Association of Psychosocial Factors with Activation Among Patients with Glaucoma

Abstract

To investigate the association of psychosocial factors with health self-management behaviors and beliefs among patients with POAG. Prospective cross-sectional cohort study. Patients (n=202) with mild, moderate, or advanced bilateral POAG. Patients (n=1,164) were identified from electronic medical records at a single academic medical center. Letters soliciting participation were mailed to 591 randomly selected potential participants. Psychometric measures and a determinants of health questionnaire were administered by phone to 202 study participants. The NEI VFQ-8 (NEI-VFQ), the Multidimensional Health Locus of Control (MHLC), the Perceived Medical Condition Self-Management Scale-4 (PMCSMS), the Patient Health Questionnaire-9 (PHQ), the Patient Activation Measure-13 (PAM), health literacy and a determinants of health questionnaire. For each increase in level of POAG severity, there was a decrease in mean NEI-VFQ score (p<0.001). For each unit increase in NEI-VFQ item 1, self-rated vision, mean PAM score increased (R2=5.3%, p=0.001; 95% CI= [0.077, 0.276]). For each unit increase in 'Internal 'on the MHLC, mean PAM score increased (R2=19.3%, 95% CI= [.649, 1.166], p<0.001). For each unit increase in 'Doctors' on the MHLC, mean PAM score increased (R2=11.0%, 95% CI= [1.555, 3.606], p<0.001). For each unit increase in 'Chance' on the MHLC, mean PAM score decreased (R2=2.6%, 95% CI= [-0.664,-0.051], p=0.023). On multivariate analysis adjusting for age, sex and race, for each unit increase in PHQ, mean PAM score decreased (95% CI = [0.061,1.35], p=0.032); for each unit increase in MHLC 'Doctors', mean PAM score increased (95% CI=[-1.448,3.453], p<0.001); for each unit increase in MHLC 'Internal', mean PAM score increased (95% CI=[0.639,1.137 ], p<0.001); for each unit increase in MHLC 'Chance' , mean PAM score decreased (95% CI=[-0.685,-0.098], p=0.009). We identified modifiable behavioral factors that could increase patients' self-perceived ability and confidence to manage their own eye care. Locus of control (MHLC), level of depression (PHQ), and self-rated functional vision (NEI-VFQ) were each associated with patient behaviors, attitudes and beliefs needed for health self-management (activation, assessed by the PAM) and may be important determinants of adherence behaviors. Targeting change in patients' care beliefs and behaviors may improve activation and treatment outcomes.