{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T07:59:46Z","timestamp":1780646386605,"version":"3.54.1"},"reference-count":26,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess how key risk factors contribute to differences in low patient activation between dual\u2010eligible and Medicare\u2010only beneficiaries and to examine whether these contributions vary by disability status or age\u2014informing more equitable engagement strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Setting and Design<\/jats:title>\n                    <jats:p>This observational study used nationally representative data from the 2019\u20132022 Medicare Current Beneficiary Survey. Survey\u2010weighted descriptive statistics assessed variation in risk factors between dual\u2010eligible and Medicare\u2010only beneficiaries. Survey\u2010weighted logistic regression models with state, year, state, and regional fixed effects estimated associations between individual risk factors and low patient activation, defined as limited knowledge, skills, and confidence to manage one's health. Marginal effects were reported. The Fairlie decomposition method quantified the extent to which specific factors (e.g., spoken English proficiency, education, vision impairment) explained differences in low patient activation. Subgroup analyses examined whether these explanatory factors differed by age and disability status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>The analytic sample included 23,805 community\u2010dwelling, continuously enrolled Medicare beneficiaries, representing 39,591 unweighted beneficiary\u2010years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>Among 189,843,094 weighted beneficiary\u2010years, 14.4% were dual\u2010eligible and 85.6% were Medicare\u2010only. Low patient activation was more prevalent among dual\u2010eligible (42.5%) than Medicare\u2010only beneficiaries (32.1%). Among older beneficiaries, differences in activation were explained by limited English proficiency, poor perceived health, psychological distress, vision impairment, and difficulties with activities of daily living (ADL). Among disabled beneficiaries, differences were primarily driven by the presence of an intellectual disability and instrumental ADL (iADL) difficulties. Low educational attainment contributed to differences across both subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Different factors contribute to low patient activation among dual\u2010eligible versus Medicare\u2010only beneficiaries, with notable variation between older and disabled subgroups. These findings support the need for tailored engagement strategies and policy efforts focused on improving activation among high\u2010need Medicare populations. Targeted interventions may help reduce activation gaps, promote equity, and improve health outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70095","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T17:12:18Z","timestamp":1772989938000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mind the Activation Gap: Factors Associated With Low Patient Activation Among Dual\u2010Eligible Versus Medicare\u2010Only Beneficiaries"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2896-0665","authenticated-orcid":false,"given":"Amanda","family":"Davis","sequence":"first","affiliation":[{"name":"Department of Health Law, Policy, and Management Boston University School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7417-6322","authenticated-orcid":false,"given":"Kevin H.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Health Law, Policy, and Management Boston University School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenton J.","family":"Johnston","sequence":"additional","affiliation":[{"name":"Division of General Medicine &amp; Geriatrics Washington University School of Medicine in St. Louis  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Louis","sequence":"additional","affiliation":[{"name":"Department of Health Law, Policy, and Management Boston University School of Public Health  Boston Massachusetts 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