Patient activation in individuals with type 2 diabetes mellitus: associated factors and the role of insulin

Vugt, Heidi A. van; Boels, Anne Meike; Weerdt, Inge de; Koning, Eelco J.P. de; Rutten, Guy E.H.M.

doi:10.2147/ppa.s188391

Cited by 26 publications

(25 citation statements)

References 33 publications

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“…We argue that gains from increased social capital include reduced isolation, feeling that life has meaning and having a support system that can be consulted for advice. This transformation prompts someone to be more activated in terms of their 'internal readiness and capabilities to undertake healthpromoting actions' [33]. Table 3 outlines a list of CMOCs we developed following further interpretation of our data through the theoretical lenses of social capital and patient activation (see Additional file 5: Final refined realist analysis, with supporting extracts from included papers).…”

Section: Bringing Existing Theories Into Our Programme Theorymentioning

confidence: 99%

Supporting social prescribing in primary care by linking people to local assets: a realist review

Tierney

Wong

Roberts

et al. 2020

BMC Med

125

141

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Background: Social prescribing is a way of addressing the 'non-medical' needs (e.g. loneliness, debt, housing problems) that can affect people's health and well-being. Connector schemes (e.g. delivered by care navigators or link workers) have become a key component to social prescribing's delivery. Those in this role support patients by either (a) signposting them to relevant local assets (e.g. groups, organisations, charities, activities, events) or (b) taking time to assist them in identifying and prioritising their 'non-medical' needs and connecting them to relevant local assets. To understand how such connector schemes work, for whom, why and in what circumstances, we conducted a realist review. Method: A search of electronic databases was supplemented with Google alerts and reference checking to locate grey literature. In addition, we sent a Freedom of Information request to all Clinical Commissioning Groups in England to identify any further evaluations of social prescribing connector schemes. Included studies were from the UK and focused on connector schemes for adult patients (18+ years) related to primary care. Results: Our searches resulted in 118 included documents, from which data were extracted to produce contextmechanism-outcome configurations (CMOCs). These CMOCs underpinned our emerging programme theory that centred on the essential role of 'buy-in' and connections. This was refined further by turning to existing theories on (a) social capital and (b) patient activation. Conclusion: Our realist review highlights how connector roles, especially link workers, represent a vehicle for accruing social capital (e.g. trust, sense of belonging, practical support). We propose that this then gives patients the confidence, motivation, connections, knowledge and skills to manage their own well-being, thereby reducing their reliance on GPs. We also emphasise within the programme theory situations that could result in unintended consequences (e.g. increased demand on GPs).

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Section: Bringing Existing Theories Into Our Programme Theorymentioning

confidence: 99%

Supporting social prescribing in primary care by linking people to local assets: a realist review

Tierney

Wong

Roberts

et al. 2020

BMC Med

125

141

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“…The mean activation measurement of participants just before the implementation of the consultation model (58.9) was lower than the mean (61.3) of a larger Dutch sample of people with a chronic disease,24 but comparable to another population of Dutch people with type 2 diabetes (59.1) 25. From patients in four European countries, the 1829 Dutch patients with a chronic illness had the lowest mean PAM score of 61.2 (SE 0.34) 26.…”

Section: Discussionmentioning

confidence: 64%

“…Perception of diabetes changed in a positive direction, as people were significantly more conscious of the consequences of their diabetes, felt more personal control and had a more coherent understanding of their diabetes. All these perceptions were independently and positively associated with the people’s activation level 25. Taken together, these findings suggest that the consultation model could enhance the person’s own role in diabetes care and improve self-management possibilities.…”

Section: Discussionmentioning

confidence: 64%

“…All these perceptions were independently and positively associated with the people’s activation level. 25 Taken together, these findings suggest that the consultation model could enhance the person’s own role in diabetes care and improve self-management possibilities. However, reported self-care activities did not change, although LDL cholesterol and BMI decreased significantly.…”

Section: Discussionmentioning

confidence: 88%

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Person-centered diabetes care and patient activation in people with type 2 diabetes

