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Roesel I, Froehlich D, Joos S, Valentini J, Mauch H, Martus P. The Patient Activation Measure-13 (PAM-13) in an oncology patient population: psychometric properties and dimensionality evaluation. Health Qual Life Outcomes 2024; 22:39. [PMID: 38764032 PMCID: PMC11103863 DOI: 10.1186/s12955-024-02255-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/27/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Accurate assessment and enhancement of health-related skills among oncology patients are pivotal for optimizing cancer care. The Patient Activation Measure (PAM-13), a questionnaire designed to reflect an individual's knowledge, skills, and confidence in self-healthcare management, has been validated across diverse countries and settings. Concerns have been raised regarding the cross-situational applicability, as patients with specific diseases and cultural backgrounds interpret questionnaire items differently. This study aimed to examine the structural validity and psychometric properties of the PAM-13 in an oncological patient cohort. METHODS Baseline data from a longitudinal non-randomized controlled study involving cancer out-patients (n = 1,125) from Comprehensive Cancer Centres in Southern Germany were analysed. The German version of the PAM-13 was employed. With classical test and item response theory methods data quality, reliability, convergent and structural validity, as well as psychometric properties were assessed. Exploratory (EFA) and confirmatory factor analyses (CFA) were employed to investigate the postulated unidimensionality of the underlying construct. With a partial credit model (PCM) we examined item fit, targeting, local independence and differential item functioning. RESULTS Participants were predominantly female (73.0%) with a breast cancer diagnosis (41.3%). While items were generally well-accepted, ceiling effects were observed and a high mean PAM-13 score (69.7, SD = 14.2) was noted, potentially compromising responsiveness to interventions. Reliability was adequate (Cronbach's α = 0.81), person and item separation reliability were good to excellent (0.81 and 0.99, respectively). Explorations of the unidimensionality of the construct (EFA, CFA, PCM) yielded inconclusive results, hinting towards a two-factor solution. Item difficulty rankings deviated from the original. No differential item functioning was identified, and local independence was confirmed. CONCLUSIONS While the PAM-13 serves as a valuable instrument for comprehending and promoting health-related skills in cancer patients, the identification of ceiling effects, disordered item-difficulty rankings, and inconclusive findings regarding unidimensionality contribute to the expanding body of evidence, emphasizing the dependency of PAM-13's validity and reliability on distinctive characteristics within the population under investigation. Future research should prioritize refining or adding PAM-13 items to better capture the specific health-related challenges within diverse populations, paving the way for more effective patient engagement strategies in oncology. TRIAL REGISTRATION NUMBER DRKS00021779.
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Affiliation(s)
- Inka Roesel
- Institute for General Practice and Interprofessional Care, Faculty of Medicine Tuebingen, University Hospital, Tuebingen, Germany.
- Institute for Clinical Epidemiology and Applied Biostatistics, University Hospital of Tuebingen, Tuebingen, Germany.
| | - Daniela Froehlich
- Institute for General Practice and Interprofessional Care, Faculty of Medicine Tuebingen, University Hospital, Tuebingen, Germany
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Care, Faculty of Medicine Tuebingen, University Hospital, Tuebingen, Germany
| | - Jan Valentini
- Institute for General Practice and Interprofessional Care, Faculty of Medicine Tuebingen, University Hospital, Tuebingen, Germany
| | - Holger Mauch
- Institute for General Practice and Interprofessional Care, Faculty of Medicine Tuebingen, University Hospital, Tuebingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biostatistics, University Hospital of Tuebingen, Tuebingen, Germany
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Holter M, Avian A, Weger M, Strini S, Michelitsch M, Brenk-Franz K, Wedrich A, Berghold A. Measuring patient activation: the utility of the Patient Activation Measure administered in an interview setting. Qual Life Res 2024; 33:1389-1400. [PMID: 38388807 PMCID: PMC11045573 DOI: 10.1007/s11136-024-03614-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Patient activation is an emerging field in healthcare research concerning knowledge, skills, and confidence of patients in managing their health. This is particularly important for patients with chronic diseases, who often require more complex care management and self-care skills. However, due to temporary or longer-lasting visual impairments, certain patient groups cannot answer a questionnaire independently. The main objective is to investigate the psychometric properties of the German Patient Activation Measure® (PAM) survey in an everyday clinical setting where it has to be read aloud. METHODS Outpatients with macular edema participated in this questionnaire-based cross-sectional study. The study assessed patient activation by the PAM® survey, self-rated health, self-efficacy, quality of life, and general mood. Interviewers read questionnaires aloud to patients. Psychometric properties of the PAM® survey were investigated by item response theory (IRT), Cronbach's α and trait-trait correlations. RESULTS The analysis included N = 554 patients. Median age was 69 (IQR 62.0-76.0) years and mean overall activation score 74.1 (SD 13.7). All items showed ceiling effects. Empirical reliability from the IRT model and Cronbach's α were 0.75. The PAM® survey showed a Spearman correlation of 0.54 with self-efficacy, 0.51 with quality of life and 0.34 with general mood. CONCLUSION The read-aloud PAM® survey has been shown to provide to adequate measurement precision and convergent validity to be used as a screening tool in an everyday clinical setting. Objective assessment in an interview setting with the PAM® survey is possible. PAM® items are good in distinguishing lower to middle activated patients, but not patients with high activation. Further, issues with structural validity need more investigation.
