Patient factors associated with activation level in peripheral artery disease

Introduction: As a chronic and incurable condition, lower extremity peripheral artery disease (PAD) and its optimal self-management requires patient participation in treatment. Patient activation (knowledge, skills, and confidence to manage one’s health) is known to improve chronic disease outcomes. We aimed to identify factors associated with activation in patients with PAD. Methods: In this single-center study, participants with PAD completed a survey assessing demographics, activation, PAD knowledge, and functional health literacy (FHL). The primary outcome, activation, was measured by the Patient Activation Measure (PAM-13). The PAD knowledge score was the percentage of correct responses, and FHL was assessed using the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Bivariable analysis and logistic regression identified factors associated with activation. Results: Of the 91 participants (49.5% women, mean ± SD age: 68.6 ± 11.9 years, 29.7% Black), 72.6% were activated, 78.7% demonstrated adequate FHL, and the mean knowledge score ± SD was 79.1% ± 13.3%. White race ( p = 0.025), higher income ( p = 0.015), ability to ambulate ( p = 0.023), and increased knowledge score ( p = 0.002) were associated with activation in bivariable analyses. In a logistic regression model, younger age ( p = 0.029), higher income ( p = 0.016), and higher knowledge score ( p = 0.012) independently correlated with odds of greater activation. Conclusions: Many participants were activated, demonstrated adequate FHL, and scored well on the PAD knowledge test. The remaining 27.5% were inactivated, which was associated with poor PAD knowledge and certain demographic characteristics. Future studies should focus on developing and implementing patient-centric educational interventions for inactivated patients and strategies to increase activation.