Judith Hibbard: How do people become good managers of their own health?

OLYMPUS DIGITAL CAMERAWithin the general population some people actively focus on reaching and maintaining good health, while others are more passive about the whole thing. So what makes the difference?

Is learning to manage your health like learning a country’s geography—where all you probably need are a list of facts and a good reference guide? Or is it more like learning to swim—where facts and a reference guide would be of limited value? In this instance you need to acquire basic skills, like putting your face in the water and learning to float, but you must also practise to gain confidence before advancing to the next step.

Not surprisingly, as our new paper “Supporting people to manage their own health” reports, becoming a good manager of one’s health is more like learning to swim: here too you must learn some basic skills, and gain confidence before you can start to take on all of the challenges. However, many healthcare providers currently treat the process more like a geography lesson; giving patients some key facts and a reference guide, rather than starting from the skills the individual has and helping them to gain further skills and confidence to progress.

More innovative healthcare systems are beginning to take into account how engaged people are in managing their own health and to help them move forward from this point. It is now possible to accurately assess “where patients are” in terms of their knowledge, skill, and confidence for managing their health using the patient activation measure (PAM). This is a simple survey that people can answer themselves. It has a zero to 100 score, indicating how engaged or activated an individual is—from being passive about their health to being very proactive.

The PAM is being used in clinical settings to assess where patients are so that healthcare teams are better able to tailor care plans for that individual patient, enable clinicians and providers to evaluate progress, and help them measure when patients or whole patient populations are improving their ability to manage their health. This last point is important to help us assess the quality of care. If patients are getting high quality healthcare, they should be getting better at managing their own health too. We can now measure this, and in doing so we will shine a light on this critical area of care, enabling us to know what is working, and which delivery systems and clinicians are effective in helping patients gain the skills and confidence for self management.

Research shows that patients can make gains in their activation level, and these gains translate into more positive health behaviours and improved outcomes. More activated patients also have lower healthcare costs, largely because they are admitted to hospital less often and are less frequent users of the accident and emergency departments.

In healthcare we measure what matters. What the patient brings to the care process may be the most important element of all. By measuring patient activation, and using the information in the design of care, we can finally bring this missing element in the healthcare equation.

Read our paper on patient activation: Supporting people to manage their own health

Read The BMJ’s News story on this paper.

Judith Hibbard is an international visiting fellow at the King’s Fund and a senior researcher and professor emerita at the University of Oregon.

Competing interests: Judith advises many healthcare organisations, foundations, and initiatives. She has served on several advisory panels and commissions, including the National Advisory Council for the Agency for Healthcare Research and Quality, the National Health Care Quality Forum, the United Health Group Advisory Panel, and the National Advisory Council for the Robert Wood Johnson Foundation. She is an equity stakeholder and consultant to Insignia Health, which holds the licensing rights to PAM.

This blog first appeared on the King’s Fund website here

  • elizabeth52

    I believe my health and well-being have been protected by insisting that doctors understand that cancer screening is MY decision. I wouldn’t use a doctor who doesn’t “get” informed consent. All cancer screening is elective and legally and ethically requires our informed consent, yet that doesn’t seem to apply in women’s cancer screening. We may face medical coercion, extreme pressure, be sacked as a patient, may be misled, (“you need one for the Pill”) be made to feel intimidated/scared, it seems anything goes, coverage is the only concern.
    I’ve never understood why it’s acceptable to so many to treat women in this way, some even think it’s preferable, “for their own good”.
    I did the unthinkable and declined cervical screening over 30 years ago, also, routine pelvic and breast exams. (the last two are no longer performed/recommended) I did my own research and made informed decisions, I found the official discourse did not adequately inform women and was more likely to mislead them. The risks of screening were too high for me, I was content with my near zero risk of cervix cancer rather than a 77% lifetime risk of referral for colposcopy and biopsy. Now I know I’m HPV- and cannot benefit from pap testing.

    As a young woman I avoided doctors, as a middle aged woman I’m not prepared to go without a doctor, so doctor-shopping found my GP, a doctor prepared to listen and respect my screening decisions.
    I’ve also declined breast screening, that was easier, the Nordic Cochrane Institute summary was very helpful. The official sources of “information” are once again a sales pitch for screening, again, the emphasis is the govt-set target, not informed consent.

    Thankfully, our cervical screening program is likely to be changed in a couple of years, but it’s likely to stay with excess. (good for vested interests and their profits)
    In my opinion, the Dutch and the Finns are the ones to watch, they’ve managed (largely) to focus on the evidence and put women first. (unlike Australia, the States and others)
    IMO, the new Dutch cervical screening program is the best in the world for those who wish to screen, they’ll scrap population pap testing (7 pap tests, 5 yearly from 30 to 60) and offer instead 5 HPV primary tests at 30,35,40,50 and 60 and only the roughly 5% who are HPV+ will be offered a 5 yearly pap test. (until they clear the virus) Dutch women are already using the Delphi Screener, a HPV self-test option. MOST women cannot benefit from pap testing, but can be harmed by false positives and over-treatment/excess biopsies. This program will save more lives and takes most women out of pap testing and harms way.
    HPV- and confidently monogamous or no longer sexually active and you might choose to stop all further testing.

    Doing your own research, making informed decisions, doctor-shopping and standing firm is very important. (especially for women) In my opinion, we cannot trust these programs to act in our interests. In this country we’ve ignored the evidence and cut women out of the decision-making process, others make screening decisions “for” us and accept risk on our behalf, but leave us to deal with the negative consequences, that’s paternalistic and unethical and must be stopped. (at the very least)
    We still have a long way to go in women’s cancer screening and women’s healthcare generally.