · Cited by 19
“…looking specifically at literature measuring engagement using the Patient Activation Measure (PAM), which is a widely used measurement tool designed to assess individual’s engagement with their health and health care (Hibbard et al. 2004, 2005), evidence regarding gender differences has been mixed.”
Method
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Salampessy, B. H., Alblas, M., Portrait, F. R. M., Koolman, X., & van der Hijden, E. J. E. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-3598-4 · Cited by 19
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Lidington, E. K., McGrath, S., Noble, J. L., Stanway, S. J., Lucas, A. N., Mohammed, K., van der Graaf, W., & Husson, O. (2020) · Trials · doi:10.1186/s13063-019-3971-6 · Cited by 19
Implementation of an Interactive Voice Response System for Cancer Awareness in Uganda: Mixed Methods Study
Kabukye, J. K., Ilozumba, O., Broerse, J. E. W., de Keizer, N. F., & Ronald Cornet, A. (2020) · JMIR mhealth and uhealth · doi:10.2196/22061 · Cited by 18
“Issues that could influence meaningful engagement with the intervention [28,37], for example, socioeconomic status, literacy, age, perception of the healthcare system, and self-efficacy with regard to IVR, were also noted.”
Patient Activation and its Predictors in Hospitalized Older Adults in Singapore
Chan, E., Glass, G. F., Cheong, R. Q., Chin, G. F., & Chng, D. Y. J. (2021) · Geriatric Nursing · doi:10.1016/j.gerinurse.2021.01.006 · Cited by 19

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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