(Part 3/4) The Portal to Wellness: Patient Activation

Activation is where things really get hot in here.

Author

Erika del Pozo MOT, OTR
March 04, 2025

Is dance a sport or an art? Is a hot dog considered a sandwich? Does the weekend begin on Friday or Saturday?!

When it comes to patient engagement, we all know it’s more of an art than a science—but what if it could be both? 

Enter the PEAR Framework, a simple, structured approach to behavior change invented by yours truly and focuses on four key elements: 

  • Priming

  • Educating

  • Activating

  • Reiterating

Why PEAR Works

The beauty of the PEAR Framework is its simplicity. It’s like the 3-ingredient olive oil, salt, and pepper dressing on a salad that knocks it out of the park. 

It’s adaptable, patient-centered, and crafted to create lasting change by focusing on the how of behavior, not just the what. 🤌

So, whether you directly treat patients or work on patient engagement initiatives in health tech, the PEAR Framework is here to help you make meaningful, sustainable connections.

Over the next four weeks, we will examine one part of the framework at a time in order. This week, we’re covering with “A” for activating.

Activate: Turning Ideas into Action

The heat is turning up 🌶️🥵

So far in this series, we’ve covered priming patients for success and equipping them with knowledge. Now, it’s time to step through the “wellness portal,” which is patient activation.

What is patient activation?

Patient activation describes behaviors in which people can manage their own healthcare. Patient who are “activated” have the knowledge, confidence, and skills to take charge of their health. 

It’s all about behavior. ✨

One does not simply pinpoint a singular behavior and call that patient activation. It is made up of a string of behaviors.

What does the journey of patient activation look like?

A person’s knowledge of their condition and degree of self-efficacy shapes their understanding and expectations about treatment, promoting collaboration with providers and treatment commitment. (4) 

Researchers at the University of Oregon developed a tool that succinctly captures four levels of health behavior. The Patient Activation Measure (PAM) is a self-report questionnaire and is the most used measure of patient activation that has been validated globally. PAM is segmented into four parts known as levels of activation:

  • Level 1: Patients are disengaged and overwhelmed. They may not believe their role in self-care management is essential.

  • Level 2: Patients are becoming aware but still struggling. They lack confidence or knowledge to take an active role.

  • Level 3: Patients are taking action and gaining control. They are beginning to be active.

  • Level 4: Patients maintain behaviors and push further. They actively attempt (even with difficulty) to support health management behaviors over time.

From the lowest level of “my doctor is in charge of my health” to the highest level of “I’m my own health advocate,” providers and those developing patient-facing journeys in digital health must consider tailoring interventions to reduce risk and help patients adopt behaviors that will better their health. 

Why should I care about patient activation?

Activated patients = better outcomes. Lemme break it down:

  • Patients who are less activated are likely to have less positive experiences than those who are highly engaged (1)

  • Activation levels are highly predictive of healthcare costs—an increase in activation is associated with reduced healthcare costs, particularly in high-risk populations (5)

  • Low PAM scores were strongly associated with increased depressive symptoms and poorer quality of life (3)

  • Patients who are more activated are more likely to receive preventive care, less likely to smoke or have a high BMI, and have better clinical indicators; they are also less likely to have been hospitalized or have used the Emergency Department (2)

  • Among participants with heart failure, a patient activation intervention was successful in improving levels of activation, as well as adherence to medication and health behavior recommendations (3)

What can I do to support patient activation?

Here are key priorities when interacting with patients across the activation spectrum (5):

  • Level 1: Building trust and making the benefits clear to help the patient move forward

  • Level 2: Supporting baby steps with regular interactions and greater emphasis on successes rather than corrections

  • Level 3: Supporting change efforts and focus on helping the patient problem-solve

  • Level 4: Reinforcing problem-solving and inviting partnership in co-creating health

Patient activation is a modifiable characteristic, meaning it can be strengthened! Here are three ways you can help patients take a more active role in their care:

  1. Collaborate. Instead of telling patients what to do, present multiple options with the trade-offs involved. Include patients in choosing the best fit for their lifestyle.

  2. Show AND tell. Teach patients how to monitor their condition versus vaguely telling them to do so. Allow patients to practice and apply what they’ve learned to their real lives.

Digital health application: Quiz patients on how they would apply their knowledge in real-life scenarios, focus on helping patients build actionable steps, and provide an interface to reinforce desired behaviors (i.e., medication log, mood tracker, exercise log—even better is an integrated data collection through wearables).

  1. Remind the mind. Keep patients informed and on top of their care through reminders.

Digital health application: The world’s your oyster—prescription reminders, appointment reminders, wellness reminders, etc. Consider the timing of these reminders, too (i.e., an appointment reminder close to the appointment and not three months before). 

Whether implementing an exercise rehab program or adopting a new medication routine, activation is where real transformation begins. 

And yes, sometimes it takes a little nudge (or a big one).

References:

🧠 Unhinged: Thoughts

I don’t have much juice left today. I spent four hours at the pet hospital (and left with $703 less than when I walked in) to be told my cat has a cold. So, as I’m writing this, it’s late, and I don’t have anything creative to add.

I will say that I love getting crappy coffee in a hospital, styrofoam cup and all. There’s nothing glamorous about pacing around in a hospital waiting room. But that cup of coffee soothes you in an infinitesimal way, in a way that matters just enough.

Take care, and see you next week.

Erika