Institute for General Practice and Interprofessional Care, Faculty of Medicine Tuebingen, University Hospital, Tuebingen, Germany.
Institute for Clinical Epidemiology and Applied Biostatistics, University Hospital of Tuebingen, Tuebingen, Germany.
Health Qual Life Outcomes. 2024 May 20;22(1):39. doi: 10.1186/s12955-024-02255-w.
Accurate assessment and enhancement of health-related skills among oncology patients are pivotal for optimizing cancer care. The Patient Activation Measure (PAM-13), a questionnaire designed to reflect an individual's knowledge, skills, and confidence in self-healthcare management, has been validated across diverse countries and settings. Concerns have been raised regarding the cross-situational applicability, as patients with specific diseases and cultural backgrounds interpret questionnaire items differently. This study aimed to examine the structural validity and psychometric properties of the PAM-13 in an oncological patient cohort.
Baseline data from a longitudinal non-randomized controlled study involving cancer out-patients (n = 1,125) from Comprehensive Cancer Centres in Southern Germany were analysed. The German version of the PAM-13 was employed. With classical test and item response theory methods data quality, reliability, convergent and structural validity, as well as psychometric properties were assessed. Exploratory (EFA) and confirmatory factor analyses (CFA) were employed to investigate the postulated unidimensionality of the underlying construct. With a partial credit model (PCM) we examined item fit, targeting, local independence and differential item functioning.
Participants were predominantly female (73.0%) with a breast cancer diagnosis (41.3%). While items were generally well-accepted, ceiling effects were observed and a high mean PAM-13 score (69.7, SD = 14.2) was noted, potentially compromising responsiveness to interventions. Reliability was adequate (Cronbach's α = 0.81), person and item separation reliability were good to excellent (0.81 and 0.99, respectively). Explorations of the unidimensionality of the construct (EFA, CFA, PCM) yielded inconclusive results, hinting towards a two-factor solution. Item difficulty rankings deviated from the original. No differential item functioning was identified, and local independence was confirmed.
While the PAM-13 serves as a valuable instrument for comprehending and promoting health-related skills in cancer patients, the identification of ceiling effects, disordered item-difficulty rankings, and inconclusive findings regarding unidimensionality contribute to the expanding body of evidence, emphasizing the dependency of PAM-13's validity and reliability on distinctive characteristics within the population under investigation. Future research should prioritize refining or adding PAM-13 items to better capture the specific health-related challenges within diverse populations, paving the way for more effective patient engagement strategies in oncology.
DRKS00021779.
准确评估和提高肿瘤患者的健康相关技能对于优化癌症护理至关重要。患者激活量表（PAM-13）是一种旨在反映个体在自我医疗保健管理方面的知识、技能和信心的问卷，已在不同国家和环境中得到验证。人们担心，具有特定疾病和文化背景的患者会对问卷项目有不同的解释，因此该量表在不同情况下的适用性存在问题。本研究旨在检验 PAM-13 在肿瘤患者队列中的结构效度和心理测量特性。
对德国南部综合癌症中心的癌症门诊患者（n=1125）进行的一项纵向非随机对照研究的基线数据进行了分析。采用德语版的 PAM-13。采用经典测试和项目反应理论方法评估数据质量、信度、收敛和结构效度以及心理测量特性。采用探索性（EFA）和验证性因素分析（CFA）来研究假设的潜在单一维度结构。采用部分信用模型（PCM）检查项目拟合、目标、局部独立性和差异项目功能。
参与者主要为女性（73.0%），乳腺癌诊断（41.3%）。虽然项目总体上被很好地接受，但观察到天花板效应，并且 PAM-13 评分较高（69.7，SD=14.2），这可能会影响对干预措施的反应性。信度适中（克朗巴赫的α=0.81），个体和项目分离信度良好至极好（分别为 0.81 和 0.99）。对结构单一性的探索（EFA、CFA、PCM）结果不确定，提示存在两因素解决方案。项目难度排名与原始排名不同。未发现差异项目功能，局部独立性得到确认。
虽然 PAM-13 是一种理解和促进癌症患者健康相关技能的有价值工具，但识别出天花板效应、无序项目难度排名以及关于单一性的不确定发现，为该工具的有效性和可靠性在受调查人群中的独特特征方面的扩展证据做出了贡献。未来的研究应优先考虑改进或添加 PAM-13 项目，以更好地捕捉不同人群中特定的健康相关挑战，为肿瘤学中的更有效的患者参与策略铺平道路。
DRKS00021779。