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Affiliation(s)
- Magdalena Holter
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.
| | - Martin Weger
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Sanja Strini
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Monja Michelitsch
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Katja Brenk-Franz
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
| | - Andreas Wedrich
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
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Chaudhry T, Ormandy P, Vasilica C. Using FLO text-messages to enhance health behaviours and self-management of long-term conditions in South-Asian patients. Digit Health 2024; 10:20552076241242558. [PMID: 38708186 PMCID: PMC11067678 DOI: 10.1177/20552076241242558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 03/12/2024] [Indexed: 05/07/2024] Open
Abstract
Objectives Cultural and communication differences faced by South-Asian (SA) ethnic minority groups have led to challenges in the delivery of health care and complex management of long-term conditions (LTCs). We aim to explore the use of text-messaging in SA communities, through the Florence (FLO) health messaging system utilised within U.K. health sectors, to enhance positive health behaviours and self-management. Methods A mixed-methods approach was used for this study involving two phases. Phase 1 includes the administration of the patient activation measure to assess SA patient level of skills, knowledge, and confidence to self-manage their LTC; whilst in Phase 2 semi-structured interviews were conducted, exploring the experiences of users and non-users of FLO text messaging to promote self-management behaviours. Findings Forty participants (Florence users (n = 20) and non-users (n = 20)) completed the patient activation survey once after using FLO, and took part in interviews. Differences were noted to exist between the two groups (p < .01). Users appeared to have higher activation levels and better self-management behaviours (p < .01 (p = .00). Interviews elicit participants' perceptions of the text messaging system, along with key themes relative to behavioural constructs: socio-demographical factors; influencing behaviour changes, self-management, and uptake of text messages amongst SA ethnic minorities. Conclusion Text messaging and mHealth are being extensively used amongst general populations to monitor and enhance health. The study of SA patient experiences and their use of text messages within the United Kingdom (UK) remains scarce. Therefore, results from the study identify health beliefs that influence patient engagement with digital health interventions and their self-management. Developing policies and culturally appropriate education guidelines for healthcare practitioners can allow for the provision of culturally sensitive interventions tailored in terms of normative, cultural, and religious beliefs; which in turn will address crucial aspects including SA patient information and educational needs supporting their self-management journey.
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Affiliation(s)
- Tahreem Chaudhry
- School of Health and Society, University of Salford, Salford, UK
| | - Paula Ormandy
- School of Health and Society, University of Salford, Salford, UK
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Lin CY, Chung ML, Schuman DL, Biddle MJ, Mudd-Martin G, Miller JL, Hammash M, Schooler MP, Rayens MK, Feltner FJ, Moser DK. Psychometric Properties of the Patient Activation Measure in Family Caregivers of Patients With Chronic Illnesses. Nurs Res 2023; 72:292-300. [PMID: 37011339 PMCID: PMC10330077 DOI: 10.1097/nnr.0000000000000659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND The Patient Activation Measure (PAM) is used clinically and in research to measure an individual's knowledge, skills, and confidence related to their health management engagement. Despite the use of "patient" in the title, the instrument can be used in nonpatient populations. A group at high risk for low activation concerning their own health is family caregivers of patients with chronic illnesses. The psychometric properties of the PAM have not been established in family caregivers. OBJECTIVES This study aimed to examine the psychometric properties of the PAM 10-item version (PAM-10) in a sample of family caregivers of patients with chronic illnesses. Our focus was on family caregivers' health activation of their own healthcare needs. METHODS We evaluated the internal consistency reliability of the PAM-10 in a sample of 277 family caregivers. Item-total correlations and interitem correlations were used to assess item homogeneity. Construct validity of the PAM-10 was examined using exploratory factor analysis and testing hypotheses on known relationships. RESULTS The PAM-10 demonstrated adequate internal consistency. Item-total correlation coefficients and interitem correlation coefficients were acceptable. Construct validity of the instrument was supported. Factor analysis yielded two factors that explained 62.3% of the variance in the model. Lower levels of depressive symptoms were significantly associated with better activation, providing evidence of construct validity. Caregivers with high activation levels were significantly more likely to engage in and adhere to self-care behaviors such as regular exercise, eating a healthy diet, and engaging in stress reduction strategies. DISCUSSION This study demonstrated that the PAM-10 is a reliable and valid measure for family caregivers of patients with chronic illnesses to measure caregivers' health activation of their own healthcare needs.
