Skip to main content

Advertisement

Log in

Patient Activation and Mental Health Care Experiences Among Women Veterans

  • Original Article
  • Published:
Administration and Policy in Mental Health and Mental Health Services Research Aims and scope Submit manuscript

Abstract

We utilized a nationally representative survey of women veteran primary care users to examine associations between patient activation and mental health care experiences. A dose–response relationship was observed, with odds of high quality ratings significantly greater at each successive level of patient activation. Higher activation levels were also significantly associated with preference concordant care for gender-related preferences (use of female providers, women-only settings, and women-only groups as often as desired). Results add to the growing literature documenting better health care experiences among more activated patients, and suggest that patient activation may play an important role in promoting engagement with mental health care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Alegria, M., Canino, G., Rios, R., Vera, M., Calderon, J., Rusch, D., & Ortega, A. N. (2002). Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites. Psychiatric Services, 53(12), 1547–1555.

    Article  PubMed  Google Scholar 

  • Alegria, M., Carson, N., Flores, M., Li, X., Shi, P., Lessios, A. S., & Shrout, P. E. (2014). Activation, self-management, engagement, and retention in behavioral health care: a randomized clinical trial of the DECIDE intervention. JAMA Psychiatry, 71(5), 557–565. doi:10.1001/jamapsychiatry.2013.4519.

    Article  PubMed  PubMed Central  Google Scholar 

  • Alegria, M., Polo, A., Gao, S., Santana, L., Rothstein, D., Jimenez, A., & Normand, S. L. (2008). Evaluation of a patient activation and empowerment intervention in mental health care. Medical Care, 46(3), 247–256. doi:10.1097/MLR.0b013e318158af52.

    Article  PubMed  PubMed Central  Google Scholar 

  • Alexander, J. A., Hearld, L. R., Mittler, J. N., & Harvey, J. (2011). Patient-physician role relationships and patient activation among individuals with chronic illness. Health Services Research,. doi:10.1111/j.1475-6773.2011.01354.x.

    Google Scholar 

  • Becker, E. R., & Roblin, D. W. (2008). Translating primary care practice climate into patient activation: the role of patient trust in physician. Medical Care, 46(8), 795–805. doi:10.1097/MLR.0b013e31817919c0.

    Article  PubMed  Google Scholar 

  • Cortes, D. E., Mulvaney-Day, N., Fortuna, L., Reinfeld, S., & Alegria, M. (2009). Patient–provider communication: understanding the role of patient activation for Latinos in mental health treatment. Health Education and Behavior, 36(1), 138–154. doi:10.1177/1090198108314618.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cuzick, J. (1985). A Wilcoxon-type test for trend. Statistics in Medicine, 4(1), 87–90.

    Article  CAS  PubMed  Google Scholar 

  • Edlund, M. J., Young, A. S., Kung, F. Y., Sherbourne, C. D., & Wells, K. B. (2003). Does satisfaction reflect the technical quality of mental health care? Health Services Research, 38(2), 631–645.

    Article  PubMed  PubMed Central  Google Scholar 

  • Elwyn, G., Dehlendorf, C., Epstein, R. M., Marrin, K., White, J., & Frosch, D. L. (2014). Shared decision making and motivational interviewing: achieving patient-centered care across the spectrum of health care problems. The Annals of Family Medicine, 12(3), 270–275. doi:10.1370/afm.1615.

    Article  PubMed  Google Scholar 

  • Eselius, L. L., Cleary, P. D., Zaslavsky, A. M., Huskamp, H. A., & Busch, S. H. (2008). Case-mix adjustment of consumer reports about managed behavioral health care and health plans. Health Services Research, 43(6), 2014–2032. doi:10.1111/j.1475-6773.2008.00894.x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Frayne, S. M., Phibbs, C. S., Friedman, S. A., Berg, E. A., Ananth, L., Iqbal, S.,… Herrera, L. S. (2013). Sociodemographic Characteristics and Use of VHA Care and Non-VA Care (Fee) (W. s. H. E. Initiative, Trans.) Sourcebook: Women Veterans in the Veterans Health Administration (Vol. 2). Washington, DC: Women Veterans Health Strategic Health Care Group, Department of Veterans Affairs.

  • Fukui, S., Salyers, M. P., Matthias, M. S., Collins, L., Thompson, J., Coffman, M., & Torrey, W. C. (2014). Predictors of shared decision making and level of agreement between consumers and providers in psychiatric care. Community Mental Health Journal, 50(4), 375–382. doi:10.1007/s10597-012-9584-0.

    Article  PubMed  PubMed Central  Google Scholar 

  • Green, C. A., Perrin, N. A., Polen, M. R., Leo, M. C., Hibbard, J. H., & Tusler, M. (2010). Development of the patient activation measure for mental health. Administration and Policy in Mental Health, 37(4), 327–333. doi:10.1007/s10488-009-0239-6.

