Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers.
BACKGROUND
Controlling costs and achieving health care quality improvements require the participation of activated and informed consumers and patients.


OBJECTIVE
We describe a process for conceptualizing and operationalizing what it means to be "activated" and delineate the process we used to develop a measure for assessing "activation," and the psychometric properties of that measure.


METHODS
We used the convergence of the findings from a national expert consensus panel and patient focus groups to define the concept and identify the domains of activation. These domains were operationalized by constructing a large item pool. Items were pilot-tested and initial psychometric analysis performed using Rasch methodology. The third stage refined and extended the measure. The fourth stage used a national probability sample to assess the measure's psychometric performance overall and within different subpopulations.


METHODS
Convenience samples of patients with and without chronic illness, and a national probability sample (N=1,515) are included at different stages in the research.


CONCLUSIONS
The Patient Activation Measure is a valid, highly reliable, unidimensional, probabilistic Guttman-like scale that reflects a developmental model of activation. Activation appears to involve four stages: (1) believing the patient role is important, (2) having the confidence and knowledge necessary to take action, (3) actually taking action to maintain and improve one's health, and (4) staying the course even under stress. The measure has good psychometric properties indicating that it can be used at the individual patient level to tailor intervention and assess changes.
Hibbard
Judith H
JH
Department of Planning, Public Policy, and Management, University of Oregon, Eugene 97403-1209, USA.
Stockard
Jean
J
Mahoney
Eldon R
ER
Tusler
Martin
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D010353:Patient Education as Topic / Q000379:methods; D010358:Patient Participation / Q000706:statistics & numerical data; D010865:Pilot Projects; D011322:Primary Prevention / Q000379:methods; D011594:Psychometrics; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards*; D013997:Time Factors; D014481:United States