Predictors of Patient Activation Among Underserved Patients in a Nurse-managed Health Center: A Pilot Study

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dc.contributor.advisorBoekeloo, Bradley O.en_US
dc.contributor.authorAntol, Susan Marieen_US
dc.contributor.departmentPublic and Community Healthen_US
dc.contributor.publisherDigital Repository at the University of Marylanden_US
dc.contributor.publisherUniversity of Maryland (College Park, Md.)en_US
dc.date.accessioned2016-09-08T05:37:51Z
dc.date.available2016-09-08T05:37:51Z
dc.date.issued2016en_US
dc.description.abstractThe concept of patient activation has gained traction as the term referring to patients who understand their role in the care process and have “the knowledge, skills and confidence” necessary to manage their illness over time (Hibbard & Mahoney, 2010). Improving health outcomes for vulnerable and underserved populations who bear a disproportionate burden of health disparities presents unique challenges for nurse practitioners who provide primary care in nurse-managed health centers. Evidence that activation improves patient self-management is prompting the search for theory-based self-management support interventions to activate patients for self-management, improve health outcomes, and sustain long-term gains. Yet, no previous studies investigated the relationship between Self-determination Theory (SDT; Deci & Ryan, 2000) and activation. The major purpose of this study, guided by the Triple Aim (Berwick, Nolan, & Whittington, 2008) and nested in the Chronic Care Model (Wagner et al., 2001), was to examine the degree to which two constructs– Autonomy Support and Autonomous Motivation– independently predicted Patient Activation, controlling for covariates. For this study, 130 nurse-managed health center patients completed an on-line 38-item survey onsite. The two independent measures were the 6-item Modified Health Care Climate Questionnaire (mHCCQ; Williams, McGregor, King, Nelson, & Glasgow, 2005; Cronbach’s alpha =0.89) and the 8-item adapted Treatment Self-Regulation Questionnaire (TSRQ; Williams, Freedman, & Deci, 1998; Cronbach’s alpha = 0.80). The Patient Activation Measure (PAM-13; Hibbard, Mahoney, Stock, & Tusler, 2005; Cronbach’s alpha = 0.89) was the dependent measure. Autonomy Support was the only significant predictor, explaining 19.1% of the variance in patient activation. Five of six autonomy support survey items regressed on activation were significant, illustrating autonomy supportive communication styles contributing to activation. These results suggest theory-based patient, provider, and system level interventions to enhance self-management in primary care and educational and professional development curricula. Future investigations should examine additional sources of autonomy support and different measurements of autonomous motivation to improve the predictive power of the model. Longitudinal analyses should be conducted to further understand the relationship between autonomy support and autonomous motivation with patient activation, based on the premise that patient activation will sustain behavior change.en_US
dc.identifierhttps://doi.org/10.13016/M2GR5G
dc.identifier.urihttp://hdl.handle.net/1903/18739
dc.language.isoenen_US
dc.subject.pqcontrolledPublic healthen_US
dc.subject.pqcontrolledNursingen_US
dc.subject.pqcontrolledHealth care managementen_US
dc.subject.pquncontrolledautonomous motivationen_US
dc.subject.pquncontrolledautonomy supporten_US
dc.subject.pquncontrolledhealth behavioren_US
dc.subject.pquncontrollednurse-manageden_US
dc.subject.pquncontrolledpatient activationen_US
dc.subject.pquncontrolledprimary careen_US
dc.titlePredictors of Patient Activation Among Underserved Patients in a Nurse-managed Health Center: A Pilot Studyen_US
dc.typeDissertationen_US

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