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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Health Services Research 1/2014

Relationships between patient activation, disease-specific knowledge and health outcomes among people with diabetes; a survey study

BMC Health Services Research > Ausgabe 1/2014
Michelle Hendriks, Jany Rademakers
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

MH participated in the design of the study, carried out the statistical analyses and drafted the manuscript. JR conceived of the study, and participated in its design and coordination and helped to draft the manuscript. Both authors read and approved the final manuscript.



Nowadays, patients are expected to be involved in their health care, well-informed and able to adjust their behavior to maintain a good health. Investigating patient activation and its relationships with patient characteristics and health-related outcomes will provide further insight into the gains to be expected if patients are more involved in their healthcare.


Based on claims data, 5,346 people were selected who received diabetes care in the last 12 months. They received a questionnaire including the Patient Activation Measure (PAM) and questions on patient characteristics, life style and self-management behaviors, knowledge about diabetes, healthcare utilization and own clinical values. We used bivariate analyses and regression analyses to investigate the relationships between patient characteristics, patient activation level, and health-related outcomes.


Data of 1,845 (35%) people were used in the analyses. Patient activation differed depending upon several patient characteristics. Patient activation level was positively related to getting the recommended feet and eye examinations after controlling for several patient characteristics; no association was found for life-style and self-management behaviors and the other healthcare utilization measures. Those with a low patient activation level less often reported to have knowledge about diabetes and of their values on clinical indicators.


Among people with diabetes, patient activation level was especially related to disease-specific knowledge and less with health-related behavior and outcomes. The PAM might therefore especially be an useful instrument for clinical practice to identify patients most in need for diabetes education.
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