Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA.
Department of Learning Sciences, School of Education and Social Policy, Northwestern University, Evanston, IL, USA.
Med Decis Making. 2018 Apr;38(3):334-343. doi: 10.1177/0272989X17753392. Epub 2018 Feb 13.
Although there has been increasing interest in patient engagement, few measures are publicly available and suitable for patients with limited health literacy.
We sought to develop a Consumer Health Activation Index (CHAI) for use among diverse patients.
Expert opinion, a systematic literature review, focus groups, and cognitive interviews with patients were used to create and revise a potential set of items. Psychometric testing guided by item response theory was then conducted among 301 English-speaking, community-dwelling adults. This included differential item functioning analyses to evaluate item performance across participant health literacy levels. To determine construct validity, CHAI scores were compared to scales measuring similar personality constructs. Associations between the CHAI and physical and mental health established predictive validity. A second study among 9,478 adults was used to confirm CHAI associations with health outcomes.
Exploratory factor analyses revealed a single-factor solution with a 10-item scale. The CHAI showed good internal consistency (alpha = 0.81) and moderate test-retest reliability (ICC = 0.53). Reading grade level was found to be at the 6 grade. Moderate to strong correlations were found with similar constructs (Multidimensional Health Locus of Control, r = 0.38, P < 0.001; Conscientiousness, r = 0.41, P < 0.001). Predictive validity was demonstrated through associations with functional health status measures (depression, r = -0.28, P < 0.001; anxiety, r = -0.22, P < 0.001; and physical functioning, r = 0.22, P < 0.001). In the validation sample, the CHAI was significantly associated with self-reported physical and mental health ( r = 0.31 and 0.32 respectively; both P < 0.001).
The CHAI appears to be a valid, reliable, and easily administered tool that can be used to assess health activation among adults, including those with limited health literacy. Future studies should test the tool in actual use and explore further applications.
尽管人们对患者参与的兴趣日益增加，但很少有措施是公开的，并且适合健康素养有限的患者。
我们旨在为不同患者开发一个消费者健康激活指数（CHAI）。
使用专家意见、系统文献回顾、焦点小组和患者认知访谈来创建和修改潜在的项目集。然后，使用项目反应理论指导的心理测量测试对 301 名讲英语的、居住在社区的成年人进行了测试。这包括差异项目功能分析，以评估项目在参与者健康素养水平上的表现。为了确定构念效度，将 CHAI 评分与测量相似人格结构的量表进行比较。CHAI 与身心健康之间的关联建立了预测效度。第二项针对 9478 名成年人的研究用于确认 CHAI 与健康结果的关联。
探索性因素分析显示，具有 10 个项目的单一因素解决方案。CHAI 表现出良好的内部一致性（α=0.81）和中等的重测信度（ICC=0.53）。阅读年级被认为是 6 年级。与相似结构（多维健康控制源，r=0.38，P<0.001；尽责性，r=0.41，P<0.001）之间存在中度到强相关性。通过与功能健康状况测量（抑郁，r=-0.28，P<0.001；焦虑，r=-0.22，P<0.001；和身体功能，r=0.22，P<0.001）的关联证明了预测效度。在验证样本中，CHAI 与自我报告的身心健康显著相关（r=0.31 和 0.32，均 P<0.001）。
CHAI 似乎是一种有效、可靠且易于管理的工具，可用于评估成年人的健康激活水平，包括健康素养有限的成年人。未来的研究应在实际使用中测试该工具，并探索进一步的应用。