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Mundal I, Laake P, Bjørkly SK, Lara-Cabrera ML. Factor structure and internal consistency of the parent patient activation measure (P-PAM) in parents of children with ADHD in norwegian paediatric mental health. BMC Psychiatry 2023; 23:60. [PMID: 36691007 PMCID: PMC9869581 DOI: 10.1186/s12888-023-04550-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND This study aimed to explore the internal consistency and factor validity of the 13-item self-report questionnaire Parent-Patient Activation Measure (P-PAM) in a sample of parents of children with Attention-deficit/hyperactivity disorder. METHODS In a cross-sectional study, 239 parents were recruited from four outpatient clinics of the Child and Adolescent Mental Health Services and completed the P-PAM along with demographic variables. The factor structure of the P-PAM was examined through exploratory factor analysis, and internal consistency was estimated with the use of both Cronbach's alpha and McDonald's omega. A confirmatory factor analysis was used to estimate and test individual parameters. RESULTS The fit indices suggest an acceptable two-factor model of P-PAM and show high internal consistency and reliability for both factors, indicating that the scale measures two concepts. CONCLUSIONS Our findings provide evidence for an acceptable factor structure and a high reliability of P-PAM as a measure of parent activation, suggesting that the theoretical factors reflect the construct of parent activation as intuitively compiled into an inner cognitive factor and an outer behavioral factor, which are related.
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Affiliation(s)
- Ingunn Mundal
- Faculty of Health Siences and Social care, Molde University College, Molde, Norway
- Division of Psychiatry, Kristiansund Community Mental Health Centre, Møre Og Romsdal Hospital Trust, Kristiansund, Norway
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Petter Laake
- Faculty of Health Siences and Social care, Molde University College, Molde, Norway
- Department of Biostatistics, Oslo Centre for Statistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Stål K. Bjørkly
- Faculty of Health Siences and Social care, Molde University College, Molde, Norway
- Oslo University Hospital, Centre for Forensic Research, Oslo, Norway
| | - Mariela L. Lara-Cabrera
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Division of Psychiatry, Nidelv Community Mental Health Centre, St. Olav’s University Hospital, Trondheim, Norway
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AY A, ÇIRAY N. Kronik Obstrüktif Akciğer Hastalığı Olan Hastaların Aktiflik Düzeyi ve Yaşam Kalitesi. DOKUZ EYLÜL ÜNIVERSITESI HEMŞIRELIK FAKÜLTESI ELEKTRONIK DERGISI 2022. [DOI: 10.46483/deuhfed.921252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Giriş: Kronik obstrüktif akciğer hastalarının etkili semptom yönetiminin, kendi bakımına katılan, aktif bir hasta ile sağlanabileceği bilinmektedir.
Amaç: Kronik obstrüktif akciğer hastalığı (KOAH) olan hastalarda aktiflik düzeyini, aktifliği etkileyen faktörleri ve aktiflik düzeyi ile yaşam kalitesi arasındaki ilişkiyi belirlemektir.
Yöntem: Tanımlayıcı, kesitsel ve ilişkisel tipte olan bu araştırma Kasım 2019- Mart 2020 tarihleri arasında bir üniversite hastanesinin göğüs hastalıkları polikliniğinde 120 KOAH’lı hasta gerçekleştirilmiştir. Veriler Hasta Tanıtım Formu, KOAH Değerlendirme Testi (CAT), Hasta Aktiflik Düzeyi Ölçeği (HADÖ) ve yaşam kalitesi için St. George Solunum Anketi (SGRQ) kullanılarak toplanmıştır. Verilerin değerlendirilmesinde tanımlayıcı istatistikler, Pearson korelasyon ve regresyon analizi kullanılmıştır.
