How to Measure Population Health: An Exploration Toward an Integration of Valid and Reliable Instruments

Abstract

Population health management initiatives are introduced to transform health and community services by implementing interventions that combine various services and address the continuum of health and well-being of populations. Insight is required into a population's health to evaluate implementation of these initiatives. This study aims to determine the performance of commonly used instruments for measuring a population's experienced health and explores the assessed concepts of population health. Survey-based Short Form 12, version 2 (SF12, health status), Patient Activation Measure 13 (PAM13), and Kessler 10 (K10, psychological distress) data of 3120 respondents was used. Floor/ceiling effects were studied using descriptive statistics. Validity was assessed using factor and discriminant analyses, and reliability was assessed using Cronbach α. Finally, to study covered concepts, exploratory factor analyses (EFAs) were conducted, which included additional surveyed characteristics. The SF12 and PAM13 sum scores showed acceptable averages and distributions, while results of the K10 indicated a floor effect. SF12 and K10 measured their expected constructs, while PAM13 did not. The EFA of PAM13 displayed 1 instead of the expected 4 constructs. Reliability was good for all instruments (α 0.89-0.93). The overall EFA identified 4 concepts: mental, physical ability, lifestyle, and self-management. SF12 and PAM13, combined with lifestyle characteristics, are shown to provide insightful information to measure the physical, mental, lifestyle, and self-management concepts of population health. Future research should include additional instruments that cover new aspects introduced by recent definitions of health.

Keywords: Triple Aim; evaluation; population health; population management.