VALIDATION OF THE PATIENT ACTIVATION MEASURE (PAM-13) AMONG ADULTS WITH CARDIAC CONDITIONS IN SINGAPORE: A MIXED METHODS STUDY

Abstract

The purpose of this study was to validate the Patient Activation Measure (PAM-13) among English-speaking cardiac patients in Singapore. A concurrent mixed methods design was utilized. The quantitative approach was conducted in a convenient sample of 270 heart clinic patients. The qualitative approach utilized cognitive interviews in a smaller purposive sample (n=13). Our results suggest that PAM-13 has good internal consistency and item fit, acceptable unidimensionality and moderate correlation with self-efficacy in this population. However, under-utilization of the ‘strongly disagree’ response category, poor separation distances and unexpected item difficulty ranking pose potential problems. The interviews offered insights into reasons for these findings. We suggest that PAM-13 can be used in combination with clinical judgement to explore patient activation and self-management practices. To improve clinical usefulness in Singapore, we recommend: 1) culturally adapt instruments even when language translation is not required, and 2) consider response categories with a wider Likert scale.