Top

Published in:

Open Access 01-12-2024 | Type 2 Diabetes | Research

Patient activation levels and socioeconomic factors among the Amazonas population with diabetes: a cross-sectional study

Authors: Elisa Brosina de Leon, Hércules Lázaro Morais Campos, Natália Barbeiro Santos, Fabiana Almeida Brito, Fabio Araújo Almeida

Published in: BMC Health Services Research | Issue 1/2024

Abstract

Background

The presence of chronic conditions such as type 2 diabetes mellitus (T2DM) requires behavioral lifestyle changes mediated by individuals’ motivation for change and adherence to treatment. This study aims to explore activation levels in individuals with T2DM treated in primary care facilities and to identify the association between demographic, clinical, psychosocial factors, and patient activation amongst populations in the Brazilian state of Amazonas.

Methods

SAPPA is a cross-sectional study conducted in Amazonas, approved by the Universidade Federal do Amazona’s IRB in Brazil. Individuals with T2DM were evaluated in their homes (n = 4,318,325). The variables were sex, age, skin color, education level; health-related variables such as body mass index, nutritional behavior, and frequency of physical activity. Measures related to patient self-management behaviors over the past 6 months (Patient Activation Measure – PAM-13) were included in the survey. Descriptive and frequency data are presented as mean (standard deviation (SD)) or numeric percentage). Statistical testing was performed using IBM SPSS V.26, and a p-value of < 0.050 showed significance. Activation levels were dichotomized into low activation (Levels 1 and 2) and high activation (Levels 3 and 4). A multivariate linear model assessed the association between the PAM-13 score and the following variables: age, sex, BMI, skin color, number of comorbidities, burden of symptoms, and number of medications.

Results

Logistic regression analyses indicated a statistically significant association between sex, age, education, self-rated health, and general satisfaction with life. men were 43% more likely to score lower levels (p < 0.001). The results also indicated that advanced age had lower PAM levels (p < 0.001). Participants with fewer years of education were 44% more likely to have lower levels of PAM (p = 0.03). Worse self-rated health (p < 0.001) and lower general life satisfaction (p = 0.014) were associated with lower PAM levels.

Conclusions

Low patient activation was associated with worse sociodemographic, health, and psychological conditions in the Amazon population. The low level of patient activation observed in this sample highlights an important impediment to diabetes disease management/self-management in disadvantaged populations.

Available only for authorised users

IDF International Diabetes Federation. IDF Diabetes Atlas 10th edition. 2021. https://diabetesatlas.org/

Iser BPM, Stopa SR, Chueiri PS, Szwarcwald CL, Malta DC, Monteiro HO da. C, Prevalência De Diabetes autorreferido no Brasil: resultados Da Pesquisa Nacional De Saúde 2013. Epidemiologia e Serviços de Saúde 2015;24:305–14. https://doi.org/10.5123/s1679-49742015000200013

Telo GH, Cureau FV, De Souza MS, Andrade TS, Copês F, Schaan BD. Prevalence of Diabetes in Brazil over time: a systematic review with meta-analysis. Diabetol Metab Syndr. 2016;8:65. https://doi.org/10.1186/s13098-016-0181-1CrossRefPubMedPubMedCentral

Mangueira HT, Silva ESda, Oliveira CDB, Nascimento MBG, Félix TGdaS, Oliveira RRde, et al. Perfil epidemiológico De Pacientes Portadores De Diabetes Mellitus cadastrados na Atenção Primária. Revista Enfermagem Atual in Derme. 2020;94(e–20076). https://doi.org/10.31011/reaid-2020-v.94-n.32-art.775

Silva-Tinoco R, Cuatecontzi-Xochitiotzi T, De La Torre-Saldaña V, León-García E, Serna-Alvarado J, Guzmán-Olvera E, et al. Role of social and other determinants of health in the effect of a multicomponent integrated care strategy on type 2 Diabetes Mellitus. Int J Equity Health. 2020;19:1–11. https://doi.org/10.1186/s12939-020-01188-2CrossRef

