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Low Patient Activation and Hispanic Immigrants' Access Barriers

Health Affairs Study Indicates Activation—Or How Confident, Skillful and Knowledgeable Patients are About Improving Their Health and Health Care—Plays Role in Access Disparities

Media Advisory
Oct. 6, 2011

Alwyn Cassil (202) 264-3484 or

WASHINGTON , DC—Increasing Hispanic immigrants’ ability to take a more active role in managing their health and health care may be as important as expanding health coverage in reducing access disparities, according to a study by the Center for Studying Health System Change (HSC) published in the October edition of Health Affairs.

Funded by the Robert Wood Johnson Foundation (RWJF), the study, titled “Raising Low ‘Patient Activation’ Rates Among Hispanic Immigrants May Equal Expanded Coverage in Reducing Access Disparities,” found that patient activation— or how confident, skillful and knowledgeable people are about taking an active role in improving their health and health care—is important in understanding access problems, or unmet medical need, for Hispanics, particularly recent immigrants.

The study used the patient activation measure, a 13-item questionnaire, to assign people to one of four levels of activation. “These four levels indicate people who (1) may not understand that they must play an active role in their health; (2) lack the confidence and knowledge necessary to take action; (3) are just beginning to take action to maintain and improve their health; or (4) have adopted many proactive health behaviors but still face challenges in maintaining those behaviors over time—for example, maintaining a healthy lifestyle,” according to the article.

Coauthored by Peter J. Cunningham, Ph.D., HSC senior fellow and director of quantitative research; Judith Hibbard, Dr. P.H., a professor at the University of Oregon; and Claire B. Gibbons, Ph.D., an  RWJF senior program officer; the study found that activation levels are lower for blacks and Hispanics than for whites.  For example, 24.8 percent of Hispanics were at the highest level of patient activation, compared to 39.5 percent of blacks and 45.3 percent of whites.

While much of the difference in activation between whites and blacks could be accounted for by controlling for differences in income, education and other socioeconomic and demographic factors, the study found that low acculturation and lack of familiarity with the U.S. health care system contribute to low activation among immigrant Hispanics.

The study was based on findings from HSC’s nationally representative 2007 Health Tracking Household Survey, which included patient activation information about 12, 396 adults aged 18 and older and had a 43 percent response rate. The survey was funded by RWJF.

“Historically, health policy makers have focused on improving the functioning of various components of the delivery system and on addressing gaps in coverage. Yet evidence is mounting that policy makers also need to focus on enabling and supporting consumers so they can be effective participants in the system…. Reform of the health care delivery system will need to include mechanisms for educating and supporting patients who are not as well prepared as others to become more engaged, activated partners in their care,” the article concludes.

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The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is affiliated with Mathematica Policy Research.


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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.