Journal of Immigrant and Minority Health

, Volume 18, Issue 6, pp 1489–1497 | Cite as

Patient Activation is Inconsistently Associated with Positive Health Behaviors Among Obese Safety Net Patients

  • Mona AuYoung
  • Ninez A. Ponce
  • O. Kenrik Duru
  • Arturo Vargas Bustamante
  • Carol M. Mangione
  • Hector P. Rodriguez
Original Paper


We examine the association of patient activation and physical activity and fruit and vegetable consumption among obese safety net patients. Adult obese patients (n = 198) of three safety net clinics completed a survey assessing patient activation, physical activity, fruit and vegetable consumption, care experiences, and health status. Multivariate logistic regression models incrementally assessed the adjusted relation of patient activation and physical activity and fruit and vegetable consumption. In adjusted analyses, higher activated patients had higher odds [Odds ratio (OR) 1.58, p < 0.01] of consuming fruits and vegetables daily than less activated patients. There was no significant association between patient activation and regular physical activity. Engaging in regular physical activity appears to be difficult, even for highly activated patients. In contrast, additional fruit and vegetable consumption is a relatively easier change. Patient activation was inconsistently associated with two positive health behaviors among obese safety net patients.


Patient activation Physical activity Safety net clinics Practice redesign Health behaviors Minority health 



The authors would like to thank Lindsay Kimbro and Socorro Ochoa for their assistance in the questionnaire development and translation process. Thanks to Ms. Kimbro, Ms. Ochoa, and clinic leaders for their assistance in the data collection process. Finally, thanks to the patients for their interest and participation in the survey process.


This research was funded by the NIH/National Heart, Lung, and Blood Institute: California Comparative Effectiveness and Outcomes Improvement (CEOI) Center Grant #RC2HL101811. Author AuYoung was supported by the UCLA Graduate Division Dissertation Year Fellowship.

Compliance with Ethical Standards

Conflict of interest

We have no conflicting or competing interests to report.