Bulgular: Bireylerin, HADÖ puan ortalaması 67.05 ± 14.69, CAT puan ortalaması 22.33 ± 7.48, SGRQ semptom puan ortalaması 55.80 ± 20.23, SGRQ aktivite puan ortalaması 74.78 ± 21.59, SGRQ etki puan ortalaması 49.78 ± 21.30, SGRQ toplam puan ortalaması 58.35 ± 20.0 olarak bulunmuştur. HADÖ ile CAT arasında istatistiksel olarak anlamlı ve negatif yönlü (r = -.415; p = .01), HADÖ ile SGRQ toplam puan arasında istatistiksel olarak anlamlı ve negatif yönlü (r = -.529; p = .01), CAT ile SGRQ toplam puan arasında istatistiksel olarak anlamlı ve pozitif yönlü (r = .846; p = .01) ilişki vardır. CAT ve yaş arttıkça HADÖ düzeyi düşmektedir (R2 = .247). SGRQ toplam puan ve yaş arttıkça HADÖ düzeyi düşmektedir (R2 = .329).
Sonuç: KOAH’lı hastalarda aktiflik düzeyi yüksek bulunmuştur. Hasta aktifliğini etkileyen faktörler yaş, eğitim düzeyi, gelir durumu, çalışma durumu, hastalık süresi, KOAH evresi, yıllık hastane yatış sayısı, yıllık atak, KOAH durumu ve yaşam kalitesidir. Hasta aktiflik düzeyi arttıkça yaşam kalitesi artmaktadır.
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Zrubka Z, Vékás P, Németh P, Dobos Á, Hajdu O, Kovács L, Gulácsi L, Hibbard J, Péntek M. Validation of the PAM-13 instrument in the Hungarian general population 40 years old and above. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1341-1355. [PMID: 35102464 PMCID: PMC9550701 DOI: 10.1007/s10198-022-01434-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 01/11/2022] [Indexed: 05/07/2023]
Abstract
BACKGROUND Patient activation comprises the skills, knowledge and motivation necessary for patients' effective contribution to their care. We adapted and validated the 13-item Patient Activation Measure (PAM-13) in the ≥ 40 years old Hungarian general population. METHODS A cross-sectional web survey was conducted among 900 respondents selected from an online panel via quota sampling. After 10 days, the survey was repeated on 100 respondents. The distribution, internal consistency, test-retest reliability, factor structure, convergent, discriminant and known-groups validity of PAM-13 were assessed according to the COSMIN guidelines. RESULTS The sample comprised 779 respondents. Mean (± SD) age was 60.4 ± 10.6 years, 54% were female and 67% had chronic illness. Mean (± SD) PAM-13 score was 60.6 ± 10.0. We found good internal consistency (Cronbach alpha: 0.77), moderate test-retest reliability (ICC: 0.62; n = 75), a single-factor structure and good content validity: PAM-13 showed moderate correlation with the eHealth Literacy Scale (r = 0.40), and no correlation with age (r = 0.02), education (r = 0.04) or income (ρ = 0.04). Higher PAM-13 scores were associated with fewer lifestyle risks (p < 0.001), more frequent health information seeking (p < 0.001), participation in patient education (p = 0.018) and various online health-related behaviours. When controlling for health literacy, sociodemographic factors and health status, the association of higher PAM-13 scores with overall fewer lifestyle risks, normal body mass index, physical activity and adequate diet remained significant. Similar properties were observed in the subgroup of participants with chronic morbidity, but not in the age group 65+. CONCLUSION PAM-13 demonstrated good validity in the general population. Its properties in clinical populations and the elderly as well as responsiveness to interventions warrant further research.
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Affiliation(s)
- Zsombor Zrubka
- University Research and Innovation Center, Óbuda University, Bécsi út 96/b, Budapest, 1034, Hungary.
- Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary.
| | - Péter Vékás
- Institute of Mathematical Statistics and Modelling, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Péter Németh
- Doctoral School of Economics, Business and Informatics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Ágota Dobos
- Centre for Foreign Language Education and Research, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Ottó Hajdu
- Institute of Business Economics, Eötvös Loránd University, Rákóczi út 7, Budapest, 1088, Hungary
| | - Levente Kovács
- University Research and Innovation Center, Óbuda University, Bécsi út 96/b, Budapest, 1034, Hungary
| | - László Gulácsi
- University Research and Innovation Center, Óbuda University, Bécsi út 96/b, Budapest, 1034, Hungary
- Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Judith Hibbard
- Health Policy Research Group, University of Oregon, 1209 University of Oregon, Eugene, OR, 97403-1209, USA
| | - Márta Péntek
- University Research and Innovation Center, Óbuda University, Bécsi út 96/b, Budapest, 1034, Hungary
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Mirmazhari R, Ghafourifard M, Sheikhalipour Z. Relationship between patient activation and self-efficacy among patients undergoing hemodialysis: a cross-sectional study. RENAL REPLACEMENT THERAPY 2022. [DOI: 10.1186/s41100-022-00431-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Patient activation in chronic kidney disease (CKD) is increasingly being prioritized and considered a quality metric in CKD. Given the importance of patients’ activation in improving the quality of chronic disease care, this study aimed to assess patients’ activation levels and its relationship with self-efficacy among patients undergoing hemodialysis.
Methods
In this cross-sectional study, a total of 180 patients undergoing maintenance hemodialysis were selected by random sampling from the largest hemodialysis center (dialysis center of Emam Reza hospital, Tabriz) in Iran. Data were collected by demographics, patient activation measure, and chronic kidney disease self-efficacy (CKD-SE) scale from March to May 2021. Collected data were analyzed using SPSS software (ver. 26) using ANOVA, t-test, Pearson correlation coefficient, and multiple regression tests.
Results
The majority of the participants (35%) were at level 1 of activation and only 28.9% of the individuals were at level 4. According to the results, the mean score of self-efficacy in patients undergoing hemodialysis (in a possible range of 0–10) was 5.50 ± 1.45. Multiple regression analysis showed that factors including self-efficacy, educational level, and marital status were significant predictors of change in patient activation (R2 = 0.85, adjusted R2 = 0.66, p < 0.001). The results showed that self-efficacy was the main predictor of patient activation (β = 0.49, p < 0.001).
Conclusion
According to the result, improving the patients' self-efficacy could improve the patient's activation. Moreover, patients with lower educational level reported the lower activation score; therefore, health care providers should improve the knowledge of patients with lower educational level, encourage them to be more active in their health care, and help them in providing more tailored strategies to improve the quality of care more efficiently. Furthermore, Measuring patients' activation level at admission to the dialysis unit is recommended for all patients undergoing hemodialysis.
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Cucato G, Snowden C, McCone E, Nesbitt C, Nandhra S, Fong M, Kane E, Rowland M, Bhattarai N, Court P, Bell O, Saxton JM, Prentis J. Evaluating the feasibility and acceptability of an exercise and behaviour change intervention in socioeconomically deprived patients with peripheral arterial disease: The textpad study protocol. PLoS One 2022; 17:e0269999. [PMID: 35749440 PMCID: PMC9231723 DOI: 10.1371/journal.pone.0269999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022] Open
Abstract
This pilot randomised controlled trial aims to assess the feasibility and acceptability of a 12-week home-based telehealth exercise and behavioural intervention delivered in socioeconomically deprived patients with peripheral artery disease (PAD). The study will also determine the preliminary effectiveness of the intervention for improving clinical and health outcomes. Sixty patients with PAD who meet the inclusion criteria will be recruited from outpatient clinic at the Freeman Hospital, United Kingdom. The intervention group will undergo telehealth behaviour intervention performed 3 times per week over 3 months. This program will comprise a home-based exercise (twice a week) and an individual lifestyle program (once per week). The control group will receive general health recommendations and advice to perform unsupervised walking training. The primary outcome will be feasibility and acceptability outcomes. The secondary outcomes will be objective and subjective function capacity, quality of life, dietary quality, physical activity levels, sleep pattern, alcohol and tobacco use, mental wellbeing, and patients’ activation. This pilot study will provide preliminary evidence of the feasibility, acceptability and effectiveness of home-based telehealth exercise and behavioural intervention delivered in socioeconomically deprived patients with PAD. In addition, the variance of the key health outcomes of this pilot study will be used to inform the sample size calculation for a future fully powered, multicentre randomized clinical trial.
