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
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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.
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
Rothman AA, Wagner EH. Chronic illness management: what is the role of primary care? Ann Intern Med. 2003;183:256–61.CrossRefGoogle Scholar
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
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
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
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
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
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
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
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
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
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
Levinson W, Lesser CS, Epstein RM. Developing physician communication skills for patient-centered care. Health Aff (Millwood). 2010;29:1310–8.CrossRefGoogle Scholar
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
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
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
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
Sallis R. Developing healthcare systems to support exercise: exercise as the fifth vital sign. Br J Sports Med. 2011;45:473–4.CrossRefPubMedGoogle Scholar
Paxton AE, Strycker LA, Toobert DJ, Ammerman AS, Glasgow RE. Starting the conversation. Am J Prev Med. 2011;40:67–71.CrossRefPubMedGoogle Scholar
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
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
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
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
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
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
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
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
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
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
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
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