Predictors of Patient Activation Among Underserved Patients in a Nurse-managed Health Center: A Pilot Study

The concept of patient activation has gained traction as the term referring to patients who understand their role in the care process and have “the knowledge, skills and confidence” necessary to manage their illness over time (Hibbard & Mahoney, 2010). Improving health outcomes for vulnerable and underserved populations who bear a disproportionate burden of health disparities presents unique challenges for nurse practitioners who provide primary care in nurse-managed health centers. Evidence that activation improves patient self-management is prompting the search for theory-based self-management support interventions to activate patients for self-management, improve health outcomes, and sustain long-term gains. Yet, no previous studies investigated the relationship between Self-determination Theory (SDT; Deci & Ryan, 2000) and activation. The major purpose of this study, guided by the Triple Aim (Berwick, Nolan, & Whittington, 2008) and nested in the Chronic Care Model (Wagner et al., 2001), was to examine the degree to which two constructs– Autonomy Support and Autonomous Motivation– independently predicted Patient Activation, controlling for covariates. For this study, 130 nurse-managed health center patients completed an on-line 38-item survey onsite. The two independent measures were the 6-item Modified Health Care Climate Questionnaire (mHCCQ; Williams, McGregor, King, Nelson, & Glasgow, 2005; Cronbach’s alpha =0.89) and the 8-item adapted Treatment Self-Regulation Questionnaire (TSRQ; Williams, Freedman, & Deci, 1998; Cronbach’s alpha = 0.80). The Patient Activation Measure (PAM-13; Hibbard, Mahoney, Stock, & Tusler, 2005; Cronbach’s alpha = 0.89) was the dependent measure. Autonomy Support was the only significant predictor, explaining 19.1% of the variance in patient activation. Five of six autonomy support survey items regressed on activation were significant, illustrating autonomy supportive communication styles contributing to activation. These results suggest theory-based patient, provider, and system level interventions to enhance self-management in primary care and educational and professional development curricula. Future investigations should examine additional sources of autonomy support and different measurements of autonomous motivation to improve the predictive power of the model. Longitudinal analyses should be conducted to further understand the relationship between autonomy support and autonomous motivation with patient activation, based on the premise that patient activation will sustain behavior change.

Principal Effectiveness: Middle School Leaders' Perceptions Of Principal Practices To Improve Middle School Reading Achievement

ABSTRACT Title of Document: PRINCIPAL EFFECTIVENESS: MIDDLE SCHOOL LEADERS’ PERCEPTIONS OF PRINCIPAL PRACTICES TO IMPROVE MIDDLE SCHOOL READING ACHIEVEMENT Kathleen R. Brady, Doctor of Education, 2016 Directed By: Dr. John Norris, Department of Education The purpose of this exploratory and descriptive study was to examine school leaders’ perceptions of leadership practices that contribute to principal effectiveness in improving reading achievement in middle schools in a large public school district. The data was gathered through the use of a Web-based survey that was emailed to 97 school based leaders including 20 principals, 40 assistant principals, 17 reading department chairpersons, and 20 professional development lead teachers in middle schools with grade 6-8 and 7-8 configurations. Data were collected and analyzed in order to make inferences about principal practices at middle school. The findings of this study indicated few differences between middle school principals’, assistant principals’, reading department chairpersons’, and professional development lead teachers’ perceptions of principal leadership practices that are most important to and have the greatest impact on student reading achievement success. Furthermore, the findings indicated that participants’ three top ranked resources needed to increase the effectiveness of principals in order to improve reading achievement at middle schools include implementing a collaborative planning protocol to support literacy instruction, adding a reading coach to the middle school staff, and providing professional development activities focused on literacy instruction across the content areas. The results were used to make recommendations that may contribute to middle school principal effectiveness.