title: Psychometric assessment of the patient activation measure short form (PAM-13) in rural settings.
abstract: OBJECTIVE
  The patient activation measure short form (PAM-13) assesses patients' self-reported health management skills, knowledge, confidence, and motivation. We used item response theory to evaluate the psychometric properties of the PAM-13 utilized in rural settings.
  
  
  METHODS
  A Rasch partial credit model analysis was conducted on the PAM-13 instrument using a sample of 812 rural patients recruited by providers and our research staff. Specially, we examined dimensionality, item fit, and quality of measures, category response curves, and item differential functioning. Convergent and divergent validities were also examined.
  
  
  RESULTS
  The PAM-13 instrument has excellent convergent and divergent validities. It is fairly unidimensional, and all items fit the Rasch model well. It has relatively high person and item reliability indices. Majority of the items were free of item differential functioning. There were, however, some issues with ceiling effects. Additionally, there was a lack of responses for category one across all items.
  
  
  CONCLUSIONS
  Patient activation measure short form (PAM-13) performs well in some areas, but not all. In general, more items need to be added to cover the upper end of the trait. The four response categories of PAM-13 should be collapsed into three.
authors.affiliation: Department of Orthopaedic Surgery Operations, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA. Man.Hung@hsc.utah.edu
authors.forename: Man
authors.initials: M
authors.lastname: Hung
authors.forename: Marjorie
authors.initials: M
authors.lastname: Carter
authors.forename: Candace
authors.initials: C
authors.lastname: Hayden
authors.forename: Rhonda
authors.initials: R
authors.lastname: Dzierzon
authors.forename: Jose
authors.initials: J
authors.lastname: Morales
authors.forename: Laverne
authors.initials: L
authors.lastname: Snow
authors.forename: Jorie
authors.initials: J
authors.lastname: Butler
authors.forename: Kim
authors.initials: K
authors.lastname: Bateman
authors.forename: Matthew
authors.initials: M
authors.lastname: Samore
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057286:Electronic Health Records; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D055991:Health Records, Personal; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010361:Patients; D011594:Psychometrics / Q000295:instrumentation* / Q000706:statistics & numerical data; D011788:Quality of Life; D015203:Reproducibility of Results; D012424:Rural Population; D012648:Self Care / Q000592:standards*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires / Q000592:standards*; D014589:Utah