Brief Report| Volume 23, ISSUE 11, P817-820, November 2017

Brief Report: Patient Activation Among Urban Hospitalized Patients With Heart Failure



      Patient activation influences patients' ability to meaningfully engage in critical heart failure self-care. The purpose of this study was to identify whether patient activation is associated with patient-reported health outcomes in an urban and racially diverse inpatient sample of patients with heart failure.


      We prospectively recruited patients with heart failure hospitalized at an urban academic medical center from October 2016 to May 2017 and measured patient activation, physical and affective symptoms, physical function, self-care, perceived control, and self-efficacy. Differences in patient-reported health outcomes between low and high activation groups were compared with the use of linear regression models adjusting for age, sex, education, left ventricular ejection fraction, and New York Heart Association functional classification.


      A total of 96 patients completed the study (mean age 57 ± 12.4 y); 39% identified as black and 35% as Latino, 35% were female, and 50% reported not having enough income to make ends meet. Based on the 4 levels of activation defined by the Patient Activation Measure–13, 22% of patients reported being “disengaged and overwhelmed,” 14% were “becoming aware, but still struggling,” 39% were “taking action,” and 26% were “maintaining behaviors and pushing further.” Higher patient activation was associated with better applied cognitive abilities, self-care behaviors, perceived control, and self-efficacy.


      Patient activation can be easily measured in hospitalized patients with heart failure and is associated with clinically meaningful patient-reported health outcomes.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Cardiac Failure
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Benjamin E.J.
        • Blaha M.J.
        • Chiuve S.E.
        • Cushman M.
        • Das S.R.
        • Deo R.
        • et al.
        Heart disease and stroke statistics—2017 update: a report from the American Heart Association.
        Circulation. 2017; 135: e146-e603
        • Mitchell S.E.
        • Gardiner P.M.
        • Sadikova E.
        • Martin J.M.
        • Jack B.W.
        • Hibbard J.H.
        • et al.
        Patient activation and 30-day post-discharge hospital utilization.
        J Gen Intern Med. 2014; 29: 349-355
        • Bos-Touwen I.
        • Schuurmans M.
        • Monninkhof E.M.
        • Korpershoek Y.
        • Spruit-Bentvelzen L.
        • Ertugrul–van der Graaf I.
        • et al.
        Patient and disease characteristics associated with activation for self-management in patients with diabetes, chronic obstructive pulmonary disease, chronic heart failure and chronic renal disease: a cross-sectional survey study.
        PLoS ONE. 2015; 10: e0126400
        • Greene J.
        • Hibbard J.H.
        • Sacks R.
        • Overton V.
        • Parrotta C.D.
        When patient activation levels change, health outcomes and costs change, too.
        Health Aff (Millwood). 2015; 34: 431-437
        • Hibbard J.H.
        • Mahoney E.
        Toward a theory of patient and consumer activation.
        Patient Educ Couns. 2010; 78: 377-381
        • Alegria M.
        • Sribney W.
        • Perez D.
        • Laderman M.
        • Keefe K.
        The role of patient activation on patient-provider communication and quality of care for US and foreign born Latino patients.
        J Gen Intern Med. 2009; 24: 534-541
        • Prey J.E.
        • Qian M.
        • Restaino S.
        • Hibbard J.
        • Bakken S.
        • Schnall R.
        • et al.
        Reliability and validity of the Patient Activation Measure in hospitalized patients.
        Patient Educ Couns. 2016; 99: 2026-2033
        • Hibbard J.H.
        • Mahoney E.R.
        • Stockard J.
        • Tusler M.
        Development and testing of a short form of the Patient Activation Measure.
        Health Serv Res. 2005; 40: 1918-1930
        • Jaarsma T.
        • Arestedt K.F.
        • Martensson J.
        • Dracup K.
        • Stromberg A.
        The European Heart Failure Self-Care Behaviour scale revised into a nine-item scale (EHFSCB-9): a reliable and valid international instrument.
        Eur J Heart Fail. 2009; 11: 99-105
        • Riegel B.
        • Dickson V.V.
        A situation-specific theory of heart failure self-care.
        J Cardiovasc Nurs. 2008; 23: 190-196
        • Moser D.K.
        • Riegel B.
        • McKinley S.
        • Doering L.V.
        • Meischke H.
        • Heo S.
        • et al.
        The Control Attitudes Scale–Revised: psychometric evaluation in three groups of patients with cardiac illness.
        Nurs Res. 2009; 58: 42-51
        • Green C.P.
        • Porter C.B.
        • Bresnahan D.R.
        • Spertus J.A.
        Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure.
        J Am Coll Cardiol. 2000; 35: 1245-1255
        • Chew L.D.
        • Bradley K.A.
        • Boyko E.J.
        Brief questions to identify patients with inadequate health literacy.
        Fam Med. 2004; 36: 588-594
        • Jurgens C.Y.
        • Lee C.S.
        • Riegel B.
        Psychometric analysis of the heart failure somatic perception scale as a measure of patient symptom perception.
        J Cardiovasc Nurs. 2017; 32: 140-147
        • Flynn K.E.
        • Dew M.A.
        • Lin L.
        • Fawzy M.
        • Graham F.L.
        • Hahn E.A.
        • et al.
        Reliability and construct validity of PROMIS measures for patients with heart failure who undergo heart transplant.
        Qual Life Res. 2015; 24: 2591-2599
        • Hibbard J.H.
        • Greene J.
        • Tusler M.
        Improving the outcomes of disease management by tailoring care to the patient's level of activation.
        Am J Manag Care. 2009; 15: 353-360
        • Hibbard J.H.
        • Mahoney E.R.
        • Stock R.
        • Tusler M.
        Do increases in patient activation result in improved self-management behaviors?.
        Health Serv Res. 2007; 42: 1443-1463
        • Shively M.J.
        • Gardetto N.J.
        • Kodiath M.F.
        • Kelly A.
        • Smith T.L.
        • Stepnowsky C.
        • et al.
        Effect of patient activation on self-management in patients with heart failure.
        J Cardiovasc Nurs. 2013; 28: 20-34
        • Dunlay S.M.
        • Griffin J.M.
        • Redfield M.M.
        • Roger V.L.
        Patient activation in acute decompensated heart failure.
        J Cardiovasc Nurs. 2016; (Epub ahead of print)