Patient activation is associated with healthy behaviors and ease in managing diabetes in an indigent population

Diabetes Educ. 2009 Jul-Aug;35(4):622-30. doi: 10.1177/0145721709335004. Epub 2009 Apr 28.


Purpose: The purpose of this study is to assess the validity of the patient activation construct as measured by the Patient Activation Measure (PAM) survey by correlating PAM scores with diabetes self-management behaviors, attitudes, and knowledge in a predominantly minority and uninsured population.

Methods: A convenience sample of patients presenting to an urban public hospital diabetes clinic was surveyed and contacted by phone 6 months later. The survey included questions about activation, health behaviors, and health care utilization.

Results: A total of 287 patients agreed to participate. Most were African American, female, and uninsured. Most respondents (62.2%) scored in the highest category of activation according to the PAM. Activated patients were more likely to perform feet checks, receive eye examinations, and exercise regularly. Activation was consistently associated with less reported difficulty in managing diabetes care but not with A1C knowledge. PAM scores at the initial interview were highly correlated with scores at 6-month follow-up. Activation level did not predict differences in health care utilization during the 6 months following the survey.

Conclusions: Higher scores on the PAM were associated with higher rates of self-care behaviors and ease in managing diabetes; however, the indigent urban population reported higher activation scores than found in previous studies. The relationship between activation and outcomes needs to be explored further prior to expanding use of this measure in this patient population.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Diabetes Mellitus / psychology
  • Diabetes Mellitus / rehabilitation*
  • Female
  • Georgia
  • Glycated Hemoglobin / metabolism
  • Health Behavior*
  • Health Knowledge, Attitudes, Practice*
  • Health Status
  • Health Surveys
  • Humans
  • Male
  • Medically Uninsured / statistics & numerical data
  • Minority Groups
  • Patient Participation / psychology*
  • Patient Satisfaction
  • Poverty*
  • Reward
  • Self Care


  • Glycated Hemoglobin A