Final published version
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Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
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TY - JOUR
T1 - Fidelity or flexibility
T2 - An ethnographic study of the implementation and use of the Patient Activation Measure
AU - Chew, Sarah
AU - Brewster, Liz
AU - Tarrant, Carolyn
AU - Martin, Graham
AU - Armstrong , Natalie
PY - 2018/5
Y1 - 2018/5
N2 - ObjectiveEvaluating using the PAM in the English National Health service. The PAM is a validated scale that measures ‘activation’ (people’s knowledge, skills, and confidence in managing their health) and assigns patients to four categories of activation (low-to-high). Some evidence suggests that higher activation levels correlate to better clinical outcomes and patient experiences, and lower healthcare costs. Empirical studies of implementing the PAM are scarce.MethodsAn ethnographic study of six healthcare organisations’ PAM implementation focused on ‘core-teams’ who designed projects, and frontline staff and patients’ experiences of those. Data comprised 123 hours of observation, 112 interviews, and document reviewing. Analysis used a constant-comparative approach.ResultsThe PAM appealed as it fitted with different logics of measurement, offering a means of quantifying soft, process-oriented qualitative constructs used in tailoring care, whilst simultaneously producing reliable high-level outcome metrics.Data revealed challenges to these logics. The PAM’s developers emphasised fidelity to ensure reliability but, in practice, flexibility was commonplace and often perceived as appropriate and beneficial by frontline staff.ConclusionThe intended logic of measurement is important in determining an appropriate balance of fidelity and flexibility and, therefore, reliability and patient benefit.
AB - ObjectiveEvaluating using the PAM in the English National Health service. The PAM is a validated scale that measures ‘activation’ (people’s knowledge, skills, and confidence in managing their health) and assigns patients to four categories of activation (low-to-high). Some evidence suggests that higher activation levels correlate to better clinical outcomes and patient experiences, and lower healthcare costs. Empirical studies of implementing the PAM are scarce.MethodsAn ethnographic study of six healthcare organisations’ PAM implementation focused on ‘core-teams’ who designed projects, and frontline staff and patients’ experiences of those. Data comprised 123 hours of observation, 112 interviews, and document reviewing. Analysis used a constant-comparative approach.ResultsThe PAM appealed as it fitted with different logics of measurement, offering a means of quantifying soft, process-oriented qualitative constructs used in tailoring care, whilst simultaneously producing reliable high-level outcome metrics.Data revealed challenges to these logics. The PAM’s developers emphasised fidelity to ensure reliability but, in practice, flexibility was commonplace and often perceived as appropriate and beneficial by frontline staff.ConclusionThe intended logic of measurement is important in determining an appropriate balance of fidelity and flexibility and, therefore, reliability and patient benefit.
KW - Activation
KW - Person-centred care
KW - Measurement
U2 - 10.1016/j.pec.2017.12.012
DO - 10.1016/j.pec.2017.12.012
M3 - Journal article
VL - 101
SP - 932
EP - 937
JO - Patient Education and Counseling
JF - Patient Education and Counseling
SN - 0738-3991
IS - 5
ER -