Background characteristics (age, gender, race, education and diagnosis of schizophrenia) were unrelated to self-reported activation, illness self-management, medication attitudes or medication adherence. As shown in , self-reported patient activation was related to higher levels of illness self-management (r = .46, p < .01) and less substance abuse according to provider report (−.35, p < .01). However, activation was not significantly related to medication attitudes or provider ratings of medication adherence.
Correlations between background measures, self-report and prescriber report
The mean length of visit was 19.0 ± 6.0 minutes (ranging from 9.0 to 32.2). Length of visit was not significantly related to activation, illness self-management, medication attitudes, prescriber ratings, or coder ratings of activation. Coder ratings of active involvement based on the transcripts were not significantly related to self-reported activation, illness self-management, medication attitudes or medication adherence ().
Correlations between self and prescriber report and observer ratings of activation
Thematic analyses revealed four broad types of consumer activation: partnership building, seeking and displaying competence, directing treatment, and missed opportunities.
Partnership Building included praise opportunities, activity outside the visit, and self-disclosure. Praise opportunities occurred when consumers called attention to positive affect or efforts, often placing themselves in a positive light along the path to recovery, e.g., “And my math is getting better…I’m working on it every day.” Activity outside the session involved consumer reports at improving mental health (e.g., adhering to a medication regimen) or broader life improvement, e.g., “I’m going back through the job training program. I have a meeting on that today.” Self-disclosure involved revealing new information containing a moral or affective component, at times prompted by the provider (e.g., asking if a consumer was taking illicit drugs), and at other times unsolicited: “I have a lot of anger toward people, a lot….To be honest with you, it is very, very embarrassing.”
Seeking/Displaying Competence was evident when consumers asked questions, often related to medication dosage, side effects, and new or unusual symptoms. Consumers frequently displayed understanding of illness (e.g., when symptoms are better or worse) and treatment (e.g., knowing timing and dosage), or deeper understanding, e.g., recognizing consequences of behaviors such as substance abuse, exercise, and taking medication as prescribed. Another degree of competence emerged when consumers took responsibility for their behaviors: “I’m a responsible adult…I can’t be acting like a teenager.”
Directing Treatment varied from more passive strategies, such as voicing a concern, to expressing opinions about treatment, to specific requests of the provider. Expressions of concern included mental health symptoms, medication side effects, physical symptoms, and general life concerns e.g., job stresses, worries about obtaining a high school diploma, and saving for retirement. Consumers offered evaluations of how the treatment was working (or not) and sometimes discussed how they felt about the treatment, e.g., “I still don’t like the way it makes me so tired at night. Cause after I take ‘em I can’t go out…I slur my speech.” At the most active end of the spectrum were direct requests. A few consumers asked for a particular medication, a change in dosage or timing, or specifically that no changes be made. For one consumer, medication was interfering with her work “I… I think…is there any way you could start me out right now on a lower dose to get me adjusted because it pretty much leaves me comatose, really.”
Missed Opportunities, the final theme, referred to missed opportunities on the consumer’s part to become more involved in treatment. Usually this occurred when the consumer responded minimally to provider questions, only to bring up concerns later. In one case the provider was trying to engage the consumer in a conversation about goals, but the consumer responded “Uh…my goals…I don’t remember.” (To be fair, this provider had also forgotten: “Well, I can’t remember exactly what they were, but I bet you’re a lot closer to them now than what you were a year ago.”)