Psychometric Properties of the Patient Activation Measure in Community-Dwelling Adults in Singapore

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.

The Patient Activation Measure-13 (PAM-13) in an oncology patient population: psychometric properties and dimensionality evaluation

“…Item 9 (“ I know the different medical treatment options available for my health condition”) emerged as the most challenging item for participants to endorse. Similar observations have been reported in other studies [ 21 , 30 , 104 ], as indicated in Table 6 . Moreno-Chico, González-de Paz [ 30 ] who investigated the psychometric properties of the PAM-13 in a Spanish population with chronic diseases argued that there might be communication issues in decision-making processes between clinicians and patients contributing to this phenomenon.…”

“…High overall PAM-13 scores at baseline and item ceiling effects may diminish the PAM-13’s discriminating ability and its responsiveness in capturing changes over time in interventional studies. Extending the PAM-13 at the higher end of the trait continuum with more difficult items to appropriately calibrate the measure for patients with stronger abilities could be beneficial in addressing this issue, as has already been suggested elsewhere [ 104 ]. Furthermore, changing the item format of existing items by modifying the question wording or optimizing and extending the response scale may help to reduce ceiling effects [ 108 , 109 ].…”

“…Moreno-Chico, González-de Paz [ 30 ] who investigated the psychometric properties of the PAM-13 in a Spanish population with chronic diseases argued that there might be communication issues in decision-making processes between clinicians and patients contributing to this phenomenon. Graffigna, Barello [ 21 ] reasoned that the item order might be influenced by European-specific aspects in the healthcare system, however, as shown in Table 6 , item 9 was also harder to endorse by community-dwelling adults in Singapore [ 104 ], whereas in another study from Singapore validating the PAM-13 among adults with cardiac conditions, item 9 did not switch to the highest activation level [ 22 ]. This finding contradicts the notion that item order can be satisfactorily explained by cultural background.…”

A Systematic Review of the Reliability and Validity of the Patient Activation Measure Tool

“…Of the remaining 357 studies, 304 were not validation or reliability studies pertaining to the PAM, 5 used variations of the PAM e.g., caregiver-PAM, 5 were abstracts or conference proceedings, and 4 did not have English translation. A total of 39 manuscripts [6,8,9, were finally included (Figure 1).…”

“…caregiver-PAM, 5 were abstracts or conference proceedings, and 4 did not have English translation. A total of 39 manuscripts [6,8,9, were finally included (Figure 1). Table 1 summarizes the key characteristics of the studies and their principal findings regarding reliability, validity, and factor analysis, arranged by their geographic regions according to the WHO regional classification [51].…”