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Objective: The aim of the present study was to evaluate the effect of a self-management program on activation and inner strength in patients with cardiovascular diseases (CVDs).Methods: This study assigned 86 patients with CVDs to an experimental and a comparison group utilizing alternate allocation based on a quasi-experimental design. The experimental group participated in a self-management program based on a theoretical framework in three stages, i.e. orientation-recognition, reinforcing-engaging and monitoring-follow-up; whereas the comparison group received routine care. The supportive program was administered through holding five individual face-to-face sessions, providing educational booklets and performing four phone-call follow-ups during three months after discharge. The outcomes were measured using the patient activation measure (PAM) and the inner strength scale (ISS).Results: The between group analysis indicated a statistically-significant difference in the mean score of patient activation (P < 0.001) in the two groups. Nevertheless, there was not a statistically-insignificant difference in the mean score of inner strength between the two groups (P < 0.104).Conclusion: Although a three-month nurse-led self-management support program was found to improve patient activation levels, it was ineffective in promoting inner strength.Practice Implications: Psychosocial dynamics should be integrated in providing self-management program by nurses. To promote patient activation, tailored consultations is recommended. [ABSTRACT FROM AUTHOR]

Objective: To assess whether participation in Stanford Youth Coaches Programs (SYCP) increases patient activation scores and patient activation levels for vulnerable youth from low income communities.Methods: From 2016 to 18, seven high schools and four residency programs in California, Alabama, Kansas and Missouri participated in SYCPs. Enrolled youth participants completed online pre and post-participation surveys including the Patient Activation Measure (PAM®10). We used paired T-tests, chi square tests, and linear multivariate models to compare pre-and post-scores and levels.Results: 143 participants completed pre- and post-participation surveys. The PAM®10 mean pre-test score was 64.5 and post-test was 69.37, with mean difference 4.89 (p=.002). Participants showed significant improvement in patient activation levels after participation. 60 % participants in lowest activation Level 1; 63 % in Level 2; and 32 % in Level 3 moved to a higher level of activation after participation; 46 % who started in Level 4 moved down to Level 3 after participation.Conclusion and Practice Implications: Participation in SYCPs has potential to significantly increase patient activation for vulnerable youth which could lead to lifelong improvements in health outcomes and decrease in healthcare costs. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of having a contract for self-referral to inpatient treatment (SRIT) in patients with severe mental disorders.Methods: A randomized controlled trial with 53 adult patients; 26 participants received a SRIT contract, which they could use to refer themselves into a Community Mental Health Centre up to five days for each referral without contacting a doctor in advance. Outcomes were assessed after 12 months with the self-report questionnaires Patient Activation Measure (PAM-13), Recovery Assessment Scale (RAS), and the Behavior and Symptom Identification Scale (BASIS-32) and analyzed using linear mixed and regression models.Results: There was no significant effect on PAM-13 (estimated mean difference (emd) -0.41, 95% CI (CI):-7.49-6.67), nor on the RAS (emd 0.02, CI:-0.27-0.31) or BASIS-32 (0.09, CI:-0.28-0.45). An exploratory post hoc analysis showed effect of SRIT in those with low PAM below ≤47 (p=0.049).Conclusion: There were no group differences after 12 months, but both groups maintained their baseline levels.Practice Implications: SRIT contracts can be recommended as it supports the rights to self-determination, promote user participation in decision-making in own treatment without any indication of adverse effects. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to use path analysis methods to determine if health literacy mediates the relationship between race and patient activation.Methods: We performed a secondary analysis of data from a randomized controlled trial in elderly, urban, minority patients using path analysis. Path analysis was used to evaluate the mediation of race on patient activation through different variables. Several models were tested for best fit for their effects on patient activation.Results: Across all models, significant mediation paths were identified from race to lower patient activation through health literacy. This relationship remained significant throughout alternative model testing for covariate combinations. The best-fit model included an indirect effect of sex on patient activation through health literacy indicating that the mediation effect of health literacy on patient activation was most profound for African American males. Health literacy had a bigger influence on patient activation for participants with a greater comorbidity than for those with fewer conditions. No significant direct effect was shown between race and patient activation in any of the models.Conclusion: Racial disparities in patient activation were fully mediated by health literacy skills.Practice Implications: Future interventions to improve racial disparities in patient activation need to be targeted at improving health literacy. [ABSTRACT FROM AUTHOR]

Objective: While there is growing interest in improving patient activation in general medical health services, there are too few randomized controlled trials in mental health settings which show how improvement can be achieved. Using the Patient Activation Measure-13 (PAM-13), we aimed to assess the effect of pre-treatment, peer co-led educational intervention on patient activation. Secondary outcomes included measures of patient satisfaction, well-being, mental health symptoms, motivation, and treatment participation.Methods: Patients from two community mental health centres were randomized to a control group (CG, n=26) receiving treatment as usual, or an intervention group (IG, n=26) consisting of a four-hour group educational seminar (aiming to encourage patients to adopt an active role in their treatment) followed by treatment as usual.Results: Only the IG improved on PAM-13, at one- and four-month follow-ups. The intervention had significant effects on patient satisfaction and treatment participation, compared to CG.Conclusion: Providing pre-treatment, peer co-led education improves patient activation in community mental health care settings.Practice Implications: The use of peers as co-educators may contribute to a different mental health care delivery, ensuring patient activation and participation in treatment. Further studies should examine peers' needs for supervision, challenges for the services, long-term and cost-benefit effects. CLINICALTRIALS.Gov Identifier: NCT01601587. [ABSTRACT FROM AUTHOR]

Objective: The Patient Activation Measure-13 (PAM-13) has been found useful for assessing patient knowledge, skills and confidence in management of chronic conditions, but the empirical evidence from mental health is sparse. The psychometric properties of PAM in out-patients waiting for treatment in community mental health centers (CMHC) have therefore been examined.Methods: A total of 290 adults from two CMHC completed PAM. An exploratory factor analysis was conducted with 273 patients. Data at baseline and after 4 weeks were used to analyze test-retest reliability (n=60) and to analyze the sensitivity to change (n=51).Results: The exploratory factor analysis revealed a fit for a two-factor model (Cronbach's α was 0.86 and 0.67), and was assessed for a one-factor model (α=0.87). The test-retest intraclass correlation coefficient was 0.76. Sensitivity to change was good with a statistically significant activation improvement (p<0.001) on patients receiving a peer co-led-educational intervention (Cohen's d was 0.85).Conclusion: PAM has appropriate and acceptable psychometric properties in mental health settings.Practice Implications: Assessing activation before treatment might be useful for scheduling the delivery of mental health services as well as evaluating educational interventions aimed at improving patient engagement in mental health. [ABSTRACT FROM AUTHOR]