Activation

An 'activated' person is aware of their own health and wellbeing, and has the motivation and capability to take action to maintain their condition or improve it. 

However, some people are more activated than others - different people have varying levels of engagement and proactive participation in managing their own health.

Some individuals actively take charge of their treatment and health decisions, while others are less involved and may rely more heavily on their healthcare providers. 

By understanding a person’s activation level, we can better support them in managing their condition(s), which in turn will lead to a wide range of benefits including:

• improved health outcomes
• reduced use of emergency care 
• better adherence to treatment plans
• potentially lower healthcare costs, as more activated people are more likely to engage in healthy behaviours and effectively self-manage chronic conditions
• a more collaborative and empowered person-provider relationship

Watch Dr Ollie Hart talk about 'Activation' - what it is and how to measure it.

One size doesn’t fit all!

Working in health or care is a fantastic place to be able to help people. It’s often the reason why colleagues come into the profession.

It feels good to be able to work with someone towards something they need, but it can also be frustrating when we can’t do that.

Likewise, it can be frustrating for us all when we are put through a certain list or process that we don’t feel is fitting.

“Why am I doing this?!”

The activation measure approach helps us to understand where a person is at and how we can best work together. It helps us to think about knowledge, support and readiness in order to manage healthcare conditions.

It can provide a framework for how interventions are tailored and can help to build up to achieving, or maintaining, a higher activation level.

This can lead to greater job satisfaction; often seeing people take more of a lead for themselves and being less reliable on certain services.

Evidence states that supporting people to be more activated in their own healthcare can have the following benefits:

• 18% fewer GP visits.
• 38% fewer emergency admissions.
• 32% fewer A&E attendances.

But how do we decide how activated a person is?

There are a range of tools available to help do this. (Yes, that’s right, we are tailoring how we tailor!) Have a read through the information below and see where you think your knowledge, support and readiness are.

You can then try some of the tools to help you have an activation conversation. Please get in touch and let us know how you get on!

You can even measure it!

There are Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) codes and templates set up on most clinical systems that allow us to input and then review a person's activation level. That means that we can see progress over time and provide more insight during future periods of care.

What does more activated look and feel like? Does low activation explain anything?

Throughout this work, we have tried to understand what levels of knowledge, support and readiness people have to improve their activation level. We have met people that have lots of knowledge but little support and others who are ready but don’t know where to begin. We’ve also talked to the workforce and heard things like this:

“I’m trying to get them on a PIFU but they’re not listening.”

• Example of agenda driven conversation. Perhaps this person knows what they want and it’s not what is being offered? Perhaps this person is totally overwhelmed by the language you are using?

“How do I end this conversation?”

• Example of someone needing to move on. They’re stuck and don't want to continue. They have other things to be doing, distractions.

“They’ve booked an appointment, but they’ve not attended.”

• Did this person have the knowledge of why they had the appointment? Was it booked with them or for them? Did they get offered it or told they’re having it? There are many reasons why people don’t turn up. Sometimes they are overwhelmed by the experience.

So, how can you tell when someone has high activation?

A conversation tells you a lot about a person but sometimes you learn a lot by observing. Think about the last conversation you had with someone. What did their eye contact and body language tell you?

Common signs of high activation:

• How much time did they talk versus you?
• Did they come prepared with questions for you?
• Was their medication list there, ready to discuss with you?
• Was it obvious that they already had some information about the appointment?

Common signs of low activation:

• Only answer with a yes or no
• Forget or don’t know why they are there
• Slouch and/or avoid eye contact
• Huff / sigh when they sit down to talk to you
• Are agitated or fidgeting

People often bring a chaperone to an appointment. For some, this is a sign that they need help and support with the topic you are about to discuss. People with high activation might want to use this person as a second pair of ears so they don’t miss anything whereas people with lower activation might find it overwhelming to hear what you have to say.

Top tip: instead of always being physically opposite someone when you have a consultation, try walking side by side and see if they behave differently. You could do this to/from the waiting room.

Activation level support tools

There are many different ways to work out how activated a person is. Here are three tools that we have been using in Lincolnshire to support us to tailor our approaches. 

So what?

Perhaps you have other ways of understanding how activated a person is? Whatever method you use, tailoring your healthcare approach will help to make it more meaningful for everyone. You can even measure it using snomed codes so can show progress as people increase levels.

Time is so precious to us in a stretched service. Try to think differently about how you use it. Would some people benefit from shorter, regular appointments whereas others prefer longer more sporadic ones?

Health Coaches (and other roles) are a great resource to support people to build activation and can often get people more ready to work with specialists. Might a different intervention help get people ready to work with you?

Likewise, is there any benefit in reducing printed information for people with low activation or increasing it for those with higher activation?

After all, we know that one size doesn’t fit all!

In the above video, you can see how Amanda tailored her approaches using the Flourish approach and the benefits that gave to Hans. 

Tailoring tools can improve a person’s ability to self-manage. They should be used hand in hand with approaches which include:

• health coaching – helping people gain and use the knowledge, skills and confidence to become active participants in their care so that they can reach their self-identified health and wellbeing goals
• self-management education – any form of formal education or training for people with long-term conditions focused on helping them to develop the knowledge, skills and confidence they need to manage their own health care effectively
• peer support – a range of approaches through which people with similar long-term conditions or health experiences support each other to better understand the conditions and aid recovery or self-manage

Please get in touch if you wish to discuss this further.