Assessing Patient Activation Among Individuals with Idiopathic Parkinson’s Disease in Iraq: A Cross-Sectional Study Using the PAM-13 Tool
DOI:
https://doi.org/10.54133/ajms.v9i2.2361Keywords:
Disease stage, Parkinson’s disease, Patient activation measure, Patient engagement, Sociodemographic factorsAbstract
Background: The Patient Activation Measure (PAM-13) is a validated tool that evaluates individuals' knowledge, confidence, and skills in managing their health. While patient activation is widely acknowledged as crucial for managing chronic diseases, research is limited regarding patients' activation among the Parkinson's disease (PD) population, particularly in middle- and low-income countries such as Iraq. Objective: To evaluate patients' activation levels and examine their association with sociodemographic variables and disease stage among Iraqi individuals with idiopathic PD. Methods: This cross-sectional study included 100 patients with idiopathic PD attending outpatient neurology clinics in two hospitals and two private neurology clinics in Baghdad. The PAM-13 and a demographic questionnaire were used to collect data. Statistical analysis, such as independent sample t-test, one-way ANOVA, Fisher's exact test, and classification and regression tree model, was performed to identify key predictors of activation. Results: The mean PAM-13 scores were 47.2, indicating generally low-to-moderate activation. Over half of the participants (52%) fell into the lowest activation category (Level 1). Advanced age, reduced educational attainment, and advanced disease stage were significantly associated with decreased activation. Classification and regression tree analysis listed age as the principal predictor, while education and illness stage functioned as secondary determinants. Conclusions: This study demonstrated suboptimal activation levels among Iraqi individuals with idiopathic Parkinson's disease. Findings highlight the need for customized interventions to improve patient involvement and self-management, particularly among elderly patients with limited education and advanced disease stages.
Downloads
References
Ray Dorsey E, Elbaz A, Nichols E, Abd-Allah F, Abdelalim A, Adsuar JC, et al. Global, regional, and national burden of Parkinson’s disease, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17(11):939–953. doi: 10.1016/S1474-4422(18)30295-3. DOI: https://doi.org/10.1016/S1474-4422(18)30295-3
Dorsey ER, Bloem BR. The Parkinson pandemic – a call to action. JAMA Neurol. 2018;75(1):9–10. doi: 10.1001/jamaneurol.2017.3299. DOI: https://doi.org/10.1001/jamaneurol.2017.3299
Dorsey ER, Sherer T, Okun MS, Bloem BR. The emerging evidence of the Parkinson pandemic. J Parkinsons Dis. 2018;8(s1):S3–8. doi: 10.3233/JPD-181474. DOI: https://doi.org/10.3233/JPD-181474
U.S. Food and Drug Administration. The voice of the patient – Parkinson’s disease [Internet]. Silver Spring (MD): FDA; 2013 [cited 2025 May 1]. Available from: http://www.fda.gov/ForIndustry/UserFees/PrescriptionDrugUserFee/ucm326192.htm
Patients activation in people with Parkinson disease and its relation to personal factors – MDS Abstracts [Internet]. 2023 [cited 2025 May 1]. Available from: https://www.mdsabstracts.org/abstract/patients-activation-in-people-with-parkinson-disease-and-its-relation-to-personal-factors/
Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the patient activation measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39(4 Pt 1):1005–1026. doi: 0.1111/j.1475-6773.2004.00269.x. DOI: https://doi.org/10.1111/j.1475-6773.2004.00269.x
