However, I am less sure about the claim that such an approach may lead to a reduction in health inequalities. Such a claim suggests a lack of appreciation of the determinants of health and the complexity of inequalities.
People who engage with patient activation are already motivated, interested and have an "internal locus of control". These are people who are likely to have better economic circumstances and who are already more likely to experience better health outcomes. Those who already have poorer health, lack in confidence and a belief in their own self-efficacy or mastery are those who are less likely to engage in such a programme. This is generally the group of people who alreday experience a range of inequalities, including poorer health outcomes. I suggest that such programmes create a risk of increasing health inequalities as those who are more able to take up the opportunities for self-management do so, resulting in an increasing gap.
This sounds like the sort of programme that requires an inequalities impact assessment, followed by consideration of the application of proportionate universalism.
I have been offered medication which I should not take, even when in hospital with pneumonia. I don't think that some medics inspect our medical records when being assessed. In hospital patients requests are forgotten. I have observed and heard that some doctors are not listening, which disturbs patients.
In my case, I have quite a few medical conditions, and everyone tells me how amazing I am, but I disagree with them. It is a case of mind over matter. Most of the time I get head tremors, severe head pains, which affect my balance, but I will still force myself to go out. I have had 9 full strokes and get regular TIA's, sometimes collapsing and finding myself in hospital 2 hours later. I have collapsed 8 times with strokes so when I get symptoms I do worry a little. Even so I carried on with my 5 different dance classes until after my 5th stroke, when I was physically incapable, and how I grieve over that!
It is really the age old case of taking each day as it comes and look for something to smile about, to try to be content. Life is as it comes...
Perhaps we shouldn't confuse patient activation with self-management,however as I am a believer in utilising what is already out there in real life and is evidenced to use, I would like to draw the King's Fund attention to a NHS owned resource for cardiac patients in use in many areas (throughout the UK) since 1992.
The Heart Manual www.theheartmanual.com
Built on a CBT model and using an individual based tailored approach,the resource meets the needs of 16,000+ patients per annum.This is a supported self management programme,facilitated by specially trained health professionals,That is the key. Whatever the resource, be it on patient activation or/and self managment the tool is only as good as the person who is skilled up/competent to deliver, introduce and support this type of journey with the patient.
(I would be happy to fw a copy to a named person within the Kings Fund-if provide me some details please).
With best wishes
Why is this? Lack of time with the patient, lack of training in the skills needed to be alongside someone rather than imparting information? As so much research shows that even small steps can have beneficial health effects in conditions like obesity and Type 2 diabetes, it makes sense to equip health professionals to 'start from the skills the individual has and help them to gain further skills and confidence to progress.'
People who are more activated are significantly more likely to attend screenings, check-ups and immunisations, to adopt positive behaviours (eg, diet and exercise), and have clinical indicators in the normal range (body mass index, blood sugar levels (A1c), blood pressure and cholesterol).
Patients who are less activated are significantly less likely to prepare questions for a medical visit, know about treatment guidelines or be persistent in clarifying advice.
Patient activation scores and cost correlations show less-activated patients have costs approximately 8 per cent higher than more-activated patients in the baseline year, and 21 per cent higher in the subsequent year.
Studies of interventions to improve activation show that patients who start with the lowest activation scores tend to increase their scores the most, suggesting that effective interventions can help engage even the most disengaged.
People become good managers of their own health in different ways and that has to do with the level of education i.e if you can read or write to start with.
Learning to manage some ones health is like a Sport man and woman who is going for a competition and wanted to excel need to know what to eat and at the right time.
How to do his or her exercise at the right time.
A good health is about eating good food and doing exercises all at the right time