Validation of the PAM-13 instrument in the Hungarian general population 40 years old and above

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.

Adaptation and measurement invariance of the 13-item version of Patient Activation Measure across Japanese young adult cancer survivors during and after treatment: A cross-sectional observational study

“…The Rasch analysis results and the multiple-group SEM with the same configuration suggest that the PAM-13 is a single underlying factor across YA cancer survivors during and after treatment. The unidimensional structure of the scale has been observed in the original study by Hibbard et al [ 11 ] that dealt with the original version and other studies that dealt with other language versions [ 12 , 13 ]. The results of McDonald’s omegas and item-total correlations supported the good internal consistency of the PAM-13 across YA cancer survivors during and after treatment.…”

“…Existing studies have confirmed the original and other language versions of PAM-13 as a unidimensional scale that indicates the degree of activation that helps chronically ill individuals become fully engaged in managing their health [ 11 – 13 ]. Furthermore, the studies validated the scale for application in individuals with various chronic conditions (e.g., arthritis, hypertension, chronic pain, kidney disease, and diabetes) [ 11 , 14 – 16 ] and for the general population [ 12 ]. Previous studies commonly reported that among the participants, demographic characteristics (e.g., older age and lower educational level), health condition (e.g., depression, fatigue, and poor quality of life), and lower self-efficacy on controlling for disease and symptom were negatively related to the score of PAM-13 [ 17 – 20 ].…”

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

“…The scarce use of the “strongly disagree” category has also been noted in other PAM-13 studies [ 19 , 21 , 23 , 31 , 41 ], and the presence of ceiling effects is a widespread phenomenon (e.g., 18, 20, 23, 36, 79, 104, 106). It is noteworthy, however, that some studies did not observe any item ceiling effects [ 24 , 26 , 79 , 107 ], which might be attributed to the specific cultural background of the population, the age groups considered or the type of disease under investigation.…”

“…Data analyses presented here adhered to the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) best practice guidelines for patient-reported outcome measures [ 51 , 52 ]. We applied methods from both classical test theory (CCT) and item-response theory (IRT) to ensure comparability to previous PAM-13 validation studies [ 18 , 19 , 24 , 40 ] and to explicitly model the relationship between an individual’s trait level and their likelihood of providing particular responses to specific items [ 53 , 54 ].…”

“…Since the development of the original PAM-13 in 2005, the questionnaire has been translated and validated in various countries, including Germany [ 18 , 19 ], Norway [ 20 ], Italy [ 21 ], Singapore [ 22 ], Denmark [ 23 ], Hungary [ 24 ] and many others [ 25 – 34 ]. Participants were typically recruited via convenience sampling from the general population with a heterogenous variety of chronic conditions (e.g., diabetes mellitus, hypertension, rheumatoid arthritis).…”