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Affiliation(s)
- Gabriel Cucato
- Dept of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
- * E-mail:
| | - Chris Snowden
- Dept of Perioperative and Critical Care Medicine, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Emma McCone
- Northern Vascular Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Craig Nesbitt
- Northern Vascular Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Sandip Nandhra
- Northern Vascular Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Mackenzie Fong
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Eileen Kane
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Maisie Rowland
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Paul Court
- Healthworks, Newcastle upon Tyne, United Kingdom
| | - Oliver Bell
- Newcastle United Foundation, Newcastle upon Tyne, United Kingdom
| | - John Michael Saxton
- Dept of Sport, Health & Exercise Science, University of Hull, Hull, United Kingdom
| | - James Prentis
- Dept of Perioperative and Critical Care Medicine, Freeman Hospital, Newcastle upon Tyne, United Kingdom
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Westman B, Bergkvist K, Karlsson Rosenblad A, Sharp L, Bergenmar M. Patients with low activation level report limited possibilities to participate in cancer care. Health Expect 2022; 25:914-924. [PMID: 35049103 PMCID: PMC9122461 DOI: 10.1111/hex.13438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/26/2021] [Accepted: 01/09/2022] [Indexed: 11/27/2022] Open
Abstract
Background Cancer care trajectories are often complex, with potent multimodality treatments and multiple interactions with health care providers. Communication and coordination are challenging and the patients' responsibilities to take on more active roles in their own care are increasing. Objective This study aimed to investigate associations between patient activation level and participation in cancer care, sociodemographic characteristics, clinical data, health‐related quality of life (HRQoL) and helpfulness of received information. Methods In this cross‐sectional population‐based study, patients completed questionnaires on patient activation, perceived participation, HRQoL, helpfulness of received information and sociodemographic characteristics. Responses to the patient activation measures (PAMs) were classified into four levels (higher levels indicating more activation). Data on age, sex and cancer diagnosis were collected from the Swedish Cancer Register. Results Data from 682 patients were analysed. On comparing patients at PAM levels 1 and 4, the latter reported significantly higher possibilities to influence care decisions (46.6% vs. 20.8%) and to ask questions regarding treatment and care (93.4% vs. 68.4%). Patients at PAM level 4 reported wanting to influence decision‐making to a higher extent, compared with patients at other PAM levels, and reported clinically significantly higher HRQoL. No significant differences were found regarding sociodemographic characteristics. Conclusion We found strong associations between perceived patient participation and activation levels, with limited possibility for participation among those with lower activation levels. Patient or Public Contribution Discussions with patient representatives have raised the importance of participation. The preliminary findings were presented and discussed in a workshop with representatives from 21 cancer patient advocacy groups.
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Affiliation(s)
- Bodil Westman
- Regional Cancer Centre Stockholm-Gotland, Stockholm, Sweden.,Department of Care Science, Sophiahemmet University, Stockholm, Sweden
| | - Karin Bergkvist
- Department of Care Science, Sophiahemmet University, Stockholm, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Karlsson Rosenblad
- Regional Cancer Centre Stockholm-Gotland, Stockholm, Sweden.,Division of Clinical Diabetology and Metabolism, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Lena Sharp
- Regional Cancer Centre Stockholm-Gotland, Stockholm, Sweden.,Division of Innovative Care Research, LIME, Karolinska Institutet, Stockholm, Sweden
| | - Mia Bergenmar
- Department of Care Science, Sophiahemmet University, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Pelvic Cancer, Psychosocial Unit, Karolinska University Hospital, Stockholm, Sweden
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Ge L, Kaur P, Yap CW, Heng BH. Psychometric Properties of the Patient Activation Measure in Community-Dwelling Adults in Singapore. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221100781. [PMID: 35535478 PMCID: PMC9096181 DOI: 10.1177/00469580221100781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction Measuring health activation in general population using valid instruments is needed to facilitate the evaluation of health education and behavioral programs in community. The 13-item Patient Activation Measure was well validated in patients with different chronic diseases but rarely validated in general population. The objective of this study was to assess the psychometric properties of the Patient Activation Measure among community-dwelling adults in Singapore. Methods Data of participants having valid responses to the English-version measure (N = 824) were analyzed. The psychometric properties were assessed by demonstrating evidence for uni-dimensionality using Rasch Principal Component Analysis of Residuals, known-group validity, convergent and divergent validity, and internal consistency reliability using Cronbach’s alpha. Results The uni-dimensionality of the Patient Activation Measure was supported by the Rasch Principal Component Analysis of Residuals results. Participants having multimorbidity or polypharmacy and being inactive in physical activity had significantly lower activation scores. The activation score was positively and moderately correlated with health confidence measured by the Health Confidence Measure (r = .38, P < .001), and negatively and weakly correlated with depressive symptoms measured by the Patient Health Questionnaire (r = − .13, P < .001). The internal reliability was good with a Cronbach’s alpha of .82. Conclusion The 13-item Patient Activation Measure has acceptable construct validity and good internal consistency among community-dwelling adults. It is a potential instrument to measure health activation in this population. Further research is required to investigate the expansion of response options, validate the cut-off scores for the activation levels and examine the test-retest reliability and responsiveness.
