Rasch analysis on the patient activation measure among people with spinal cord injury in China.

Abstract

Cross-sectional study. This study has three objectives: 1. to examine the validity of American Patient Activation Measure short form (PAM-13) in China by using Rasch measurement model; 2. to identify the PAM-13 items' difficulty/challenge in relation to the patient activation level among people with chronic spinal cord injury (SCI); 3. to find out the potential item bias in Chinese social environment. Shanghai Sunshine Rehabilitation Center (SSRC), China. Participants were 284 individuals who had at least one-half year post SCI in China. We did Principal Component Analysis and Confirmatory Factor Analysis to examine the PAM-13's unidimensionality and applied the Rasch analysis with maximum likelihood estimation by using WINSTEPS. The study found PAM-13 has satisfied all the validity criteria, and it can successfully separate participants into four distinct strata of patient activation. The most challenging items of PAM-13 were those related to confidence in taking action to address medical treatment or health problems, while the least challenging items were those reflecting general opinions. The item 1 has different interpretations between urban and rural residents in China. Our study demonstrated the metric validity of the PAM-13 for assessing patient activation among people with SCI in China. However, caution is needed when comparing results across different cultural or social groups, as interpretations of self-reported items may differ.