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. 2022 Nov;23(8):1341-1355.
doi: 10.1007/s10198-022-01434-0. Epub 2022 Jan 31.

Validation of the PAM-13 instrument in the Hungarian general population 40 years old and above

Zsombor Zrubka  1   2 , Péter Vékás  3 , Péter Németh  4 , Ágota Dobos  5 , Ottó Hajdu  6 , Levente Kovács  7 , László Gulácsi  7   8 , Judith Hibbard  9 , Márta Péntek  7
Affiliations

Validation of the PAM-13 instrument in the Hungarian general population 40 years old and above

Zsombor Zrubka et al. Eur J Health Econ. 2022 Nov.

Abstract

Background: Patient activation comprises the skills, knowledge and motivation necessary for patients' effective contribution to their care. We adapted and validated the 13-item Patient Activation Measure (PAM-13) in the ≥ 40 years old Hungarian general population.

Methods: A cross-sectional web survey was conducted among 900 respondents selected from an online panel via quota sampling. After 10 days, the survey was repeated on 100 respondents. The distribution, internal consistency, test-retest reliability, factor structure, convergent, discriminant and known-groups validity of PAM-13 were assessed according to the COSMIN guidelines.

Results: The sample comprised 779 respondents. Mean (± SD) age was 60.4 ± 10.6 years, 54% were female and 67% had chronic illness. Mean (± SD) PAM-13 score was 60.6 ± 10.0. We found good internal consistency (Cronbach alpha: 0.77), moderate test-retest reliability (ICC: 0.62; n = 75), a single-factor structure and good content validity: PAM-13 showed moderate correlation with the eHealth Literacy Scale (r = 0.40), and no correlation with age (r = 0.02), education (r = 0.04) or income (ρ = 0.04). Higher PAM-13 scores were associated with fewer lifestyle risks (p < 0.001), more frequent health information seeking (p < 0.001), participation in patient education (p = 0.018) and various online health-related behaviours. When controlling for health literacy, sociodemographic factors and health status, the association of higher PAM-13 scores with overall fewer lifestyle risks, normal body mass index, physical activity and adequate diet remained significant. Similar properties were observed in the subgroup of participants with chronic morbidity, but not in the age group 65+.

Conclusion: PAM-13 demonstrated good validity in the general population. Its properties in clinical populations and the elderly as well as responsiveness to interventions warrant further research.

Keywords: Health literacy; I10; Lifestyle-related risks; Online survey; PAM-13; Patient activation; Psychometric validation; eHEALS.

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Conflict of interest statement

Financial interests: In connection with writing the manuscript, ZZ, PV, PN, ÁD, OH, LG and MP have received financial support from project no. TKP2020-NKA-02 of the National Research, Development and Innovation Fund of Hungary, financed under the Tématerületi Kiválósági Program funding scheme at Corvinus University of Budapest. During writing this article, ZZ has received funding from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant agreement No 679681). MP has received funding from Project no. 2019-1.3.1-KK-2019-00007 implemented with the support provided from the National Research, Development and Innovation Fund of Hungary, financed under the 2019-1.3.1-KK funding scheme. PV has received funding from the National Research, Development and Innovation Office (FK-132343) Health Economics Research Center. Non-financial interests: MP is member of the EuroQol Group, a not-for-profit organisation that develops and distributes instruments that assess and value health. KNIA has no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Adjusted probability of lifestyle-related risks at various PAM-13 levels in the entire sample. PBS preventive behaviour score, LRI lifestyle risk index, BMI body mass index
Fig. 2
Fig. 2
Adjusted probability of lifestyle-related risks at various PAM-13 levels in the subgroup with chronic morbidity. PBS preventive behaviour score, LRI lifestyle risk index, BMI body mass index
Fig. 3
Fig. 3
Adjusted probability of lifestyle-related risks at various PAM-13 levels in the 65+ subgroup. PBS preventive behaviour score, LRI lifestyle risk index, BMI body mass index
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