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.
Highlights
The Patient Activation Measure (PAM13) is an instrument that assesses patient knowledge, skills, and confidence for disease self-management
Translation and adaptation During the translation and forward translation process, we recognized few general problems when comparing the Italian version with the American one [17]
The instrument pre-testing administered to patients in a preliminary phase of the study, allowed understanding that some terms - i.e. “health” and “disease”- might have different meanings and conceptualizations for Italian patients
Summary
The Patient Activation Measure (PAM13) is an instrument that assesses patient knowledge, skills, and confidence for disease self-management. The American Patient Activation Measure short form (PAM 13) [17] consists of 13 items measuring patients’ self-reported knowledge, motivation, and skills for self-management (see Appendix 1). It was developed using a Rasch model [18] and it has been validated in the US general population and, more recently, in other countries – such as Germany [24], Netherlands [25], Denmark [26] Israel [27], Norway [28], and Korea [29] – across different clinical settings [22, 23, 30,31,32]
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