Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-15-2025

Graduate Advisor

Amanda Finley, PhD, RN

Committee

Elizabeth Segura, DNP, APRN, FNP-C

Victoria Famuyide, DO, MBA

Abstract

Abstract

Background

The introduction of a race-neutral equation to predict normal values on pulmonary function testing (PFT) has led to changes in the diagnosis of pulmonary diseases previously diagnosed using a race specific equation. Minority patients appear to be most likely impacted by this change, potentially impacting how they self-manage their pulmonary health. Patient self-management can be measured and assessed by using the Patient Activation Measure (PAM) tool.

Purpose

The purpose of this project is to assess patient activation levels amongst minority patients with a new or changed pulmonary diagnosis to identify a possible need for interventions to improve patient activation.

Methods

A prospective study was conducted at an adult pulmonary medicine clinic. An initial PAM survey was conducted for adult patients who identified as a minority in the electronic health record with a previous pulmonary function test who are scheduled for a race-neutral PFT. A second PAM survey was conducted for those patients who received a new or modified diagnosis after the race-neutral PFT. Demographic data including race, age, and biological sex was collected from the electronic health record. The pre- and post-PAM survey data was analyzed using a paired t-test and Wilcoxon signed-rank test.

Results

There were 630 patients scheduled for a PFT during the study period. Out of the 630 patients, 21 patients met initial criteria to receive the PAM survey, and eight patients received both the initial and secondary (pre and post) PAM survey. The sample included six patients who identified as black/African American, one who identified as Hispanic, and one who identified as Asian. The mean pre-PAM score was found to be 1.38 and the post PAM score was 2, showing a slight average improvement. Both the two-sided paired t-test and Wilcoxon signed rank test were not statistically significant.

Conclusion

Although limited by the small sample size, the study identified a low baseline PAM level of the participants which is consistent with existing literature. Identifying a low PAM level is clinically significant because it highlights a critical area for possible interventions to improve patient outcomes and self-management. Future studies are needed to improve statistical insights and generalizability of the findings.

Keywords: race-neutral pulmonary function testing, Patient Activation Measure (PAM), health equity, chronic lung disease

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