Relation of Patient Activation to Medication Adherence in Low-Literacy Older Adults with Chronic Health Conditions

OBJECTIVES: Patient engagement may depend on patient activation and is one of the primary areas of focus in health economics and outcomes research. Data suggest demographic factors and health literacy impact patient activation to varying degrees. The primary purpose of this study was to explore the relation of patient activation to medication adherence in adults 40 years of age or older with chronic health conditions and low health literacy. Secondary objectives were to determine if demographic factors including age, education, gender, and race/ethnicity were related in this group to level of patient activation.

METHODS: Participants completed self-report questionnaires as part of a larger study of chronic disease self-management. Patient activation was measured using Hibbard’s Patient Activation Measure (PAM). Self-report of medication adherence was determined by using the Gonzalez-Lu adherence questionnaire. Block regressions first assessed the relation of demographic variables (i.e., age, gender, race/ethnicity) and education to adherence, and then the added relation of patient activation in a second block.

RESULTS: A total of 302 participants (mean age 57.6 years; 143 men and 159 women with a mean number of chronic health conditions of 6.6) were included in the analyses. Several variables in the first block were related to adherence (p = 0.02). The addition of the PAM in the second block showed that it was robustly related, increasing the R squared value to 0.08 (p < 0.001).

CONCLUSIONS: Evaluating patient activation at baseline can assess those less likely to be adherent to medications. Patient activation may be improved with increasing certain types of health literacy. Those with poor patient activation at initial visits may benefit from health literacy interventions that increase patient engagement and medication adherence. Such interventions should be culturally adapted as it appears race/ethnicity plays a role in patient activation.