March 2009

Document Type


Degree Name



Dept. of Public Health and Preventive Medicine


Oregon Health & Science University


Background: Patient activation has been defined as “a broad range of elements including the knowledge, skills, beliefs, and behaviors that a patient needs to manage a chronic illness" (Hibbard et al., 2004). The Patient Activation Measure (PAM) has been used to measure patient activation in several chronic diseases (Hibbard et al., 2004, 2005) but has not yet been applied among populations with the human immunodeficiency virus (HIV). We investigated factors associated with patient activation in an HIV-positive population: demographic factors, self-perceptions of social status, substance abuse, and depression. We also assessed the association between patient activation and the outcomes of CD4-cell counts, adherence to highly-active antiretroviral therapy (HAART), and viral suppression. Methods: We used data from the Enhancing Communication and Health Outcomes (ECHO) trial, a cross-sectional study conducted at four clinical sites in the US. Using linear and logistic regression, we assessed the relationships, respectively, between demographic variables and PAM score, and between PAM score and clinical outcomes. Results: Patient activation is statistically significantly (p< .05) associated with educational level, self-perceived social status, current problematic alcohol use, and depression. Patient activation is also significantly associated with CD4 count and patient adherence when adjusted for gender, age, race, education, self-perceived social status, alcohol abuse, illicit drug use, depression, location and provider. Patient activation is significantly associated with viral suppression prior to controlling for adherence, but the association is not significant when controlling for adherence. Conclusions: PAM represents a promising means of assessing the self-management of patients with HIV, and for improving their clinical outcomes.




School of Medicine



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.