Is it possible to raise a patient's 'activation level' through an intervention targeted specifically at that outcome?

Problem

Patient activation measurements (such as Insignia's PAM) measure a person's level of knowledge, skills and confidence to self-manage effectively with one or more long term health conditions. Observational studies have shown that high patient activation scores are associated with better health outcomes along with reduced and more effective use of health services, resulting in cost-savings for the NHS. However, this gives rise to the question of whether it is possible to raise an individual’s activation score through an intervention targeted specifically at that outcome and, if so, whether this change in activation level results in the anticipated improvements to health and service utilisation. An intervention that is successful in achieving the specific aim of increasing activation in patients with long term conditions will be a quicker, easier and more cost-effective intervention than one that aims to build a person's knowledge, skills and confidence to self-manage, with patient activation as a possible eventual outcome. Supported Self-Management (“SSM”) interventions usually focus on the latter.

Approach

We report on a service evaluation of an established health coaching programme, the Structured Agenda-Free Coaching Conversation model. The programme was commissioned for patients who were struggling to manage with one or more long-term health conditions. The evaluation measured activation levels before and after the intervention using a validated measure, initially the “HeiQ” and later in the programme the “PAM”. We then looked at studies that compared outcomes for people at low levels of activation with those of people at high levels of activation to see whether the quantitative and qualitative outcomes from the health coaching intervention matched the outcomes that would be expected if the intervention had been successful at moving people up the activation levels.

Findings

The results showed a significant rise in HeiQ and PAM levels following the Structured Agenda-Free Coaching Conversation intervention. Health service utilisation was looked at towards the end of the programme for all patients who had completed the Coaching intervention up until that point (n=186). It was found that the rise in activation scores for completers was accompanied by reductions in health service utilisation in line with observational studies, suggesting that patient activation is a legitimate interventional target. Patient-reported outcomes also reconfirmed that raised activation levels, as demonstrated by raised activation scores, were associated with a range of improved health outcomes, improved sense of wellbeing, more effective use of clinical services, and greater engagement with non-healthcare activities for health and wellbeing.

Consequences

There are significant implications both in terms of health and wellbeing outcomes for patients and for costs to the NHS. Currently it is of particular significance in terms of the new Health & Wellbeing Coach role and the coaching models they are using.