Asking Questions: The effect of a brief intervention on patient activation in community health centers

Abstract Objective To evaluate the impact of a pre-visit intervention that focused on building skills for question formulation for patients attending in community health centers. Methods Level of patient activation and patient preferred role were examined pre-intervention respectively by the Patient Activation Measure (PAM) and the Patient Preference for Control (PPC) measure. PAM scores were measured again post-intervention, post-visit. Results Before the intervention, more patients were at lower levels of activation (PAM levels 1 or 2) than U.S. population norms. Paired samples t-test revealed a statistically and clinically significant increase from pre-intervention to post-visit PAM scores. One-third of participants moved from low levels of activation to higher levels (PAM levels 3 or 4) post PAI. Patients preferring a more passive role had lower initial PAM scores and greater increases in their post-intervention PAM score than did those who preferred a more active role. Conclusion Patients exposed to the PAI demonstrated significant improvement on a measure of activation. This increase was greatest in those whose baseline preference for control was lowest. The PAI may be useful in helping patients prepare for more effective encounters with their physicians. Practice Implications Patients who are more participatory in their interactions with physicians have been shown to be more effective in self-management skills and to have better health outcomes. Many patients have cultural barriers to questioning the physician authority figure. The PAI was feasible to deliver in the health center setting and may be a useful method for activating low-income, racial/ethnic minority patient populations.