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Affiliation(s)
- Lixia Ge
- National Healthcare Group Pte. Ltd, Singapore, Singapore
| | - Palvinder Kaur
- National Healthcare Group Pte. Ltd, Singapore, Singapore
| | - Chun Wei Yap
- National Healthcare Group Pte. Ltd, Singapore, Singapore
| | - Bee Hoon Heng
- National Healthcare Group Pte. Ltd, Singapore, Singapore
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Lightfoot CJ, Wilkinson TJ, Memory KE, Palmer J, Smith AC. Reliability and Validity of the Patient Activation Measure in Kidney Disease: Results of Rasch Analysis. Clin J Am Soc Nephrol 2021; 16:880-888. [PMID: 34117081 PMCID: PMC8216620 DOI: 10.2215/cjn.19611220] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/22/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite the increasing prioritization of the promotion of patient activation in nephrology, its applicability to people with CKD is not well established. Before the Patient Activation Measure is universally adopted for use in CKD, it is important to critically evaluate this measure. The aim of this study was to describe the psychometric properties of the Patient Activation Measure in CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A survey containing the 13-item Patient Activation Measure was completed by 942 patients with CKD, not treated with dialysis. Data quality was assessed by mean, item response, missing values, floor and ceiling effects, internal consistency (Cronbach's alpha and average interitem correlation), and item-rest correlations. Rasch modeling was used to assess item performance and scaling (item statistics, person and item reliability, rating scale diagnostics, factorial test of residuals, and differential item functioning). RESULTS The item response was high, with a small number of missing values (<1%). Floor effect was small (range 1%-5%), but the ceiling effect was above 15% for nine items (range 15%-38%). The Patient Activation Measure demonstrated good internal consistency overall (Cronbach α=0.925, and average interitem correlation 0.502). The difficulty of the Patient Activation Measure items ranged from -0.90 to 0.86. Differential item functioning was found for disease type (item 3) and age (item 12). The person separation index was 9.48 and item separation index was 3.21. CONCLUSIONS The 13-item Patient Activation Measure appears to be a suitably reliable and valid instrument for assessing patient activation in CKD. In the absence of a kidney-specific instrument, our results support the 13-item Patient Activation Measure as a promising measure to assess activation in those with CKD, although consideration for several items is warranted. The high ceiling effect may be a problem when using the 13-item Patient Activation Measure to measure changes over time.
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Affiliation(s)
- Courtney J Lightfoot
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
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Melby K, Nygård M, Brobakken MF, Gråwe RW, Güzey IC, Reitan SK, Vedul-Kjelsås E, Heggelund J, Tchounwou PB. Test-Retest Reliability of the Patient Activation Measure-13 in Adults with Substance Use Disorders and Schizophrenia Spectrum Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031185. [PMID: 33572717 PMCID: PMC7908201 DOI: 10.3390/ijerph18031185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 11/16/2022]
Abstract
Patient Activation Measure-13 (PAM-13) is a valid and widely used questionnaire that assess an individual’s knowledge, confidence, and skills for self-management of their chronic illness. Although there is some evidence regarding its reliability, the test–retest reliability has not been investigated among patients with substance use disorders (SUDs) or schizophrenia spectrum disorders. We investigated the internal consistency and test–retest reliability of PAM-13 in these populations. Test–retest reliability was analysed using data from 29 patients with SUDs and 28 with schizophrenia spectrum disorders. Cronbach’s α and Intraclass Correlation Coefficient (ICC) scores were used to examine internal consistency and test–retest reliability, respectively. Of the 60 collected test–retest questionnaires, 57 were included in the analyses. No mean differences between time one (T1) and time two (T2) were observed in either patient group, except for item 12 in schizophrenia spectrum disorders patients (p < 0.05). Internal consistency for T1 and T2 was 0.75 and 0.84 in SUDs patients and 0.87 and 0.81 in schizophrenia spectrum disorders patients, respectively. The ICC was r = 0.86 in patients with SUDs and r = 0.93 in patients with schizophrenia spectrum disorders. To conclude, PAM-13 showed good internal consistency and test–retest reliability in SUDs and schizophrenia spectrum disorders patients.
