University of Oulu

Paukkonen, L, Oikarinen, A, Kähkönen, O, Kaakinen, P. Patient activation for self-management among adult patients with multimorbidity in primary healthcare settings. Health Sci Rep 2022; 5:e735. doi:10.1002/hsr2.735

Patient activation for self-management among adult patients with multimorbidity in primary healthcare settings

Saved in:
Author: Paukkonen, Leila1,2; Oikarinen, Anne1,2; Kähkönen, Outi1,2;
Organizations: 1Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
2Medical Research Centre, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.3 MB)
Persistent link:
Language: English
Published: John Wiley & Sons, 2022
Publish Date: 2022-09-01


Background and Aims: Multimorbidity is a major public health and healthcare challenge around the world, including in Finland. As multimorbidity necessitates self-management in everyday life, the effects of patient activation — a patient’s knowledge, skills, and confidence in managing own health — on the capacity for self-management warrant study, especially in primary healthcare settings. This study aimed to assess patient activation among multimorbid primary healthcare patients, identify factors associated with patient activation, and determine whether patients with low and high activation differ in terms of health and self-management behavior, related perceptions, and health-related quality of life (HRQoL).

Methods: A cross-sectional survey was conducted among multimorbid patients who attended Finnish primary healthcare consultations (November 2019 to May 2020). The main outcome, patient activation, was assessed using the patient activation measure, PAM-13®. Responses from 122 patients were analyzed using descriptive statistics, t-tests, analysis of variance, linear modeling, the χ2 test, and binary regression analysis.

Results: The mean score of patient activation was 56.12 (SD 12.82) on a scale 0–100 where ≤55.1 indicate low activation. The lower activation scores were significantly associated with old age, obesity, loneliness, and lower perceived health, functional ability, and vitality. Patients with low activation (47%) had significantly poorer physical activity, diets, adherence to care, and HRQoL, and significantly worse perceptions related to self-management including motivation and energy, sense of normality, and support from physicians, nurses, and close people.

Conclusion: Patient activation among multimorbid outpatients was rather low. Findings indicate that patients’ perceptions of their health and psychosocial factors may be important for activation and that patients with low and high activation differ with respect to several health variables. Determining patient activation in multimorbid patients may facilitate adaptation of care to better meet patient capabilities and needs in clinical settings. Knowledge of a patient’s activation level may also be useful when developing interventions and care strategies for this patient group.

see all

Series: Health science reports
ISSN: 2398-8835
ISSN-E: 2398-8835
ISSN-L: 2398-8835
Volume: 5
Issue: 4
Article number: e735
DOI: 10.1002/hsr2.735
Type of Publication: A1 Journal article – refereed
Field of Science: 316 Nursing
Funding: This study was supported by the University of Oulu Graduate School, UniOGS, Health and Biosciences Doctoral Programme, the Finnish Nursing Education Foundation, and State Hospital District Research Funding. Funding bodies had no role in the study; not in the design of the study, in the collection, analysis, and interpretation of data, in the writing of the report; or in the decision to submit the article for publication.
Copyright information: © 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.