Skip to content

This content is more than five years old


Supporting people to manage their health

An introduction to patient activation


With 60 to 70 per cent of premature deaths caused by detrimental health behaviours, it is vital that people engage more with improving their own health. This paper introduces a way of conceptualising and measuring that engagement known as 'patient activation'.

Patient activation can be used to reduce health inequalities and deliver improved outcomes, better quality care and lower costs. Drawing on US and UK-based evidence, the paper describes the robust patient-reported measure – the PAM – used to gauge patient activation. PAM measures an individual's knowledge, skill, and confidence for self-management.  Research shows that appropriately designed interventions can increase patients’ levels of activation, with associated health benefits. The paper explores how this is being achieved in practice and offers recommendations for extending early use of the PAM in the United Kingdom.

Key findings

  • Patient activation is a better predictor of health outcomes than known socio-demographic factors such as ethnicity and age.

  • 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.

Policy implications

  • Used in population segmentation and risk stratification, patient activation can provide new insights into risk that go beyond those using traditional socio-demographic factors.

  • The PAM provides a simple, evidence-based mechanism for establishing the capacity of individuals to manage their health – and then using that information to optimise the delivery of care.

  • Given the links between low levels of activation and poor health outcomes, the role of the PAM in addressing health inequalities in the United Kingdom should be considered further.

  • It would be beneficial if the Department of Health and NHS England echoed calls for use of patient activation in England.