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. 2018 Apr;38(3):334-343.
doi: 10.1177/0272989X17753392. Epub 2018 Feb 13.

Development and Validation of the Consumer Health Activation Index

Michael S Wolf  1   2 , Samuel G Smith  1   3 , Anjali U Pandit  1 , David M Condon  4 , Laura M Curtis  1 , James Griffith  4 , Rachel O'Conor  1 , Steven Rush  5 , Stacy C Bailey  6 , Gordon Kaplan  7 , Vincent Haufle  7 , David Martin  5
Affiliations

Development and Validation of the Consumer Health Activation Index

Michael S Wolf et al. Med Decis Making. 2018 Apr.

Abstract

Background: Although there has been increasing interest in patient engagement, few measures are publicly available and suitable for patients with limited health literacy.

Objective: We sought to develop a Consumer Health Activation Index (CHAI) for use among diverse patients.

Methods: 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.

Results: 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 6th 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).

Conclusions: 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.

Keywords: engagement; health; healthcare; literacy; measurement; patient activation.

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References

    1. Weil AR. The patient engagement Imperative. Health Aff. 2016;35:563. - PubMed
    1. Institute of Medicine. Partnering with patients to drive shared decisions, better value, and care improvement: workshop proceedings. Washington D.C.: National Academies Press; 2014. - PubMed
    1. Bloomrosen M, Sennett C. Patient engagement: challenges and opportunities for physicians. Ann Allergy Asthma Immunol. 2015;115:459–62. - PubMed
    1. Congress US. Patient Protection and Affordable Care Act HR 35902010
    1. Services CfMM. Engaging Patients in their Health Care. http://www.cms.gov/eHealth/ListServ_Stage2_EngagingPatients.html. Accessed June 8, 2016.

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