Psychometric evaluation of the German version of the Patient Activation Measure (PAM13)

Jördis M Zill, Sarah Dwinger, Levente Kriston, Anja Rohenkohl, Martin Härter, Jörg Dirmaier, Jördis M Zill, Sarah Dwinger, Levente Kriston, Anja Rohenkohl, Martin Härter, Jörg Dirmaier

Abstract

Background: The Patient Activation Measure (PAM) consists of 13 items and assesses patient (or consumer) self-reported knowledge, skills, and confidence for self-management of one's health or chronic condition. The aim of this study was to translate the original American version of the PAM13 into German and to test the psychometric properties of the German version in an elderly, multimorbid population with various chronic conditions.

Methods: Translation was performed by a standardized forward-backward translation process. The PAM13 was sent to 9.075 participants enrolled in a randomized controlled study. 4.306 participants responded to the questionnaire. Descriptive and reliability analyses were carried out. To examine scale properties, Andrich's Rasch Rating Scale Model was fitted.

Results: The internal consistency is good (α = 0.88) and the item-rest-correlations were found as strong to moderate. The unidimensionality of the construct was confirmed, with a variance explanation of 40.9% and good model-fits for the Rasch model. However, the lowest response options were very rarely used across all items (below 5%) and ranking order of items according to their difficulty was substantially different from that of the American version. Differential item functioning (DIF) was found in subgroups (sex, age, health status), but differences were small.

Conclusion: The German version of the PAM13 showed acceptable reliability and the model-fit statistics confirmed the Rasch model. The different ranking order of the items and the unfair distribution of the response options suggest further research on validation and revision of the construct.

Figures

Figure 1
Figure 1
Person item-map.

