The structural and convergent validity of three commonly used measures of self-management in persons with neurological conditions

Abstract

Purpose Self-management ability is commonly assessed in chronic disease research and clinical practice. The purpose of this study was to assess the structural and convergent validity of three commonly used self-management outcome measures in a sample of persons with neurological conditions. Methods We used data from a Canadian survey of persons with neurological conditions, which included three commonly used self-management measures: the Partners in Health Scale (PIH), the Patient Activation Measure (PAM), and the Self-Efficacy for Managing a Chronic Disease Scale (SEMCD). Confirmatory factor analysis was used to assess the structural and convergent validity of the three measures. Results When treated as single-factor constructs, none of the measurement models provided a good fit to the data. A fourdomain version of the PIH was the best fitting model. Confirmatory factor analysis suggests that the three tools measure different, but correlated constructs. Conclusions While the PAM, PIH and SEMCD scales are all used as measures of patient self-management, our study indicates that they measure different, but correlated latent variables. None, when treated as single, uni-dimensional construct, provides an acceptable fit to our data. This is probably because self-management is multi-dimensional, as is consistently shown by qualitative evidence. While these measures may provide reliable summative measures, multi-dimensional scales are needed for clinical use and more detailed research on self-management.

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

“…PAM-13 validation studies were conducted also in a series of specific patient populations, including diabetes [37,84,85], metabolic syndrome [86], multiple sclerosis [87], neurological disorders [88,89], hypertension [37,85], cardiac conditions [90], schizophrenia [91], mental disorders [92], osteoarthritis [93][94][95], rheumatic diseases [37,96], HIV [97] or not specified chronic diseases [98][99][100], and clinical settings in different countries [101][102][103][104][105]. In some of these studies, convergent validity was assessed using generic and disease-specific measures of health-related attitudes or behaviours, such as self-efficacy [87,88,96,101], selfesteem [98], lifestyle [89] or health literacy [103,106]. For the assessment of convergent validity, we chose the eHEALS scale, a widely used measure of self-reported eHealth literacy that is strongly rooted in self-efficacy theory [19,42].…”

Protocol for development, calibration and validation of the Patient-Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC)

“…Evidence suggests that this tool is a reliable generic measure of self-management with evidence of construct validity. 24 …”

“…Evidence suggests that this tool is a reliable generic measure of selfmanagement with evidence of construct validity. 24 In addition to the SEMCD, individual TEDSS domains will be validated by examining associations with the known correlates of education, general and mental health (including number of chronic conditions) and/ or a measure of impact on everyday life (see table 2). Level of education (categorical) and number of chronic conditions will be extracted from collected demographic information.…”

“… 19 Yet, a scoping review conducted to understand the different instruments used to measure self-management found that 15 of 28 included self-management measures are unidimensional, providing only a single score. 20 While statistical evidence for the unidimensionality of some measures is documented, 21–23 this may result from limiting the focus to one domain of self-management 24 or from the use of insufficient statistical criteria such as principal components analysis or exploratory factor analysis. 25 Other measures, for example, the Partners in Health Scale, provide a single composite score but analyses provide strong evidence of underlying multidimensionality.…”

“… 25 Other measures, for example, the Partners in Health Scale, provide a single composite score but analyses provide strong evidence of underlying multidimensionality. 24 26 27 While the scoping review found that 13 of the 28 measures were multidimensional, none of them captured the range of domains important to patients, as identified by the TEDSS. 19 …”