Patient activation

Patient activation is when an individual is aware of their own health and wellbeing and has the motivation and capability to take action to maintain their condition or improve it. 

Torbay and South Devon NHS Trust describes it similarly: “Patient activation’ describes the knowledge, skills and confidence a person has in managing their own health and care. By understanding a person’s activation levels, we can better support people in managing their condition(s), which in turn will improve their experience of care.”

What is the difference between patient activation and patient engagement? 

Patient activation and patient engagement are two sides of the same coin. If patient activation is an individual’s awareness of their health and wellbeing, patient engagement is the deliberate intent to cooperate or collaborate from healthcare providers with these people. This could be an NHS trust, a private hospital, or a GP surgery, but whoever the care provider is it’s more of an onus on them to bridge that gap and connect with the person. 

Patient activation and engagement are cause and effect. By activating the person they are open to connecting with healthcare professionals to work together for a better care outcome.

So, what is a patient activation measure? Patient activation measures (PAMS) are measurement scales that can be used by healthcare providers to assess how capable an individual is regarding their own care management and investment. The results from these measurements then inform them of the best actions to take to encourage self-care and self-preservation from said patients. With patients encouraged to have a greater interest in their own healthcare and broader facets of wellbeing, then healthcare providers can work on patient engagement and getting patients involved in their care as a collaborative activity – typically through healthcare software and applications. 

In the United States, typically a patient activation measure is a test with a 100-point score. Such tests aren’t exclusive to the USA but the PAM test was created by researchers in the States. In the UK, the National Health Service has a much shorter 13 question PAMs test, with the same brackets 1 – 4 based on least to most confident. This NHS England guide (PDF) presents a helpful table version of the below information: 

• Level 1 – Disengaged and overwhelmed
  “Individuals are passive” and lacking confidence and/or knowledge.
• Level 2 – Becoming aware, but still struggling
  Gaps in knowledge. Have simple goals but lack confidence in their impact. 
• Level 3 – Taking action
  Know the key factors, have some management, learning best practices.
• Level 4 – Maintaining behaviours and pushing further
  Focused on a healthy lifestyle but might deviate in times of stress.  

This brings us on to the next section: NHS patient activation measure.

Healthcare uses a lot of acronyms, and the NHS – case in point – is guilty of that too.  

PAMS stands for Patient Activation Measure (which we explored in the last section), but is referred to as PAMS or PAMs and not PAM. This is because it’s a Patient Activation Measure score but also an important distinction due to a clash with the NHS Premises Assurance Model; a guide for management regarding property, land ownership, and groundskeeping. 

A patient activation assessment tool is typically a questionnaire or survey, designed to gauge how much an individual knows about their own health, managing existing conditions, or the medication they’re receiving. Referring back to the Torbay and South Devon document from earlier in the article, their approach is to follow up on outpatient appointments with a survey. 

The NHS state that their approach is so that services and support can be tailored to the patient – something we’re seeing more of in modern healthcare. In their words, “The right intervention can help to increase their knowledge, skills and confidence and so, improve their ability to look after their wellbeing”. The King’s Fund reported research from the United States about how patient engagement and activation correlates with better behaviour and thus better outcomes, which in turn improves experiences in care, reduces incidents of needing care, and altogether brings down costs.

This is why we defined patient activation and engagement at the start of this article, because to assess activation you’re encouraging engagement, which activates a person to become more engaged. This poses a chicken-and-egg conundrum though: how do you increase patient activation with people who might not be that engaged in the first place? 

In truth, the patient activation and engagement models have a heavy overlap. That isn’t to say there isn’t a patient activation best practice guide, it’s just that the reality is the same ways we increase patient engagement are the same ways we increase patient activation. 

Guideway Care has an article of their own about the best strategies for improving activation, which flags six key goals: 

1. Provide people with clear and concise health information
2. Foster patient-provider relationships
3. Utilise technology
4. Streamline payments (private care only)
5. Incorporate incentives
6. Deliver continuous and remote support 

This ties in with previous articles published here at Access, in which we explored many of these points ourselves. Examples included technology to provide multiple language choices for patients in waiting rooms and receptions, healthy eating programmes, local partnerships with gyms for patient discounts to encourage exercise, patient portals for personal care management and educational resources, the option of video call appointments, and automated emails or text reminders for appointments. 

There’s no right way to increase patient activation or to increase patient engagement. Instead, the first step should be taken by you, the healthcare provider, to just attempt to engage with patients. It’s very much a ‘build it and they will come’ scenario: if you provide the opportunities and resources, people will take you up on them. It might not be that many at first, but this is where you speak to patients in person and explain what’s available to them and how it can help. 

The Access Group has an array of patient engagement articles available to read in conjunction with this piece, should you wish to further your knowledge on the subject: 

• Patient engagement explained 
• Measuring patient engagement 
• Patient engagement strategies 
• Patient engagement software 
• Increase patient engagement