    Article  PubMed  PubMed Central  Google Scholar 

  • Greene, J., Hibbard, J. H., Sacks, R., & Overton, V. (2013). When seeing the same physician, highly activated patients have better care experiences than less activated patients. Health Affairs (Millwood), 32(7), 1299–1305. doi:10.1377/hlthaff.2012.1409.

    Article  Google Scholar 

  • Gruman, J., Rovner, M. H., French, M. E., Jeffress, D., Sofaer, S., Shaller, D., & Prager, D. J. (2010). From patient education to patient engagement: implications for the field of patient education. Patient Education and Counseling, 78(3), 350–356. doi:10.1016/j.pec.2010.02.002.

    Article  PubMed  Google Scholar 

  • Hausmann, L. R., Gao, S., Mor, M. K., Schaefer, J. H, Jr, & Fine, M. J. (2013). Understanding racial and ethnic differences in patient experiences with outpatient health care in veterans affairs medical centers. Medical Care, 51(6), 532–539. doi:10.1097/MLR.0b013e318287d6e5.

    Article  PubMed  Google Scholar 

  • Hausmann, L. R., Gao, S., Mor, M. K., Schaefer, J., & Fine, M. J. (2014). patterns of sex and racial/ethnic differences in patient health care experiences in US veterans affairs hospitals. Medical Care, 52(4), 328–335.

    PubMed  Google Scholar 

  • Heller, A., Elliott, M. N., Haviland, A. M., Klein, D. J., & Kanouse, D. E. (2009). Patient activation status as a predictor of patient experience among Medicare beneficiaries. Medical Care, 47(8), 850–857. doi:10.1097/MLR.0b013e318197b661.

    Article  PubMed  Google Scholar 

  • Hibbard, J. H., & Cunningham, P. J. (2008). How engaged are consumers in their health and health care, and why does it matter? Center for Studying of Health Systems Change Research Brief, 8, 1–9.

    Google Scholar 

  • Hibbard, J. H., & Greene, J. (2013). What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Affairs, 32(2), 207–214. doi:10.1377/hlthaff.2012.1061.

    Article  PubMed  Google Scholar 

  • Hibbard, J. H., Greene, J., & Tusler, M. (2009). Improving the outcomes of disease management by tailoring care to the patient’s level of activation. The American journal of managed care, 15(6), 353–360.

    PubMed  Google Scholar 

  • Hibbard, J. H., Mahoney, E. R., Stock, R., & Tusler, M. (2007). Do increases in patient activation result in improved self-management behaviors? Health Services Research, 42(4), 1443–1463. doi:10.1111/j.1475-6773.2006.00669.x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hibbard, J. H., Mahoney, E. R., Stockard, J., & Tusler, M. (2005). Development and testing of a short form of the patient activation measure. Health Services Research, 40(6 Pt 1), 1918–1930. doi:10.1111/j.1475-6773.2005.00438.x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hibbard, J. H., Stockard, J., Mahoney, E. R., & Tusler, M. (2004). Development of the patient activation measure (pam): conceptualizing and measuring activation in patients and consumers. Health Services Research, 39(4 Pt 1), 1005–1026. doi:10.1111/j.1475-6773.2004.00269.x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Institute of Medicine, & Committee on Quality of Health Care in America. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington: National Academies Press.

    Google Scholar 

  • Kimerling, R., Bastian, L., Bean-Mayberry, B., Bucossi, M., Carney, D., Goldstein, K., Frayne, S. M., et. al. (2014). Patient Centered Mental Health Care for Women Veterans. Psychiatric Services, 66(2), 155–162. doi:10.1176/appi.ps.201300551.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kimerling, R., Pavao, J., Greene, L., Karpenko, J., Rodriguez, A., Saweikis, M., & Washington, D. L. (2015). Access to mental health care among women veterans: is VA meeting women’s needs? Medical Care, 53(4 Suppl 1), S97–S104. doi:10.1097/MLR.0000000000000272.

    Article  PubMed  Google Scholar 

  • Knutsen, E. J., Paryavi, E., Castillo, R. C., & O’Toole, R. V. (2014). Is satisfaction among orthopaedic trauma patients predicted by depression and activation levels? Journal of Orthopaedic Trauma,. doi:10.1097/bot.0000000000000241.

    Google Scholar 

  • Kukla, M., Salyers, M. P., & Lysaker, P. H. (2013). Levels of patient activation among adults with schizophrenia: associations with hope, symptoms, medication adherence, and recovery attitudes. The Journal of Nervous and Mental Disease, 201(4), 339–344. doi:10.1097/NMD.0b013e318288e253.

    Article  PubMed  Google Scholar 

  • MacGregor, C., Hamilton, A. B., Oishi, S. M., & Yano, E. M. (2011). Description, development, and philosophies of mental health service delivery for female veterans in the VA: A qualitative study. Women’s Health Issues, 21(4, Supplement), S138–S144.

    Article  PubMed  Google Scholar 

  • Magnezi, R., Glasser, S., Shalev, H., Sheiber, A., & Reuveni, H. (2014). Patient activation, depression and quality of life. Patient Education and Counseling, 94(3), 432–437. doi:10.1016/j.pec.2013.10.015.

