OBJECTIVE: Patient activation, which reflects a patient's confidence in managing her healthcare, is associated with better adherence to treatment and less hospitalization. Although activation has been cited as a cause of health disparities outside of pregnancy, it has not been studied in pregnancy. Our objectives were to describe patient activation, identify patient factors associated with activation, and determine associations between activation and other features of cognition in a pregnant and postpartum population. STUDY DESIGN: In this prospective, observational cohort study, pregnant and postpartum women underwent assessments of health activation (using the validated Patient Activation Measure [PAM]), cognitive skills, and health literacy. The PAM, which yields a maximum score of 100, is categorized into 4 pre-defined activation levels, with the highest level (i.e., Level 4) indicating high engagement with healthy behaviors and self-advocacy. Differences by demographic characteristics and comparisons with other measures were assessed using chi-square tests and Pearson's correlations. RESULTS: In this cohort of pregnant (N=77) and postpartum (N=24) women, the median PAM score was 82.8 (IQR 75.3, 91.6). A majority (90.1%) scored in Level 4; none scored in Level 1. Maternal age was associated with a greater likelihood of scoring above the median (48.1% under 35y vs 72.7% over 35y, p=0.04), whereas gestational age, race/ethnicity, insurance, parity, and education were not associated with PAM score. The PAM score was not significantly associated with long-term memory, processing speed, inductive reasoning, working memory, verbal ability, health literacy or depression screening. CONCLUSION: In this perinatal cohort, unlike in the general population, patient activation was nearly universally high. These results may indicate pregnancy is a "golden opportunity" for health interventions given the high degree of motivation and engagement that exists. Moreover, patient activation was stable across most maternal demographic traits, literacy levels, and cognitive skills, indicating it may not be a mediator of obstetric health disparities.
Yee, L. M., Kamel, L. A., Rajan, P. V., & Simon, M. A. (2018). 894: Pregnancy as a ”golden opportunity” for patient activation and engagement. American Journal of Obstetrics and Gynecology, 218(1), S532. https://doi.org/10.1016/j.ajog.2017.11.481