Definition of Concept: A focus on the patient’s role in managing his or her own health care is increasingly being promoted as an important strategy for improving the quality of care in the United States. The notion that patients should be more active and involved managers of their health and health care is a foundational principle in the widely adopted Chronic Care Model (Bodenheimer et al, 2002) and in many current health care reform efforts, such as the newly established Patient-Centered Outcomes Research Institute (

The concept of patient activation, largely developed by Hibbard and colleagues (2004) refers to the knowledge, skills and confidence an individual has about making effective decisions to manage his or her health. Activation is developmental in nature and involves four stages: (1) believing the patient role is important; (2) having the knowledge and confidence to take action; (3) taking action to maintain and improve one’s health; and (4) staying the course even under stress (Hibbard, et al, 2004).

A body of research over the past ten years demonstrates that patient activation predicts many health behaviors, health outcomes, and health care utilization (Hibbard et al, 2004; Hibbard et al, 2005; Mosen, et al, 2007; Becker and Roblin, 2008; Fowles, et al, 2009; Remmers, et al, 2009; Harvey, et al, 2012). More activated individuals are more likely to engage in health promoting behaviors such as regular physical activity, to practice self-management behaviors for chronic conditions such as adherence to diabetic testing, to have improved health outcomes such as good glycemic control, and to obtain preventive care.

Utility for Nursing: Nursing has long been focused on many aspects of patient activation, such as health locus of control (Wallston, Stein, & Smith, 1994); self-efficacy in self-management (Lorig et al, 1996); and readiness to change health behaviors (DiClemente et al, 1991; Prochaska, Redding, & Evers, 1997). However, conceptual confusion about activation remains.

What does patient activation really mean? How is it different from other theoretical approaches to self-management and shared decision making in health? What is the full range of behaviors that individuals should perform if they are to optimally benefit from their health care (ie., the highly activated)? What is the utility of the concept of patient activation for nursing? How would we tailor our interventions to the individual’s level of activation or apply at the aggregate level to evaluate interventions and health care delivery systems? These and other questions will be examined in this presentation.

Conclusions: This paper explores the conceptual dimensions of patient activation. Attention will be given to how this developmental concept involves a learned behavior, reflects an individual’s self-concept as self-manager, and emphasizes the role of emotional balance. Contextual factors that may impact patient activation such as age, gender, ethnicity, and health status will be examined and a model explicating this concept will be presented.

READ MORE:,%2C%20et%20al%2C%202004).