How Engaged are Consumers in Their Health?

By Linda Hollinger-Smith

There is a growing consensus that activating and engaging consumers is an essential component to health care reform in the United States. The health care choices of individual consumers and daily management of their own health can profoundly affect health care utilization, costs and outcomes. Activation refers to people’s ability and willingness to take on the role of man¬aging their health and health care.

The Center for Studying Health System Change (HSC), designed a Patient Activation Measure (PAM) to assess an individual’s knowledge, skill and confidence in managing their health. The PAM consists of a 13-item scale that asks people about their beliefs, knowledge and confidence for engaging in a wide range of health behaviors. Studies have shown that consumers who get support for being proactive about their health from their care team, from their coworkers and supervisors, and from friends and family tend to be more activated and to engage in healthier behaviors and choices.

Research on patient activation suggests that individuals go through phases or levels on their way to becoming effective self-managers. These levels are also useful for designing interventions to help people improve their ability to self-manage. Four levels of activation based on the individual’s overall activation score have been identified. Less than half of all adults in the United States (41.4%) are in the highest level of activation, according to findings from HSC’s 2007 Health Tracking Household Survey.

There is a substantial amount of variation in activation levels across the U.S. population. Most of the differences in activation by education, race/ethnicity, age and insurance coverage remain after controlling for other characteristics. Activation also varies by the type and number of chronic conditions, as well as other measures of health status. People with multiple chronic conditions, who report their health as fair or poor and who are obese are less activated than people with a single condition or those with better health indicators. All other things being equal, having multiple conditions may necessitate greater self-management and more careful monitoring of one’s own health. Moreover, health care providers may be more proactive about teaching self-management skills to patients with multiple conditions.

It is important to note that it is difficult to discern the direction of causality in the observed relationships as the data were collected at a single moment in time. Longitudinal data are needed to determine whether poor health status causes lower activation, or whether low activation and passivity contribute to poorer health. Likely the causality operates in both directions, although low activation resulting from poor health may lead to a vicious cycle that precludes behaviors that could improve health.

Ultimately, the value of more highly activated patients is that it will lead to better health outcomes and health practices. For example, prior research has shown that higher levels of activation are associated with higher levels of preventive health behaviors and preventive care, as well as increased self-management of health conditions. Part of being more activated is seeking and using relevant health information. For example, those who are more activated are more likely to report that they read about possible side effects when they get a new prescription drug. Ninety-four percent of those at the highest level of activation read about possible side effects, compared with 74 percent of the least activated.

Activated consumers take a proactive approach to managing their health and health care. Activation level is a reflection of the individual’s beliefs about their role in managing their health, as well as their knowledge and confidence for doing so. This is a much broader view of consumer activation than is often the focus of consumer-directed health plans, which primarily seek to increase consumer cost sensitivity. From a policy perspective, cost sensitivity by itself may be a necessary but not sufficient condition for greater consumer engagement in their own health care.

Source: http://www.hschange.com

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