Understanding patient-provider relational contributors to patient activation

Objective: Patient activation, which has been associated with improved health outcomes, has been conceptualized as an individual attribute describing a patient's ability to self-manage his or her own health care. The contribution of patient-provider relational factors such as therapeutic alliance to patient activation remains underexplored, particularly in the community mental health setting and through longitudinal studies. Our purpose is to estimate the association between therapeutic alliance and patient activation as assessed by the Patient Activation Measure (PAM) over time. Design: Participants were from the control group (n=264) of the DECIDE intervention. We evaluated unadjusted and adjusted PAM scores at baseline and follow up, considering the contribution of therapeutic alliance. We controlled for sociodemographic variables and clinical characteristics such as diagnosis and length in treatment. Participants: Patients were recruited from 13 community-based mental health clinics across the United States. Results: Participants were 69% women, 65% Latino, and 56% non-US born. Unadjusted PAM scores generally were higher at follow-up. Therapeutic alliance emerged as a significant and independent predictor of greater PAM scores at baseline and at follow-up, even after adjustment. Implications: Despite being generally conceptualized as an individual trait, patient activation partially depends on the interaction between patient and provider. Interventions to increase patient activation should consider how improving patient-provider interactions such as coming to collaborative agreement on the tasks/goals of care may contribute to patients' ability to manage their own mental health and mental health care.