Patient activation in primary healthcare: a comparison between healthier individuals and those with a chronic illness

Med Care. 2011 May;49(5):469-79. doi: 10.1097/MLR.0b013e31820bf970.


Background and objective: Current policy directions place increasing expectations on patients to actively engage in their care, especially in chronic disease management. We examined relationships between patient activation and multiple dimensions of primary healthcare (PHC), including access, utilization, responsiveness, interpersonal communication, and satisfaction for patients with and without chronic illness.

Research design: Cross-sectional, random digit dial survey conducted in British Columbia (BC), Canada.

Subjects: Stratified sample of adults (n=504), aged 19 to 90 years, who had visited their regular provider within the past 24 months. All data were weighted to represent residents living in BC.

Measures: Patient activation and PHC experiences include accessibility, continuity, whole-person care, interpersonal communication, responsiveness, chronic disease management, and satisfaction.

Results: The multivariate models provide evidence that both quantity of time and quality of interactions with one's regular provider are associated with higher patient activation. Those with no chronic illness had higher activation scores when they spent more time talking with their regular provider, experienced less hurried communication, or if their test results were explained. The more time people with chronic illness are able to spend with their physician, the more activated they were. Chronic illness respondents also had higher activation scores if they reported higher whole-person care or if they were more satisfied.

Conclusions: Positive interactions between the patient and the provider can influence the patient's abilities to engage in and be confident in maintaining/improving his/her health. Supporting patients in becoming actively engaged, in ways that work for them, is essential to providing high quality care, especially among those with a chronic condition.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • British Columbia
  • Chronic Disease / psychology*
  • Cross-Sectional Studies
  • Female
  • Health Care Surveys
  • Health Status
  • Humans
  • Male
  • Middle Aged
  • Patient Participation* / psychology
  • Patient Participation* / statistics & numerical data
  • Patient Satisfaction / statistics & numerical data
  • Primary Health Care* / standards
  • Primary Health Care* / statistics & numerical data
  • Psychometrics
  • Socioeconomic Factors
  • Young Adult