Association Between Patient Activation and Medication Adherence in Patients With Stroke: A Cross-Sectional Study

Abstract

Background: Medication adherence is key to secondary prevention in patients with stroke. Poor medication adherence can lead to recurrence, disability, or even death in stroke survivors. Patient activation is associated with increased healthy behaviors and improved clinical outcomes in many chronic diseases. However, the association between patient activation and medication adherence in patients with stroke remains unclear.Objective: The study aimed to explore the influence of patient activation on the medication adherence of patients with stroke and to analyze the reasons for medication nonadherence.Materials and Methods: A cross-sectional design with convenience sampling was used in this study. A total of 119 patients with stroke were recruited from a tertiary hospital in Guangzhou. A social-demographic and clinical data form, a self-developed medication adherence questionnaire, and the 13-item Patient Activation Measure (PAM-13) were used. Univariate analysis and multiple linear regression analysis with dummy variables were conducted to investigate the associations between medication adherence and patient activation. Data were analyzed with IBM® SPSS® version 25.0.Results: The mean PAM-13 score in patients with stroke was 51.56 ± 12.58. A low level of patient activation was reported by up to 66.4% of the patients. The self-reported medication adherence questionnaire score was 5.59 ± 1.52. A low level of medication adherence was reported by up to 59.7% of the patients, while a moderate level was reported by 34.4%, and a high level was reported by only 5.9%. In the multiple stepwise regression analysis, patient activation was found to be an independent influencing factor of medication adherence in patients with stroke (p < 0.05).Conclusion: Medication adherence was poor in patients in Guangzhou, China, following an ischemic stroke. Patient activation as the independent influencing factor identified in this study will support healthcare givers to develop the tailored intervention to improve medication adherence among patients with stroke in China.

Patient Activation During the First 6 Months After the Start of Stroke Rehabilitation

“…12 In contrast, the mean PAM score in the present study was higher than in a cross-sectional study with patients with stroke from a tertiary hospital (60.2 vs 51.56). 16 The authors hypothesized that this low patient activation might be because of underdeveloped health literacy and health care awareness. 16 A strength of this study is that it gives insight in the course of patient activation in patients with stroke during the first 3 months after stroke when most recovery takes place 29 and also up until 6 months when it is thought that a plateau effect is reached.…”

“…16 The authors hypothesized that this low patient activation might be because of underdeveloped health literacy and health care awareness. 16 A strength of this study is that it gives insight in the course of patient activation in patients with stroke during the first 3 months after stroke when most recovery takes place 29 and also up until 6 months when it is thought that a plateau effect is reached. 29 Another strength of our study is that PAM levels are described.…”

“…Although having a sufficient level of activation is important for patients with stroke, research on this topic in patients with stroke is scarce. To our knowledge, there are only a few studies done in community-based [12][13][14][15] or hospital-based 16 patients with stroke. These studies show different levels of patient activation, varying between a level where patients are disengaged and overwhelmed 16 to a level where patients are maintaining behaviors and pushing further.…”

“…To our knowledge, there are only a few studies done in community-based [12][13][14][15] or hospital-based 16 patients with stroke. These studies show different levels of patient activation, varying between a level where patients are disengaged and overwhelmed 16 to a level where patients are maintaining behaviors and pushing further. 12 Increasing patient activation during stroke rehabilitation is not explicitly included in stroke rehabilitation guidelines as a treatment goal.…”

The Patient Activation Measure (PAM) and the pandemic: Predictors of patient activation among Australian health consumers during the COVID‐19 pandemic

“… 6 Patient activation has been linked to a person's level of health literacy, and whilst there has been research showing that patient activation tends to be lower in older populations and in those with chronic conditions, 1 , 7 , 8 there is a limited body of research on what other predictors exist for patient activation within the general population. In previous research, the PAM has been found to be a reliable predictor of medication adherence, 9 engagement with prevention strategies, reductions in unnecessary emergency department (ED) visits, 10 and hospital readmission rates. 10 Studies have shown that a single point increase in PAM score equates to a 2%–3% gain in health outcomes and a decrease in health service use.…”