Assessing Patient Activation Among Individuals with Idiopathic Parkinson’s Disease in Iraq: A Cross-Sectional Study Using the PAM-13 Tool

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.