Ministério da Saúde. Manual do pé diabético: estratégias para o cuidado da pessoa com doença crônica. Manual do pé diabético: estratégias para o cuidado da pessoa com doença crônica., 2016, p. 62. https://doi.org/ISBN978-85-334-2361-9

Brasil. Planificação Da atenção primária à saúde nos estados. Conselho Nac De Secretários De Saúde. 2011;23:436. (CONASS Documenta, 23).

van Vugt HA, Boels AM, de Weerdt I, de Koning EJP, Rutten GEHM. Patient activation in individuals with type 2 Diabetes Mellitus: Associated factors and the role of insulin. Patient Prefer Adherence. 2019;13:73–81. https://doi.org/10.2147/PPA.S188391CrossRefPubMed

Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the patient activation measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39:1005–26. https://doi.org/10.1111/j.1475-6773.2004.00269.xCrossRefPubMedPubMedCentral

10.

Hosseinzadeh H, Verma I, Gopaldasani V. Patient activation and type 2 Diabetes Mellitus self-management: a systematic review and meta-analysis. Aust J Prim Health. 2020;26:431–42. https://doi.org/10.1071/PY19204CrossRefPubMed

11.

Golubinski V, Wild EM. Factors associated with patient activation in a socially deprived population: evidence from Germany. Patient Educ Couns. 2021;104:2791–802. https://doi.org/10.1016/j.pec.2021.03.039CrossRefPubMed

12.

Bahrom NH, Ramli AS, Isa MR, Abdul-Hamid H, Badlishah-Sham SF, Baharudin N, et al. Factors Associated with High Patient Activation Level among individuals with metabolic syndrome at a primary care teaching clinic. J Prim Care Community Health. 2020;11. https://doi.org/10.1177/2150132720931301

13.

Zimbudzi E, Lo C, Ranasinha S, Fulcher GR, Jan S, Kerr PG, et al. Factors associated with patient activation in an Australian population with comorbid Diabetes and chronic Kidney Disease: a cross-sectional study. BMJ Open. 2017;7:e017695. https://doi.org/10.1136/bmjopen-2017-017695CrossRefPubMedPubMedCentral

14.

Hendriks M, Rademakers J. Relationships between patient activation, disease-specific knowledge and health outcomes among people with Diabetes; a survey study. BMC Health Serv Res. 2014;14:393. https://doi.org/10.1186/1472-6963-14-393CrossRefPubMedPubMedCentral

15.

Golubinski V, Oppel EM, Schreyögg J. A systematic scoping review of psychosocial and psychological factors associated with patient activation. Patient Educ Couns. 2020;103:2061–8. https://doi.org/10.1016/j.pec.2020.05.005CrossRefPubMed

16.

Hill-Briggs F, Adler NE, Berkowitz SA, Chin MH, Gary-Webb TL, Navas-Acien A, et al. Social determinants of health and Diabetes: a scientific review. Diabetes Care. 2021;44:258–79. https://doi.org/10.2337/dci20-0053CrossRef

17.

SRMM. Secretaria da Região Metropolitana de Manaus. Governo Do Estado Do Amazonas 2016. www.srmm.am.gov.br (accessed May 2, 2018).

18.

de Leon EB, Campos HLM, Brito FA, Almeida FA. Study of Health in Primary Care of the Amazonas Population: protocol for an observational study on Diabetes Management in Brazil. JMIR Res Protocols. 2022;11(9):e37572. https://doi.org/10.2196/37572CrossRef

19.

Iser BPM, Malta DC, Duncan BB, De Moura L, Vigo Á, Schmidt MI. Prevalence, correlates, and description of self-reported Diabetes in Brazilian capitals - results from a telephone survey. PLoS ONE. 2014;9:e108044. https://doi.org/10.1371/journal.pone.0108044ADSCrossRefPubMedPubMedCentral

20.