  1. 1.
    Coleman K, Austin BT, Brach C, Wagner EH. Evidence on the chronic care model in the new millennium. Health Aff. 2009;28:75–85.CrossRefGoogle Scholar
  2. 2.
    Rothman AA, Wagner EH. Chronic illness management: what is the role of primary care? Ann Intern Med. 2003;183:256–61.CrossRefGoogle Scholar
  3. 3.
    Desouza CV, Padala PR, Haynatzki G, Anzures P, Demasi C, Shivaswamy V. Role of apathy in the effectiveness of weight management programmes. Diabetes Obes Metab. 2012;14:419–23.CrossRefPubMedGoogle Scholar
  4. 4.
    Tsai AC, Morton SC, Mangione CM, Keeler EB. A meta-analysis of interventions to improve care for chronic illnesses. Am J Manag Care. 2005;11:478–88.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Rittenhouse DR, Casalino LP, Shortell SM, et al. Small and medium-size physician practices use few patient-centered medical home processes. Health Aff. 2011;30:1575–84.CrossRefGoogle Scholar
  6. 6.
    Shortell SM, Gillies R, Siddique J, et al. Improving chronic illness care: a longitudinal cohort analysis of large physician organizations. Med Care. 2009;42:932–39.CrossRefGoogle Scholar
  7. 7.
    Carman KL, Dardess P, Maurer M, et al. Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health Aff. 2013;32:223–31.CrossRefGoogle Scholar
  8. 8.
    Hibbard JH, Greene J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff. 2013;32:207–14.CrossRefGoogle Scholar
  9. 9.
    Greene J, Hibbard JH. Why does patient activation matter? an examination of the relationships between patient activation and health-related outcomes. J Gen Intern Med. 2011;27:520–6.CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Rask KJ, Ziemer DC, Kohler SA, Hawley JN, Arinde FJ, Barnes CS. Patient activation is associated with healthy behaviors and ease in managing diabetes in an indigent population. Diabetes Educ. 2009;35:622–30.CrossRefPubMedGoogle Scholar
  11. 11.
    Alexander JA, Hearld LR, Mittler JN, Harvey J. Patient–physician role relationships and patient activation among individuals with chronic illness. Health Serv Res. 2012;47:1201–23.CrossRefPubMedGoogle Scholar
  12. 12.
    Tarn DM, Young HN, Craig BM. Development of the patient approach and views toward healthcare communication (PAV-COM) measure among older adults. BMC Health Serv Res. 2012;12:289.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Levinson W, Lesser CS, Epstein RM. Developing physician communication skills for patient-centered care. Health Aff (Millwood). 2010;29:1310–8.CrossRefGoogle Scholar
  14. 14.
    Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the patient activation measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39:1005–26.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Hibbard JH, Mahoney ER, Stockard J, Tusler M. Development and testing of a short form of the patient activation measure. Health Serv Res. 2005;40:1918–30.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Hibbard JH, Mahoney E. Toward a theory of patient and consumer activation. Patient Educ Couns. 2010;78:377–81.CrossRefPubMedGoogle Scholar
  17. 17.
    Chubak J, Anderson ML, Saunders KW, et al. Predictors of 1-year change in patient activation in older adults with diabetes mellitus and heart disease. J Am Geriatr Soc. 2012;60:1316–21.CrossRefPubMedGoogle Scholar
  18. 18.
    Munson GW, Wallston KA, Dittus RS, Speroff T, Roumie CL. Activation and perceived expectancies: correlations with health outcomes among veterans with inflammatory bowel disease. J Gen Intern Med. 2009;24:809–15.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Johnson SS, Paiva AL, Cummins CO, et al. Transtheoretical model-based multiple behavior intervention for weight management: effectiveness on a population basis. Prev Med. 2008;46:238–46.CrossRefPubMedGoogle Scholar
  20. 20.
    Sallis R. Developing healthcare systems to support exercise: exercise as the fifth vital sign. Br J Sports Med. 2011;45:473–4.CrossRefPubMedGoogle Scholar
  21. 21.
    Paxton AE, Strycker LA, Toobert DJ, Ammerman AS, Glasgow RE. Starting the conversation. Am J Prev Med. 2011;40:67–71.CrossRefPubMedGoogle Scholar
  22. 22.
    Browne K, Roseman D, Shaller D, Edgman-Levitan S. Analysis and commentary measuring patient experience as a strategy for improving primary care. Health Aff. 2010;29:921–5.CrossRefGoogle Scholar
  23. 23.
    Anastario MP, Rodriguez HP, Gallagher PM, et al. A randomized trial comparing mail versus in-office distribution of the CAHPS Clinician and Group Survey. Health Serv Res. 2010;45:1345–59.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Jenkinson C, Layte R, Jenkinson D, et al. A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies? J Public Health Med. 1997;19:179–86.CrossRefGoogle Scholar
  25. 25.
    Hibbard JH, Mahoney ER, Stock R, Tusler M. Do increases in patient activation result in improved self-management behaviors? Health Serv Res. 2007;42:1443–63.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Harvey L, Fowles JB, Xi M, Terry P. When activation changes, what else changes? the relationship between change in patient activation measure (PAM) and employees’ health status and health behaviors. Patient Educ Couns. 2012;88:338–43.CrossRefPubMedGoogle Scholar
  27. 27.
    Drieling RL, Ma J, Stafford RS. Evaluating clinic and community-based lifestyle interventions for obesity reduction in a low-income Latino neighborhood: Vivamos Activos Fair Oaks Program. BMC Public Health. 2011;11:98.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Deen D, Lu WH, Weintraub MR, Maranda MJ, Elshafey S, Gold MR. The impact of different modalities for activating patients in a community health center setting. Patient Educ Couns. 2012;89:178–83.CrossRefPubMedGoogle Scholar
  29. 29.
    Alegría M, Sribney W, Perez D, Laderman M, Keefe K. The role of patient activation on patient-provider communication and quality of care for US and foreign born Latino patients. J Gen Intern Med. 2009;24:534–41.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Lubetkin EI, Lu W-H, Gold MR. Levels and correlates of patient activation in health center settings: building strategies for improving health outcomes. J Health Care Poor Underserved. 2010;21:796–808.CrossRefPubMedGoogle Scholar
  31. 31.
    Cunningham PJ, Hibbard J, Gibbons CB. Raising low ‘patient activation’ rates among Hispanic immigrants may equal expanded coverage in reducing access disparities. Health Aff. 2011;30:1888–94.CrossRefGoogle Scholar
  32. 32.
    Cunningham PJ, Hibbard JH. How engaged are consumers in their health and health care, and why does it matter?. Washington, DC: Center for Studying Health System Change; 2008.Google Scholar
  33. 33.
    Otero-Sabogal R, Arretz D, Siebold S, et al. Physician-community health worker partnering to support diabetes self-management in primary care. Qual Prim Care. 2010;18:363–72.PubMedGoogle Scholar
  34. 34.
    Dixon A, Hibbard J, Tusler M. How do people with different levels of activation self-manage their chronic conditions? Patient. 2009;2:257–68.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Mona AuYoung
    • 1
    • 4
  • Ninez A. Ponce
    • 1
    • 5
  • O. Kenrik Duru
    • 2
  • Arturo Vargas Bustamante
    • 1
  • Carol M. Mangione
    • 2
  • Hector P. Rodriguez
    • 3
  1. 1.Department of Health Policy and Management, Fielding School of Public HealthUniversity of California, Los AngelesLos AngelesUSA
  2. 2.Division of General Internal Medicine and Health Services Research, Geffen School of MedicineUniversity of California, Los AngelesLos AngelesUSA
  3. 3.Division of Health Policy and Management, School of Public HealthUniversity of California, BerkeleyBerkeleyUSA
  4. 4.Department of Veterans Affairs, Center for Clinical Management ResearchVA HSR&D/CCMR (Mail Stop 152)Ann ArborUSA
  5. 5.UCLA Center for Health Policy ResearchUniversity of California, Los AngelesLos AngelesUSA

Personalised recommendations