Measuring patient activation in Italy: Translation, adaptation and validation of the Italian version of the patient activation measure 13 (PAM13-I)

Abstract

BackgroundThe Patient Activation Measure (PAM13) is an instrument that assesses patient knowledge, skills, and confidence for disease self-management. This cross-sectional study was aimed to validate a culturally-adapted Italian Patient Activation Measure (PAM13-I) for patients with chronic conditions.Methods519 chronic patients were involved in the Italian validation study and responded to PAM13-I. The PAM 13 was translated into Italian by a standardized forward-backward translation. Data quality was assessed by mean, median, item response, missing values, floor and ceiling effects, internal consistency (Cronbach's alpha and average inter-item correlation), item-rest correlations. Rasch Model and differential item functioning assessed scale properties.ResultsMean PAM13-I score was 66.2. Rasch analysis showed that the PAM13-I is a good measure of patient activation. The level of internal consistency was good (α = 0.88). For all items, the distribution of answers was left-skewed, with a small floor effect (range 1.7–4.5 %) and a moderate ceiling effect (range 27.6–55.0 %). The Italian version formed a unidimensional, probabilistic Guttman-like scale explaining 41 % of the variance.ConclusionThe PAM13-I has been demonstrated to be a valid and reliable measure of patient activation and the present study suggests its applicability to the Italian-speaking chronic patient population. The measure has good psychometric properties and appears to be consistent with the developmental nature of the patient activation phenomenon, although it presents a different ranking order of the items comparing to the American version.PAM13-I can be a useful assessment tool to evaluate interventions aimed at improving patient engagement in healthcare and to train doctors in attuning their communication to the level of patients’ activation. Future research could be conducted to further confirm the validity of the PAM13-I.

Outcomes in patient education programmes for people with rheumatic diseases: Results from a Delphi process and a study of feasibility and responsiveness

“…Both EC‐17 and PAM had low values of missing data and showed good internal consistency. PAM exhibited ceiling effects up to 83% in 10 of 13 questions, and similar results are found in other studies (Graffigna, Barello, Bonanomi, Lozza, & Hibbard, ; Moljord et al, ; Zill et al, ). High ceiling effects reduce the ability to detect changes, and may have influenced the low responsiveness of PAM in this study.…”

An Educational Intervention to Train Professional Nurses in Promoting Patient Engagement: A Pilot Feasibility Study

“…The supporting materials used in the program included: the main measures of patient engagement currently available in the scientific literature (i.e., Patient Activation Measure by Hibbard et al, 2005; Patient Health Engagement Scale by Graffigna et al, 2015b), the case studies discussed and memory-aid materials including the scales' scoring system, guidance on changes in patients' needs across the patient engagement levels, and related suggested actions, and scientific articles discussing the evidence base that oriented the program's contents.…”

The EMPOWER-SUSTAIN e-Health Intervention to improve patient activation and self-management behaviours among individuals with Metabolic Syndrome in primary care: study protocol for a pilot randomised controlled trial

“…Patient activation reflects patients' central role in having the knowledge, skills and confidence to make effective decisions to self-manage their own health and change their behaviour (e.g., in adopting a healthy lifestyle) [23][24][25][26]. It is considered to be the most reliable indicator of the willingness and ability to manage health autonomously [27][28][29]. Previous studies have emphasised that increased patient activation level has been shown to improve self-management behaviours, such as physical activity (PA), diet and medication adherence, in patients with various chronic conditions [25,[30][31][32].…”