Stages of change and patient activation measure scores in the context of incentive-based health interventions

Purpose. To determine if two widely used behavioral change measures-Stages of Change (SoC) and Patient Activation Measure (PAM)-correlate with each other, are affected by financial incentives, or predict positive outcomes in the context of incentive-based health interventions. Design. Secondary analysis of two randomized controlled trials of incentives for weight loss and for improved diabetes self-monitoring. Setting. Philadelphia, Pennsylvania; Newark, New Jersey. Subjects. A total of 132 obese and 75 diabetic adults enrolled in one of two trials. Measures. SoC and PAM scores; weight loss and usage rate of diabetes self-monitoring equipment. Analysis. Multiple regression; Kruskal-Wallis test. Results. We found no association between baseline SoC and PAM scores in either study (p =.30 and p = .89). Regression models showed no association between baseline PAM score and SoC and subsequent outcomes for either study (weight loss study: PAM: p = .14, SoC: p = .1; diabetes study: PAM: p = .45, SoC: p = .61). Change in PAM score and SoC among participants in the intervention groups did not differ by study arm or among participants with better outcomes. Conclusion. PAM score and SoC may not effectively predict success or monitor progress among individuals enrolled in incentive-based interventions.