title: How do People with Different Levels of Activation Self-Manage their Chronic Conditions?
abstract: BACKGROUND
  : People with chronic conditions are better able to self-manage if they are more engaged, informed, and confident. Healthcare providers are increasingly offering support for self-management, and there is interest in improving the efficacy of these efforts by tailoring them to a person's knowledge, skill, and confidence to self-manage - so-called 'activation'.
  
  
  OBJECTIVE
  : To explore how people with chronic conditions at different levels of 'activation' (as measured by the Patient Activation Measure) understand successful self-management, what barriers to self-management they face, and what strategies they employ to manage their condition and to cope with stress.
  
  
  METHODS
  : Face-to-face semi-structured interviews were conducted with a stratified convenience sample of respondents with at least one chronic condition (n = 27) who were non-faculty staff at the University of Oregon (Eugene, OR, USA). Stratification was performed using the level of patient activation. Interviews took place in February and March 2006 in a private office on the university campus.
  
  
  RESULTS
  : Those people lower in activation tended to see successful self-management as compliance whereas those at higher activation levels saw it as being in control. People with lower activation levels indicated that lack of knowledge and lack of confidence were barriers for them. Both the high and low activated could be derailed by stress. People with lower activation levels talked about a more limited number of strategies for coping but both the high and low activated had learned strategies from professionals and by trial and error.
  
  
  CONCLUSIONS
  : Some aspects of self-management support may need to be tailored for people at different levels of activation to ensure that differences in their understanding, knowledge, and confidence are addressed. However, there are also likely to be some types of self-management support such as stress-coping strategies and problem-solving skills that are beneficial for all patients with chronic conditions regardless of activation level.
authors.affiliation: 1 The King's Fund, London, UK 2 Institute for Policy Research and Innovation, University of Oregon, Eugene, Oregon, USA 3 Decision Research, Eugene, Oregon, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Dixon
authors.forename: Judith
authors.initials: J
authors.lastname: Hibbard
authors.forename: Martin
authors.initials: M
authors.lastname: Tusler