Reliability and validity of the Chinese version of Patient Activation Measure

Objective To measure the reliability and validity of the Chinese version of Patient Activation Measure (PAM) and to explore its applicability in assessment of self-health management among lumbar degenerative disease patients scheduled for lumbar spinal fusion. Methods From January to June 2017, we selected 120 lumbar degenerative disease patients who had a right mind, none communication disorders and were treated at a Class Ⅲ Grade A hospital in Suzhou as well as scheduled for lumbar spinal fusion as subjects by convenience sampling. All of the patients were investigated with the questionnaire involving the general information questionnaire, the Chinese version of PAM and Self-Efficacy for Managing Chronic Disease Scale (SEMCDS) . Psychometric characteristics of the Chinese version of PAM were assessed by indexes, such as item analysis, internal consistency reliability, retest reliability, content validity, construct validity and criterion-related validity. Results A total of 120 questionnaires were sent out and all of them were collected with 100.0% for the effective recovery rate. The Chinese version of PAM included 13 items and 4 levels. Its standardized total score ranged from 33 to 100 and the average score was (50.25±11.33) . There were 59 patients (49.2%) with the score less than or equal to 47.0 belong to the first level of activation which indicated they were not aware the importance of self-health management; 22 patients (18.3%) the score between 47.1 and 55.1 belong to the second level of activation which indicated they lacked knowledge and confidence of self-health management; 31 patients (25.8%) with the score from 55.2 to 67.0 belong to the third level of activation which indicated they began to take action of self-health management; 8 patients (6.7%) with the score greater than or equal to 67.1 belong to the fourth level of activation which showed they insisted on life style of self-health management even facing pressure. The Cronbach's α of the whole scale was 0.835. Guttman split-half reliability and retest reliability was 0.736 and 0.878 respectively. The content validity was 0.923 with it of each item ranging from 0.833 to 1. Exploratory factor analysis extracted four common factors which were renamed as the awareness of self-health management for disease, preoperative disease-related knowledge, postoperative prevention ability and the belief to insist on healthy life style transformation according to the rehabilitative characteristics of lumbar spinal fusion with 63.75% for the cumulative variance contribution rate. Spearman rank correlation coefficient in criterion-related validity was 0.689 between the Chinese version of PAM and the SEMCDS. Conclusions The Chinese version of PAM has good reliability and validity. It could be an assessment instrument of self-disease and health management activation for lumbar degenerative disease inpatients scheduled for lumbar spinal fusion in China. Clinic workers could preliminarily screen potential high-risk patients who may undergo unsatisfactory postoperative rehabilitation based on the level of activation and formulate individualized nursing intervention, reasonably distribute medical resources and improve patients satisfaction. Key words: Spinal fusion; Patient activation; Self-management; Reliability; Validity; Scale assessment