Patient Activation Measure

Take as much time as you need to answer these questions. There are no right or wrong answers, only what you feel is most true/accurate for you today.

Patient Activation Measure

Patient Activation Measure

Please use format: DD/MM/YYYY
Below are some statements that people sometimes make when they talk about their health. Please indicate how much you agree or disagree with each statement as it applies to you personally by circling your answer. If the statement does not apply to you, circle N/A.
I am the person who is responsible for taking care of my health. *
Taking an active role in my own healthcare is the most important thing that affects my health. *
I know what each of my prescribed medications do. *
I am confident that I can tell whether I need to go to the doctor or whether I can take care of a health problem myself. *
I am confident that I can tell a doctor or nurse concerns I have even when he or she does not ask. *
I am confident that I can carry out medical treatments I may need to do at home. *
I have been able to maintain lifestyle changes, like healthy eating or exercising. *
I know how to prevent problems with my health. *
I am confident I can work out solutions when new problems arise with my health. *
I am confident that I can maintain lifestyle changes, like healthy eating and exercising, even during times of stress. *