References

    1. Holman HR. Chronic disease and the healthcare crisis. Chronic Illn. 2005;1(4):265–279.
    1. World Health Organization. Preventing Chronic Diseases. A Vital Investment: WHO Global Report. Geneva: World Health Organization; 2005.
    1. Donald M, Ware RS, Ozolins IZ, Begum N, Crowther R, Bain C. The role of patient activation in frequent attendance at primary care: a population-based study of people with chronic disease. Patient Educ Couns. 2011;83(2):217–221. doi: 10.1016/j.pec.2010.05.031.
    1. Boult C, Reider L, Frey K, Leff B, Boyd CM, Wolff JL, Wegener S, Marsteller J, Karm L, Scharfstein D. Early effects of “Guided Care” on the quality of health care for multimorbid older persons: a cluster-randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2008;63(3):321–327. doi: 10.1093/gerona/63.3.321.
    1. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288(14):1775–1779. doi: 10.1001/jama.288.14.1775.
    1. Hibbard JH, Greene J, Overton V. Patients with lower activation associated with higher costs; delivery systems should know their patients’ ‘scores’. Health Aff. 2013;32(2):216–222. doi: 10.1377/hlthaff.2012.1064.
    1. Coulter A, Ellins J. Effectiveness of strategies for informing, educating, and involving patients. Br Med J. 2007;335(7609):24–27. doi: 10.1136/bmj.39246.581169.80.
    1. Von Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH. Collaborative management of chronic illness. Ann of Intern Med. 1997;127(12):1097–1102. doi: 10.7326/0003-4819-127-12-199712150-00008.
    1. Hibbard J, Stockard J, Mahoney E, Tusler M. Development of the patient activation measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39(4):1005–1026.
    1. Hibbard JH, Mahoney E. Toward a theory of patient and consumer activation. Patient Educ Couns. 2010;78(3):377–381. doi: 10.1016/j.pec.2009.12.015.
    1. Hibbard JH, Mahoney ER, Stockard J, Tusler M. Development and testing of a short form of the patient activation measure. Health Serv Res. 2005;40(6 Pt 1):1918–1930.
    1. Hibbard JH, Mahoney ER, Stock R, Tusler M. Do increases in patient activation result in improved self-management behaviors? Health Serv Res. 2007;42(4):1443–1463. doi: 10.1111/j.1475-6773.2006.00669.x.
    1. Mosen DM, Schmittdiel J, Hibbard J, Sobel D, Remmers C, Bellows J. Is patient activation associated with outcomes of care for adults with chronic conditions? J Ambul Care Manage. 2007;30(1):21–29. doi: 10.1097/00004479-200701000-00005.
    1. Remmers C, Hibbard J, Mosen DM, Wagenfield M, Hoye RE, Jones C. Is patient activation associated with future health outcomes and healthcare utilization among patients with diabetes? J Ambul Care Manage. 2009;32(4):320–327. doi: 10.1097/JAC.0b013e3181ba6e77.
    1. Greene J, Hibbard JH. Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes. J Gen Intern Med. 2012;27(5):520–526. doi: 10.1007/s11606-011-1931-2.
    1. Maindal HT, Sokolowski I, Vedsted P. Translation, adaptation and validation of the american short form patient activation measure (PAM13) in a Danish version. BMC Public Health. 2009;9:209. doi: 10.1186/1471-2458-9-209.
    1. Rademakers J, Nijman J, van der Hoek L, Heijmans M, Rijken M. Measuring patient activation in the netherlands: translation and validation of the american short form patient activation measure (PAM13) BMC Public Health. 2012;12(1):577. doi: 10.1186/1471-2458-12-577.
    1. Steinsbekk A. Maling av effect av pasientoploering [Norwegian version of patient activation measure (PAM)] Tidsskr Nor Legeforen. 2008;128:2316–2318.
    1. Green CA, Perrin NA, Polen MR, Leo MC, Hibbard JH, Tusler M. Development of the patient activation measure for mental health. Adm Policy Mental Health. 2010;37(4):327–333. doi: 10.1007/s10488-009-0239-6.
    1. Maurischat C, Herschbach P, Peters A, Bullinger M. Factorial validity of the short form 12 (SF-12) in patients with diabetes mellitus. Psychol Sci Q. 2008;50(1):7–20.
    1. Everitt BS, Skrondal A. The Cambridge Dictionary of Statistics – Fourth Edition. New York: Cambridge University Press; 2010.
    1. Weinberg SL, Knapp Abramowitz S. Statistics Using SPSS: An Integrative Approach. 2. New York: Cambridge University Press; 2008.
    1. Bond TG, Fox CM. Applying the Rasch Model: Fundamental Measurement in the Human Sciences, Volume 2. New Jersey: Lawrence Erlbaum Associates; 2007.
    1. Andrich D. Application of a psychometric rating model to ordered categories which are scored with successive integers. Appl Psych Meas. 1978;2:581–594. doi: 10.1177/014662167800200413.
    1. Mair P, Reinhold H. Extended rasch modeling: the eRm package for the application of IRT models in R. J Stat Softw. 2007;20(9):1–20.
    1. Cook KF, Teal CR, Bjorner JB, Cella D, Chang CH, Crane PK, Gibbons LE, Hays RD, McHorney CA, Ocepek-Welikson K. et al.IRT health outcomes data analysis project: an overview and summary. Qua Life Res. 2007;1:121–132.
    1. Las Hayas C, Quintana J, Padierna J, Bilbao A, Munoz P. Use of rasch methodology to develop a short version of the health related quality of life for eating disorders questionnaire: a prospective study. Health Qual of Life Out. 2010;8(1):29. doi: 10.1186/1477-7525-8-29.
    1. Doucette A, Wolf AW. Questioning the measurement precision of psychotherapy research. Psychother Res. 2009;19(4–5):374–389.
    1. Strobl C, Kopf J, Zeileis A. Using the raschtree function for detecting differential item functioning in the Rasch model. .
    1. Shively MJ, Gardetto NJ, Kodiath MF, Kelly A, Smith TL, Stepnowsky C, Maynard C, Larson CB. Effect of patient activation on self-management in patients with heart failure. J Cardiovasc Nurs. 2013;28(1):20–34. doi: 10.1097/JCN.0b013e318239f9f9.
    1. Rademakers J, Nijman J, Brabers AE, de Jong JD, Hendriks M. The relative effect of health literacy and patient activation on provider choice in the Netherlands. Health Policy. 2013;23(13):00209–00201.
    1. Harvey L, Fowles JB, Xi M, Terry P. When activation changes, what else changes? The relationship between change in patient activation measure (PAM) and employees’ health status and health behaviors. Patient Educ Couns. 2012;88(2):338–343. doi: 10.1016/j.pec.2012.02.005.
    1. Fowles JB, Terry P, Xi M, Hibbard J, Bloom CT, Harvey L. Measuring self-management of patients’ and employees’ health: further validation of the patient activation measure (PAM) based on its relation to employee characteristics. Patient Educ Couns. 2009;77(1):116–122. doi: 10.1016/j.pec.2009.02.018.

Source: PubMed

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