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Abstract: TH-PO260

The Relationship Between the Patient Activation Measure and Changes in Patient Self-Efficacy on In-Center Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Fotheringham, James, Sheffield Kidney Institute, Sheffield, South Yorkshire, United Kingdom
  • Hnynn Si, Pannn Ei, Sheffield Kidney Institute, Sheffield, South Yorkshire, United Kingdom
  • Laboi, Paul, York Hospital, York, United Kingdom
  • Henwood, Andy, York Hospital, York, United Kingdom
  • Lee, Sonia K., Sheffield Kidney Institute, Sheffield, South Yorkshire, United Kingdom
  • Ariss, Steven Mark brian, University of Sheffield, Sheffield, United Kingdom
  • Wilkie, Martin E., Sheffield Kidney Institute, Sheffield, South Yorkshire, United Kingdom

Group or Team Name


The patient activation measure (PAM) assesses the knowledge, skills and confidence to manage their health condition. Low PAM is associated with worse outcomes and increased healthcare cost, and is increasingly seen as an endpoint for complex interventions in chronic diseases. PAM includes many domains applicable to in-center (ICHD) and home (HHD) hemodialysis but its sensitivity to change in more objective measures of self-efficacy in ICHD and HHD patients is unknown.


A stepped wedge randomised trial involving 12 centers supported patients to learn and undertake ICHD-related tasks over 18 months. PAM and how many of 15 ICHD tasks patients were undertaking was measured on 4 occasions. The relationship between within-patient changes in PAM (scored 0-100%) and the endpoints of numbers of ICHD tasks and moving to HHD were assessed using mixed-effects linear regression models, adjusting for patient characteristics.


534 patients completed 1611 PAM questionnaires during the study. The proportion of patients doing 5+ tasks increased from 44.3% to 52.3% (P=0.01), with 10.3% performing HHD or ICHD independently by the end of the study. At baseline (left figure) performing 5+ tasks was associated with a 10.7% difference in PAM score (95% CI 6.8 – 14.6). During the study (right figure) moving from <5 to 5+ tasks was associated with a 4.3% change in PAM (95% CI 2.3 – 6.4%) and 4.8% (95% CI 0.4 – 9.2%) moving to independent ICHD or HHD.


This supported learning intervention was effective at increasing patient participation in ICHD-related tasks. Despite a strong baseline relationship between PAM and ICHD tasks, the longitudinal change in PAM with increased ICHD tasks, independent ICHD and HHD only just exceed the minimum clinically meaningful difference (4%). The relationship between PAM and self-efficacy is complex and greater understanding of their measurement is needed to avoid potential underestimation of benefits of complex interventions.