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Affiliation(s)
- Katrine Melby
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway;
- Blue Cross Lade Addiction Treatment Centre, 7041 Trondheim, Norway
- Department of Clinical Pharmacology, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Mona Nygård
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Østmarka, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
- Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
- Correspondence: ; Tel.: +47-452-03-870
| | - Mathias Forsberg Brobakken
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Østmarka, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Rolf W. Gråwe
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Ismail Cüneyt Güzey
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Solveig Klæbo Reitan
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Einar Vedul-Kjelsås
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Jørn Heggelund
- Regional Center for Healthcare Improvement, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway;
| | - Paul B. Tchounwou
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (M.F.B.); (R.W.G.); (I.C.G.); (S.K.R.); (E.V.-K.); (M.L.L.-C.)
- Department of Research and Development, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
- Tiller Community Mental Health Centre, Division of Psychiatry, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
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Bahrom NH, Ramli AS, Isa MR, Baharudin N, Badlishah-Sham SF, Mohamed-Yassin MS, Abdul-Hamid H. Validity and reliability of the Patient Activation Measure® (PAM®)-13 Malay version among patients with Metabolic Syndrome in primary care. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2020; 15:22-34. [PMID: 33329860 PMCID: PMC7735884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The Patient Activation Measure (PAM) is one of the most extensively used, widely translated, and tested instruments worldwide in measuring patient activation levels in self-management. This study aimed to determine the validity and reliability of the PAM-13 Malay version among patients with Metabolic Syndrome (MetS) attending a primary care clinic. METHODS This work is a cross-sectional validation study among patients with MetS attending a university primary care clinic in Selangor. The PAM-13 Malay version underwent a validation process and field testing. Psychometric properties were examined using principal component analysis (PCA) with varimax rotation, scree plot, Monte Carlo simulation, internal consistency, and test-retest reliability analyses. RESULTS The content of the PAM-13 Malay version and the original version were conceptually equivalent. The questionnaire was refined after face validation by 10 patients with MetS. The refined version was then field-tested among 130 participants (response rate 89.7%). The Kaiser-Meyer-Olkin test was 0.767, and Bartlett's test of sphericity was ≤0.001, indicating sampling adequacy. Two factors were identified and labeled as (1) Passive and Building Knowledge, and (2) Taking Action and Maintaining Behavior. These labels were chosen as they were conceptually consistent with the items representing the levels of activation in PAM-13. The validated PAM-13 Malay version consisted of 13 items, framed into two domains. The overall Cronbach's α was 0.79, and the intraclass correlation coefficient was 0.45. CONCLUSIONS The PAM-13 Malay version is valid, reliable, and fairly stable over time. This questionnaire can be used to evaluate the levels of activation among patients with MetS in primary care in Malaysia.
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Affiliation(s)
- N H Bahrom
- MD (Calgary), Department of Primary Care, Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| | - A S Ramli
- MBBS (Newcastle, UK), MRCGP (UK), Deputy Director, Institute of Pathology Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia,
| | - M R Isa
- MBBS (UM), MPH (UM), Department of Population Health and Preventive Medicine, Faculty of Medicine, Universiti Teknologi MARA Sungai Buloh Campus, Selangor Malaysia
| | - N Baharudin
- MBBS (Monash), FRACGP (Australia), Department of Primary Care Medicine, Faculty of Medicine Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| | - S F Badlishah-Sham
- MBBCh BAO (Cork, Ireland), MFamMed (UiTM), Department of Primary Care Medicine, Faculty of Medicine Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| | - M S Mohamed-Yassin
- MBBS (Monash), FRACGP (Australia), Department of Primary Care Medicine, Faculty of Medicine Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
| | - H Abdul-Hamid
- MB BCh (Cardiff), MRCGP (UK), Department of Primary Care Medicine, Faculty of Medicine Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia
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