    Article  PubMed  Google Scholar 

  • Mengeling, M. M., Sadler, A. G., Torner, J., & Booth, B. M. (2011). Evolving comprehensive VA women’s health care: Patient characteristics, needs, and preferences. Women’s Health Issues, 21(4S), S120–S129. doi:10.1016/j.whi.2011.04.021.

    Article  PubMed  Google Scholar 

  • National Center for Veterans Analysis and Statistics. (2014). Unique veteran users report FY2012 (Department of Veteran Affairs Office of Policy and Planning, Trans.): U.S. Department of Veterans Affairs.

  • National Committee for Quality Assurance. (2013). HEDIS 2014: Healthcare effectiveness data and information set. Washington DC: National Committee for Quality Assurance (NCQA).

    Google Scholar 

  • Oishi, S. M., Rose, D. E., Washington, D. L., MacGregor, C., Bean-Mayberry, B., & Yano, E. M. (2011). National variations in VA mental health care for women veterans. Womens Health Issues, 21(4 Suppl), S130–S137. doi:10.1016/j.whi.2011.04.029.

    Article  PubMed  Google Scholar 

  • Phibbs, C. S., Cowgill, E. H., & Fan, A. Y. (2013). Guide to the PSSG Enrollee FileGuidebook. Menlo Park, CA: VA Palo Alto, Health Economics Resource Center. Retrieved from http://www.herc.research.va.gov/files/BOOK_739.pdf.

  • Roblin, D. W., Howard, D. H., Junling, R., & Becker, E. R. (2011). An evaluation of the influence of primary care team functioning on the health of Medicare beneficiaries. Medical Care Research and Review, 68(2), 177–201. doi:10.1177/1077558710374619.

    Article  PubMed  Google Scholar 

  • Sacks, R. M., Greene, J., Hibbard, J. H., & Overton, V. (2014). How well do patient activation scores predict depression outcomes one year later? Journal of Affective Disorders, 169, 1–6. doi:10.1016/j.jad.2014.07.030.

    Article  PubMed  Google Scholar 

  • Salyers, M. P., Matthias, M. S., Spann, C. L., Lydick, J. M., Rollins, A. L., & Frankel, R. M. (2009). The role of patient activation in psychiatric visits. Psychiatric Services (Washington, D. C.), 60(11), 1535–1539. doi:10.1176/appi.ps.60.11.1535.

    Article  Google Scholar 

  • Salyers, M. P., Matthias, M. S., Sidenbender, S., & Green, A. (2013). Patient activation in schizophrenia: insights from stories of illness and recovery. Administration and policy in mental health, 40(5), 419–427. doi:10.1007/s10488-012-0435-7.

    Article  PubMed  Google Scholar 

  • StataCorp. (2007). Stata 10. College Staion, TX.

  • Tai-Seale, M., Foo, P. K., & Stults, C. D. (2013). Patients with mental health needs are engaged in asking questions, but physicians’ responses vary. Health Affairs (Millwood), 32(2), 259–267. doi:10.1377/hlthaff.2012.0962.

    Article  Google Scholar 

  • VA Information Resource Center. (2011). VHA Medical SAS ® Outpatient Datasets and Inpatient Encounters Dataset FY2009: VIReC Research User Guide. Retrieved from http://www.virec.research.va.gov/DataSourcesName/Medical-SAS-Datasets/MedSAS-Outpt-RUG/MedSAS-RUG-Outpt.htm.

  • Veterans Health Administration. (2014). VHA Blueprint for Excellence.

  • Washington, D. L., Bean-Mayberry, B., Riopelle, D., & Yano, E. M. (2011). Access to care for women veterans: delayed healthcare and unmet need. Journal of General Internal Medicine, 26(Suppl 2), 655–661. doi:10.1007/s11606-011-1772-z.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wong, S. T., Peterson, S., & Black, C. (2011). Patient activation in primary healthcare: a comparison between healthier individuals and those with a chronic illness. Medical Care, 49(5), 469–479.

    Article  PubMed  Google Scholar 

  • Wright, S., Craig, T., Campbell, S., Schaefer, J., & Humble, C. (2006). Patient satisfaction of female and male users of Veterans Health Administration services. Journal of General Internal Medicine, 21, S26–S32.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This study was funded by the VA HSR&D SDR 12-196. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government. The authors have no financial involvement with organizations whose financial interest may be affected by the material in the manuscript or which might potentially bias it. The authors wish to thank Julie Karpenko MSW, Liberty Greene, MS, M.Ed. and Meghan Saweikis, MS, JD, for their contributions to the WOMAN Study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rachel Kimerling.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kimerling, R., Pavao, J. & Wong, A. Patient Activation and Mental Health Care Experiences Among Women Veterans. Adm Policy Ment Health 43, 506–513 (2016). https://doi.org/10.1007/s10488-015-0653-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10488-015-0653-x

Keywords

Navigation