Can modifiable behavioral factors be identified to increase activation in patients with glaucoma?

Abstract

Purpose : Targeting inventions to increase activation may improve adherence with treatment protocols and outcomes. Activation reflects patients’ willingness and ability to manage their own care, while adherence is the extent to which patient behaviors correspond with their physician’s recommendations. Patients with lower activation are less likely to understand their glaucoma diagnosis, more likely to delay medical care and be less adherent with medications and care protocols.

Methods : Design: Prospective cross-sectional cohort study
Methods:Patients with mild, moderate, or advanced bilateral glaucoma seen in an urban glaucoma service with visits between 4/1/2020 to 3/31/2022 were identified from electronic health records (n=1164). IRB-approved information/solicitation letters were mailed to 591 randomly selected potential study participants. After the mailing, potential study participants who did not opt out were called, verbal informed consent obtained and they were enrolled as study participants. The following instruments were administered by phone:
Sociodemographic questionnaire
Health literacy screen
Patient Activation Measure (PAM)
National Eye Institute Vision Function Questionnaire-8
Multidimensional Health Locus of Control Form C (MHLC) scales to assess the influence of Doctors, Internal, Chance, or Others on locus of control.
Perceived Medical Condition Self-Management Scale-short form
Patient Health Questionnaire-9

Results : A total of 202 participants with bilateral glaucoma were enrolled; 81 had mild glaucoma, 75 moderate glaucoma, and 46 advanced glaucoma. Mean age was 74, 61% were female. 75% were White, 14% Black, 11% all other. 91% had at least some college. There were no significant differences in sociodemographic characteristics among study participants based on level of glaucoma. On multivariate analysis adjusting for age, sex and race, with PAM score as the dependent variable, MHLC scales for Internal and Doctors were significant (p<.001); MHLC Chance was significant (p<.009) and the PHQ-9 was significant (p=.03). A total of 17 (8%) of study participants reported needing help to take their medications, while 43 (21%) reported needing help to read healthcare materials.

Conclusions : This study provides evidence that behavioral factors contributing to activation in patients with glaucoma can be identified. Applying these findings in practice may improve treatment outcomes

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.