Rutten

Vugt

Koning

2020

BMJ Open Diab Res Care

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IntroductionThe American Diabetes Association and the European Association for the Study of Diabetes advocate a person-centered approach to enhance patient engagement in self-care activities. To that purpose, people with diabetes need adequate diabetes knowledge, motivation, skills and confidence. These prerequisites are captured by the concept ‘patient activation’. The Dutch Diabetes Federation implemented a person-centered consultation model for the annual diabetes review. To assess its relationship with patient activation, we measured the change in patient activation, and in person and disease-related factors in people with type 2 diabetes after their second person-centered annual review.Research design and methodsObservational study in 47 primary care practices and six outpatient hospital clinics. Follow-up: 1 year. From 2.617 people with diabetes and capable of completing questionnaires (no additional exclusion criteria) 1.487 (56.8%) participated, 1366 with type 2 diabetes. Main outcome: patient activation (13-item Patient Activation Measure, score 0–100). Before the first and after the second review, participants completed questionnaires. Medical data were retrieved from electronic records. We performed a repeated measure analysis using a linear mixed model in 1299 participants, who completed the first set of questionnaires.ResultsIn 1299 participants (41.6% female, mean age 66 years, median diabetes duration 10 years, median glycated hemoglobin (HbA1c) 6.8%/51 mmol/mol), the mean baseline activation level was 58.9 (SD 11.7). Independent of actual diabetes care, activation levels increased 1.53 units (95% CI 0.67 to 2.39, p=0.001). Several diabetes perceptions improved significantly; diabetes distress level decreased significantly. Body mass index (−0.22, 95% CI −0.33 to −0.10, p<0.001) and low-density lipoprotein cholesterol (−2.71 mg/dL, 95% CI −4.64 to −0.77, p=0.004) decreased, HbA1c increased 0.08% (95% CI 0.03 to 0.12) (p=0.001).ConclusionsPerson-centered diabetes care was associated with a slightly higher patient activation level, improved diabetes perception and small improvements in clinical outcomes. Person-centered care may enhance patient engagement, but one should not expect substantial improvement in patient outcomes in the short term.

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“…This finding is contrary to prior research showing less activation among those who are less educated. 32 One possible explanation is that study participants with less education may have had less baseline understanding of prediabetes and were highly motivated to enroll in the study and learn about their condition and prevention strategies to avoid diabetes. Similarly, patients with more education who were highly activated may have already raised this issue with their PCP and/or sought information from other sources and may have been less interested in participating in SDM for diabetes prevention.…”

Section: Discussionmentioning

confidence: 99%

Psychometric Properties of the Altarum Consumer Engagement (ACE) Measure of Activation in Patients with Prediabetes

Castellon-Lopez

Jeffers²,

Duru

et al. 2020

J GEN INTERN MED

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BACKGROUND: Patient activation is associated with better outcomes in chronic conditions. OBJECTIVE: We evaluated the psychometric properties of the 12-item Altarum Consumer Engagement™ Measure (ACE-12) in patients with prediabetes. PARTICIPANTS: ACE-12 was administered to patients in the Prediabetes Informed Decisions and Education Study. MAIN MEASURES: We conducted an exploratory factor analysis followed by confirmatory factor analytic models. We evaluated item response categories using item characteristic curves. Construct validity was assessed by examining correlations of the ACE-12 scales with education, depressive symptoms, self-rated health, hemoglobin A1c, body mass index, and weight loss. KEY RESULTS: Participants (n = 515) had a median age of 58; 56% were female; 17% Hispanic; 54% were non-White. The scree plot and Tucker and Lewis reliability coefficient (0.95) suggested three factors similar to the original scales. One item loaded on the navigation rather than the informed choice scale. Ordinal alpha coefficients for the original scales were commitment (0.75); informed choice (0.71); and navigation (0.54). ICCs indicated that one or more of the response categories for 5 of the 12 items were never most likely to be selected. Patients with lower education were less activated on the commitment (r = − 0.124, p = 0.004), choice (r = − 0.085, p = 0.009), and overall score (r = − 0.042, p = 0.011). Patients with depressive symptoms had lower commitment (r = − 0.313, p ≤ 0.001) and overall scores (r = − 0.172, p = 0.012). Patients with poorer health scored lower on the Commitment (r = − 0.308, p ≤ 0.001), Navigation (r = − 0.137, p ≤ 0.001), and overall score (r = − 0.279, p ≤ 0.001). CONCLUSION: The analyses provide some support for the psychometric properties of the ACE-12 in prediabetic patients. Future research evaluating this tool among patients with other chronic conditions are needed to determine whether Q1 (I spend a lot of time learning about health) should remain in the informed choice or be included in the navigation scale. Additional items may be needed to yield acceptable reliability for the navigation scale.

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Patient activation in individuals with type 2 diabetes mellitus: associated factors and the role of insulin

Cited by 26 publications

References 33 publications

Supporting social prescribing in primary care by linking people to local assets: a realist review

Supporting social prescribing in primary care by linking people to local assets: a realist review

Person-centered diabetes care and patient activation in people with type 2 diabetes

Psychometric Properties of the Altarum Consumer Engagement (ACE) Measure of Activation in Patients with Prediabetes

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