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Beyond Demographics: Differences in Patient Activation Across New Immigrant, Diverse Language Subgroups

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Abstract

The federal government promotes “patient-centered medical homes” to plan care with respect to patients’ cultures and values and support patients’ self-care efforts. To promote self-care, the medical home would be best utilized by activated, engaged patients. The objective of this study was to measure and compare patient activation scores in English-, Spanish-, and Haitian Creole-speaking patients seen at an inner-city hospital ambulatory care practice. Patient activation was measured using the patient activation measure (PAM). Mean PAM scores and activation levels differed according to survey language (p < 0.001). US-born participants had higher mean PAM scores than persons born outside of the US. Participants living in the US longer had higher mean PAM scores than participants newer to the US. Levels of activation and mean PAM scores increased with greater comfort reading, speaking, and thinking in English. The mean PAM (SD) score of 61.5 (16.5) for Haitian Creole-speaking Caribbean Blacks was significantly lower than the mean PAM score of 68.8 (15.6) for English-speaking Caribbean Blacks (p value = 0.006). Although mean PAM scores did not significantly differ between Haitian Creole and Spanish speakers, PAM stages differed according to language of survey completion (p < 0.001), with a greater percentage of Haitian Creole speakers being categorized as stage 1 (least activated) as well as stage 4 (most activated). Spanish and Haitian Creole speakers have lower mean PAM scores than English speakers. Mean PAM scores did not differ between Hispanics and non-Hispanics or according to race, illustrating the need to examine the role of language and culture on patient activation.

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Acknowledgments

We acknowledge the vital contributions of our study coordinators, Alexa Berk and Julie Ruckel Kumar, our interviewers, Robert Reynoso, Mauricio Toussaint, Carlos Vaca, and Valerie Zamor, and our Queens Hospital Center collaborator, Linda Bulone. This research was supported by a grant from the National Cancer Institute #U54CA137788 City College of New York/Memorial Sloan-Kettering Cancer Center Partnership.

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Authors and Affiliations

  1. Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education, The City College of New York, 160 Convent Avenue, H404B, New York, NY, 10031, USA

    Erica I. Lubetkin

  2. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10021, USA

    Emily C. Zabor

  3. Department of Ambulatory Care, Queens Hospital Center, Jamaica, NY, 11432, USA

    Debra Brennessel

  4. Queens Cancer Center, Queens Hospital Center, Jamaica, NY, USA

    M. Margaret Kemeny

  5. Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, 10022, USA

    Jennifer L. Hay

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  1. Erica I. Lubetkin
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Correspondence to Erica I. Lubetkin.

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Lubetkin, E.I., Zabor, E.C., Brennessel, D. et al. Beyond Demographics: Differences in Patient Activation Across New Immigrant, Diverse Language Subgroups. J Community Health 39, 40–49 (2014). https://doi.org/10.1007/s10900-013-9738-1

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