Hibbard JH, Mahoney ER, Stock R, Tusler M. Do increases in patient activation result in improved self-management behaviors? Health Serv Res. 2007;42:1443–63. https://doi.org/10.1111/j.1475-6773.2006.00669.xCrossRefPubMedPubMedCentral

21.

Cunha CM, da Cunha DCPT, Manzato R, de O, Nepomuceno E, da Silva D, Dantas RAS. Validation of the Brazilian version of the patient activation measure 13. J Nurs Meas. 2019;1:97–113. https://doi.org/10.1891/1061-3749.27.1.97CrossRef

22.

Taunay TC, Cristino ED, Machado MO, Rola FH, Lima JWO, Macêdo DS, et al. Development and validation of the intrinsic religiousness inventory (IRI). Revista Brasileira De Psiquiatria. 2012;34:76–81. https://doi.org/10.1590/s1516-44462012000100014CrossRefPubMed

23.

Forti S, Serbena CA, Scaduto AA. Spirituality/religiousity measurement and health in Brazil: a systematic review. Ciencia E Saude Coletiva. 2020;25:1463–74. https://doi.org/10.1590/1413-81232020254.21672018CrossRefPubMed

24.

Tusa N, Kautiainen H, Elfving P, Sinikallio S, Mäntyselkä P. Relationship between patient activation measurement and self-rated health in patients with chronic Diseases. BMC Fam Pract. 2020;21:1–8. https://doi.org/10.1186/s12875-020-01301-yCrossRef

25.

Lubetkin EI, Lu WH, Gold MR. Levels and correlates of patient activation in health center settings: building strategies for improving health outcomes. J Health Care Poor Underserved. 2010;21:796–808. https://doi.org/10.1353/hpu.0.0350CrossRefPubMed

26.

Su D, Michaud TL, Estabrooks P, Schwab RJ, Eiland LA, Hansen G, et al. Diabetes Management through Remote Patient Monitoring: the Importance of Patient Activation and Engagement with the technology. Telemedicine and E-Health. 2019;10:952–9. https://doi.org/10.1089/tmj.2018.0205CrossRef

27.

Walker RJ, Smalls BL, Egede LE. Social determinants of health in adults with type 2 diabetes-contribution of mutable and immutable factors. Diabetes Res Clin Pract. 2015;110:193–201. https://doi.org/10.1016/j.diabres.2015.09.007CrossRefPubMedPubMedCentral

28.

Silva-Tinoco R, Cuatecontzi-Xochitiotzi T, De La Torre-Saldaña V, León-García E, Serna-Alvarado J, Orea-Tejeda A, et al. Influence of social determinants, Diabetes knowledge, health behaviors, and glycemic control in type 2 Diabetes: an analysis from real-world evidence. BMC Endocr Disord. 2020;20:1–11. https://doi.org/10.1186/s12902-020-00604-6CrossRef

29.

Chan EY, Glass GF, Cheong RQ, Chin GF, Chng DYJ. Patient activation and its predictors in hospitalized older adults in Singapore. Geriatr Nurs (Minneap). 2021;42:336–43. https://doi.org/10.1016/j.gerinurse.2021.01.006CrossRef

30.

Humphries MD, Welch P, Hasegawa J, Mell MW. Correlation of patient activation measure level with patient characteristics and type of Vascular Disease. Ann Vasc Surg. 2021;73:55–61. https://doi.org/10.1016/j.avsg.2020.11.019CrossRefPubMed

31.

Begum N, Donald M, Ozolins IZ, Dower J. Hospital admissions, emergency department utilisation and patient activation for self-management among people with Diabetes. Diabetes Res Clin Pract. 2011;93:260–7. https://doi.org/10.1016/j.diabres.2011.05.031CrossRefPubMed

32.

Fleary SA, Ettienne R. Social Disparities in Health Literacy in the United States. HLRP: Health Literacy Research and Practice. 2019;3:e47–52. https://doi.org/10.3928/24748307-20190131-01CrossRefPubMedPubMedCentral

33.

