Patient activation in inflammatory arthritis

Abstract

Patient activation covers the skills, abilities and behaviour that contribute to how able and willing someone is to take an active role in managing their health. Patient activation is currently often assessed using the Patient Activation Measure (PAM). While there is growing interest in patient activation, there has been limited research about it within inflammatory arthritis (IA). Consequently, three studies were conducted to address these knowledge gaps and better understand patient activation. The findings of these studies were synthesised into a framework reporting factors related to patient activation within inflammatory arthritis that may be amenable to intervention.A systematic literature review reported that interventions targeting patient activation in long-term conditions can be effective but that no specific format or style of delivery was more effective than others.Qualitative interviews conducted at two timepoints explored how patients who were skilled at managing their health considered patient activation to incorporate many of the ways that they already self-managed. This included knowing what techniques (both pharmacological and non-pharmacological) suited them and reduced the impact of their symptoms, and when and how to seek appropriate help, including navigating the National Health Service (NHS). They identified that the PAM did not always reflect the fluctuating nature of their conditions.A survey study administered at two time points reported associations with PAM scores and a range of clinical, demographic and psychosocial variables across a sample of rheumatology patients in England. Regression analysis confirmed that self-efficacy, health literacy, illness beliefs and health locus of control significantly contributed to variance in PAM scores.Longitudinal, mixed-methods data indicate that patient activation is more than the items listed in the PAM. It incorporates several factors including health literacy, illness beliefs, self-efficacy and health locus of control underneath a broader umbrella of skills and abilities. Training healthcare professionals about the nature of patient activation in rheumatology may contribute to conversations being more collaborative and equip them with the skills to effectively support patient activation