Shively MJ, Gardetto NJ, Kodiath MF, Kelly A, Smith TL, Stepnowsky C, et al. Effect of patient activation on self-management in patients with heart failure. J Cardiovasc Nurs. 2013;28(1):20–34. doi: 10.1097/JCN.0b013e318239f9f9. DOI: https://doi.org/10.1097/JCN.0b013e318239f9f9
Young HN, Larson TL, Cox ED, Moreno MA, Thorpe JM, MacKinnon NJ. The active patient role and asthma outcomes in an underserved rural community. J Rural Health. 2014;30(2):121–127. doi: 10.1111/jrh.12031. DOI: https://doi.org/10.1111/jrh.12031
Hendriks M, Rademakers J. Relationships between patient activation, disease-specific knowledge and health outcomes among people with diabetes: a survey study. BMC Health Serv Res. 2014;14:393. doi: doi: 10.1186/1472-6963-14-393. DOI: https://doi.org/10.1186/1472-6963-14-393
Packer TL, Kephart G, Ghahari S, Audulv Å, Versnel J, Warner G. The Patient Activation Measure: a validation study in a neurological population. Qual Life Res. 2015;24(7):1587–1596. doi: 10.1007/s11136-014-0908-0. DOI: https://doi.org/10.1007/s11136-014-0908-0
Degirmenci Y, Angelopoulou E, Georgakopoulou VE, Bougea A. Cognitive impairment in Parkinson’s disease: an updated overview focusing on emerging pharmaceutical treatment approaches. Medicina (Kaunas). 2023;59(10):1756. doi: 10.3390/medicina59101756. DOI: https://doi.org/10.3390/medicina59101756
Miladinovic A, Ajçevic M, Busan P, Jarmolowska J, Deodato M, Mezzarobba S, et al. EEG changes and motor deficits in Parkinson’s disease patients: correlation of motor scales and EEG power bands. Procedia Comput Sci. 2021;192:2616–2623. doi: doi: 10.48550/arXiv.2106.02387. DOI: https://doi.org/10.1016/j.procs.2021.09.031
American Parkinson Disease Association. Cognitive fluctuations in Parkinson’s disease [Internet]. [cited 2025 May 18]. Available from: https://www.apdaparkinson.org/article/cognitive-fluctuations/?utm_source=chatgpt.com.
Roesel I, Froehlich D, Joos,S, Valentini J, Mauch H, Martus P. The Patient Activation Measure-13 (PAM-13) in an oncology patient population: psychometric properties and dimensionality evaluation. Health Qual Life Outcomes. 2024;22:39. doi: 10.1186/s12955-024-02255-w. DOI: https://doi.org/10.1186/s12955-024-02255-w
Erdfelder E, Faul F, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149–60. doi: 10.3758/BRM.41.4.1149. DOI: https://doi.org/10.3758/BRM.41.4.1149
Hoehn MM, Yahr MD. Parkinsonism: onset, progression, and mortality. Neurology. 1967;17(5):427–442. doi: 10.1212/wnl.17.5.427. DOI: https://doi.org/10.1212/WNL.17.5.427
Collier TJ, Kanaan NM, Kordower JH. Aging and Parkinson’s disease: different sides of the same coin? Mov Disord. 2017;32(7):983–990. doi: 10.1002/mds.27037. DOI: https://doi.org/10.1002/mds.27037
Raket LL, Oudin Åström D, Norlin JM, Kellerborg K, Martinez-Martin P, Odin P. Impact of age at onset on symptom profiles, treatment characteristics and health-related quality of life in Parkinson’s disease. Sci Rep. 2022;12:222. doi: 10.1038/s41598-021-04356-8. DOI: https://doi.org/10.1038/s41598-021-04356-8
Yao F, Zheng M, Wang X, Ji S, Li S, Xu G, et al. Patient activation level and its associated factors in adults with chronic pain: a cross-sectional survey. Medicine (Baltimore). 2021;100(19):e25929. doi: 10.1097/MD.0000000000025929. DOI: https://doi.org/10.1097/MD.0000000000025929
Lin HY, Lin YT, Chiou CP, Pan HH. The impact of fatigue severity and depression level on the quality of life in individuals with Parkinson’s disease in Taiwan. Front Psychiatry. 2024;15:1309989. doi: 10.3389/fpsyt.2024.1309989. DOI: https://doi.org/10.3389/fpsyt.2024.1309989