McCormack L, Bann C, Squiers L, Berkman ND, Squire C, Schillinger D, et al. Measuring health literacy: a pilot study of a new skills-based instrument. J Health Commun. 2010;15(15 Suppl 2):51–71. https://doi.org/10.1080/10810730.2010.499987CrossRefPubMed

34.

Bailey SC, Brega AG, Crutchfield TM, Elasy T, Herr H, Kaphingst K, et al. Update on health literacy and Diabetes. Diabetes Educ. 2014;40:581–604. https://doi.org/10.1177/0145721714540220CrossRefPubMedPubMedCentral

35.

Smith SG, Curtis LM, Wardle J, von Wagner C, Wolf MS. Skill set or mind set? Associations between Health Literacy, patient activation and health. PLoS ONE. 2013;8:e74373. https://doi.org/10.1371/journal.pone.0074373ADSCrossRefPubMedPubMedCentral

36.

Arifin B, Idrus LR, van Asselt ADI, Purba FD, Perwitasari DA, Thobari JA, et al. Health-related quality of life in Indonesian type 2 Diabetes Mellitus outpatients measured with the Bahasa version of EQ-5D. Qual Life Res. 2019;28:1179–90. https://doi.org/10.1007/s11136-019-02105-zCrossRefPubMedPubMedCentral

37.

Trikkalinou A, Papazafiropoulou AK, Melidonis A. Type 2 Diabetes and quality of life. World J Diabetes. 2017;8:120–9. https://doi.org/10.4239/wjd.v8.i4.120CrossRefPubMedPubMedCentral

38.

Rumsfeld JS. Health status and clinical practice: when will they meet? Circulation. 2002;106:5–7. https://doi.org/10.1161/01.CIR.0000020805.31531.48CrossRefPubMed

39.

Alves LC, Leite I, da Machado C. Factors associated with functional disability of elderly in Brazil: a multilevel analysis. Rev Saude Publica. 2010;44:468–78. https://doi.org/10.1590/s0034-89102010005000009CrossRefPubMed

40.

Sari Y, Isworo A, Upoyo AS, Taufik A, Setiyani R, Swasti KG, et al. The differences in health-related quality of life between younger and older adults and its associated factors in patients with type 2 Diabetes Mellitus in Indonesia. Health Qual Life Outcomes. 2021;19:124. https://doi.org/10.1186/s12955-021-01756-2CrossRefPubMedPubMedCentral

41.

Chubak J, Anderson ML, Saunders KW, Hubbard RA, Tuzzio L, Liss DT, et al. Predictors of 1-year change in patient activation in older adults with Diabetes Mellitus and Heart Disease. J Am Geriatr Soc. 2012;60:1316–21. https://doi.org/10.1111/j.1532-5415.2012.04008.xCrossRefPubMed

Title: Patient activation levels and socioeconomic factors among the Amazonas population with diabetes: a cross-sectional study
Authors: Elisa Brosina de Leon
Hércules Lázaro Morais Campos
Natália Barbeiro Santos
Fabiana Almeida Brito
Fabio Araújo Almeida
Publication date: 01-12-2024
Publisher: BioMed Central
Keyword: Type 2 Diabetes
Published in: BMC Health Services Research / Issue 1/2024
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-023-10529-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Patient activation levels and socioeconomic factors among the Amazonas population with diabetes: a cross-sectional study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2024

Care-receivers with physical disabilities’ perceptions on having humanoid assistive robots as assistants: a qualitative study

Effective strategies for Fecal Immunochemical Tests (FIT) programs to improve colorectal cancer screening uptake among populations with limited access to the healthcare system: a rapid review

Surgical waiting lists and queue management in a Brazilian tertiary public hospital

Individual and community-level factors associated with women’s utilization of postnatal care services in Uganda, 2016: a multilevel and spatial analysis

Barriers and facilitators of implementation of new antibacterial technologies in patient care: an interview study with orthopedic healthcare professionals at a university hospital

The relationship between community social risk factors and regional hospital-reported cash, negotiated, and chargemaster prices for 14 common services