Ngooi Bi Xia, Packer Tanya L, Kephart George, Warner Grace, Koh Karen Wei Ling, Wong Raymond Ching Chiew, Lim Serene Peiying
Department of Rehabilitation, National University Hospital, 5 Lower Kent Ridge Road, Main Building 1, Level 1, Singapore, 119074, Singapore.
School of Occupational Therapy, Dalhousie University, Room 214 Forrest Building, 5869 University Ave, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada.
Qual Life Res. 2017 Apr;26(4):1071-1080. doi: 10.1007/s11136-016-1412-5. Epub 2016 Sep 19.
The Patient Activation Measure (PAM-13) measures patients' knowledge, skill, and confidence in chronic condition self-management. The purpose of this study was to assess the validity of PAM-13 (English version) among English-speaking adults with cardiac conditions in Singapore.
A cross-sectional study was conducted in a convenient sample of 270 heart clinic patients. Using the unitary concept of validity, evidence of (1) internal structure via data quality, unidimensionality, differential item functioning, and internal consistency, (2) response process through item difficulty and item fit using Rasch modeling, and (3) relationship to other variables via correlations with depression and self-efficacy were examined.
The item response was high with only one missing answer. All items had a small floor effect, but nine out of 13 items had a ceiling effect larger than 15 %. Cronbach's α was 0.86, and average inter-item correlations was 0.324. Results suggested unidimensionality; however, differences in item difficulty ranking were found. A low, negative correlation was found with depression, while a moderate, positive correlation was found with self-efficacy.
Evidence in all three areas of validity were mixed. Caution should be exercised when using categorical activation "level" to inform clinical decisions.
患者激活量表（PAM - 13）用于测量患者在慢性病自我管理方面的知识、技能和信心。本研究旨在评估PAM - 13（英文版）在新加坡讲英语的心脏病成年患者中的有效性。
对270名心脏科门诊患者的便利样本进行了横断面研究。运用效度的单一概念，考察了以下方面的证据：（1）通过数据质量、单维度性、项目功能差异和内部一致性来评估内部结构；（2）使用Rasch模型通过项目难度和项目拟合来评估反应过程；（3）通过与抑郁和自我效能的相关性来考察与其他变量的关系。
项目回答率很高，只有一个缺失答案。所有项目都有较小的地板效应，但13个项目中有9个项目的天花板效应大于15%。Cronbach's α为0.86，平均项目间相关性为0.324。结果表明具有单维度性；然而，发现项目难度排名存在差异。与抑郁呈低负相关，与自我效能呈中等正相关。
效度的所有三个方面的证据参差不齐。在使用分类激活“水平”为临床决策提供依据时应谨慎。