Muslim AT. Non-motor symptoms in patients with Parkinson’s disease in Baghdad hospitals. Al-Kindy Coll Med J. 2017;13(1):122–127. doi: 10.47723/kcmj.v13i1.141. DOI: https://doi.org/10.47723/kcmj.v13i1.141
McCabe PJ, Stuart-Mullen LG, McLeod CJ, Byrne TO, Schmidt MM, Branda ME, et al. Patient activation for self-management is associated with health status in patients with atrial fibrillation. Patient Prefer Adherence. 2018;12:1907–1916. doi: 10.2147/PPA.S172970. DOI: https://doi.org/10.2147/PPA.S172970
Magnezi R, Glasser S, Shalev H, Sheiber A, Reuveni H. Patient activation, depression and quality of life. Patient Educ Couns. 2014;94(3):432–437. doi: 10.1016/j.pec.2013.10.015. DOI: https://doi.org/10.1016/j.pec.2013.10.015
Haaxma CA, Bloem BR, Borm GF, Oyen WJG, Leenders KL, Eshuis S, et al. Gender differences in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2007;78(8):819–824. doi: 10.1136/jnnp.2006.103788. DOI: https://doi.org/10.1136/jnnp.2006.103788
Cerri S, Mus L, Blandini F. Parkinson’s disease in women and men: what’s the difference? J Parkinsons Dis. 2019;9(3):501–515. doi: 10.3233/JPD-191683. DOI: https://doi.org/10.3233/JPD-191683
Yates BC, Bensley LS, Lalonde B, Lewis FM, Woods NF. The impact of marital status and quality on family functioning in maternal chronic illness. Health Care Women Int. 1995;16(5):437–449. doi: 10.1080/07399339509516297. DOI: https://doi.org/10.1080/07399339509516197
Schultz WM, Hayek SS, Tahhan AS, Ko YA, Sandesara P, Awad M, et al. Marital status and outcomes in patients with cardiovascular disease. J Am Heart Assoc. 2017;6(12):e005890. doi: 10.1161/JAHA.117.005890. DOI: https://doi.org/10.1161/JAHA.117.005890
Nassrullah ZM, Al-Jumaili AA. Professional challenges facing pharmacists working at public hospitals in an Iraqi province: a qualitative study. Iraqi J Pharm Sci. 2023;32(Suppl.):204–213. doi: 10.31351/vol32issSuppl.pp204-213. DOI: https://doi.org/10.31351/vol32issSuppl.pp204-213
Al-Jumaili AA, Younus MM, Kannan YJA, Nooruldeen ZE, Al-Nuseirat A. Pharmaceutical regulations in Iraq: from medicine approval to postmarketing. East Mediterr Health J. 2021;27(10):1007–1015. doi: 10.26719/emhj.21.025. DOI: https://doi.org/10.26719/emhj.21.025
Mohammed SI, Dawood EB, Abaas IS. Perceptions and attitudes of community pharmacists towards patient counseling and continuing pharmacy education programs in Iraq. Iraqi J Pharm Sci. 2019;28(2):30–6. doi: 10.31351/vol28iss2pp30-36. DOI: https://doi.org/10.31351/vol28iss2pp30-36
Munaf ZA, Mohammed SI, Ali GA, Al-Gawwam S. Impact of clinical pharmacist-led interventions on short term quality of life among multiple sclerosis patients taking disease-modifying therapy. Iraqi J Pharm Sci. 2025;34(1):256–265. doi: doi: 10.31351/vol34iss1pp256-265. DOI: https://doi.org/10.31351/vol34iss1pp256-265
Alkashaf KH, Mohammed SI. Impact of clinical pharmacist-led interventions on short term quality of life among breast cancer women taking chemotherapy. Iraqi J Pharm Sci. 2024;33(4):16673. doi: doi: 10.31351/vol33iss4pp166-173. DOI: https://doi.org/10.31351/vol33iss4pp166-173
Khazal AA, Jamal MY. Pharmacist intervention to address drug related problems in patients with decompensated liver cirrhosis. Al-Kindy Coll Med J. 2023;19(1):121–126. doi: 10.47723/kcmj.v19i1.888. DOI: https://doi.org/10.47723/kcmj.v19i1.888

Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 )

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Published by Al-Rafidain University College. This is an open access journal issued under the CC BY-NC-SA 4.0 license (https://creativecommons.org/licenses/by-nc-sa/4.0/).