Association of Behavioral Factors with Activation in Patients with Age-Related Macular Degeneration or Diabetic Retinopathy.

Introduction: Activation is the degree that individuals have the knowledge, skills, beliefs, and behaviors necessary for effective health-care self-management. Those with higher activation are more likely to engage in behaviors associated with improved care outcomes, including increased medication and appointment adherence. Identifying and addressing patients' activation levels and associated behaviors at the outset of care can help to develop interventions to improve patients' participation in their healthcare. Our objective was to study the association of psychosocial factors with activation to identify behavioral factors that could increase activation.

Methods: Individuals with bilateral AMD or DR (n = 1146) were identified from electronic medical records at a single academic medical center. Randomly selected potential participants (n = 682) were sent a letter inviting their participation. Consenting participants (AMD n = 161; DR n = 94) were administered the Patient Activation Measure (PAM), the National Eye Institute Visual Function Questionnaire-8 (NEI-VFQ), Multidimensional Health Locus of Control - form C (MHLC), Perceived Medical Condition Self-Management Scale (PMCSMS), Patient Health Questionnaire-9 (PHQ-9), a measure of health literacy and a sociodemographic health questionnaire by phone.

Results: In multivariable analysis of participants with AMD, for each unit increase in MHLC Internal score, mean PAM score increased by 0.50 (P = 0.001). In multivariable analysis of participants with DR, for each unit increase in MHLC Chance, mean PAM score decreased by 0.48 (P = 0.0391). Differences on MHLC Internal and Chance scores among and between those with dry or wet AMD and non-proliferative or proliferative DR were all significant (P < 0.001).

Discussion: In this cross-sectional cohort study of 255 participants with bilateral diabetic retinopathy or age-related macular degeneration, higher internal LOC and lower external LOC were associated with higher activation scores. Interventions that increase patient activation may increase internal LOC and reduce external LOC, improving patients' participation in their care, and improve health-care outcomes.