Assessing Degrees of Health Care Involvement Survey

Patient Activation Survey Domains—7/10/07 DRAFT

Domain		Item Numbers
Our 15-item MCBS PA instrument		1-15
Judy’s 13-item shortened PAM instrument		16
Porter Novelli’s 10-item segmentation instrument		17
VA SF-12 for health status and perceived health status		46-56
CAHPS chronic conditions, including diabetes		42-45
Basic demographics		57-64
Insurance and health care decision-making* (3)		39-41
Knowledge* (3)	Desired Outcome Behaviors Choosing a healthy diet Choosing a doctor you like Choosing a Medicare drug plan that meets your needs Desired Outcomes Positive effect on your health Positive effect on the quality of the health care you receive	30, 32, & 33
Expectancies* (6)		21-26—
Values* (4)		27-29
Self-Efficacy* (3)		18-20
Behavior* (5+)		34-38—

*For cognitive testing—24+ items