title: Factor structure of the autonomy preference index in people with severe mental illness.
abstract: People vary in the amount of control they want to exercise over decisions about their healthcare. Given the importance of patient-centered care, accurate measurement of these autonomy preferences is critical. This study aimed to assess the factor structure of the Autonomy Preference Index (API), used widely in general healthcare, in individuals with severe mental illness. Data came from two studies of people with severe mental illness (N=293) who were receiving mental health and/or primary care/integrated care services. Autonomy preferences were assessed with the API regarding both psychiatric and primary care services. Confirmatory factor analysis was used to evaluate fit of the hypothesized two-factor structure of the API (decision-making autonomy and information-seeking autonomy). Results indicated the hypothesized structure for the API did not adequately fit the data for either psychiatric or primary care services. Three problematic items were dropped, resulting in adequate fit for both types of treatment. These results suggest that with relatively minor modifications the API has an acceptable factor structure when asking people with severe mental illness about their preferences to be involved in decision-making. The modified API has clinical and research utility for this population in the burgeoning field of autonomy in patient-centered healthcare.
authors.affiliation: Psychology Department, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States; Assertive Community Treatment Center, Indianapolis, IN, United States. Electronic address: kbonfils@iupui.edu.
authors.forename: Kelsey A
authors.initials: KA
authors.lastname: Bonfils
authors.affiliation: Psychology Department, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States; Assertive Community Treatment Center, Indianapolis, IN, United States.
authors.forename: Erin L
authors.initials: EL
authors.lastname: Adams
authors.affiliation: Center for Psychiatric Rehabilitation, Boston University, Boston, MA, United States.
authors.forename: Kim T
authors.initials: KT
authors.lastname: Mueser
authors.affiliation: School of Social Work, University of Cincinnati, Cincinnati, OH, United States.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wright-Berryman
authors.affiliation: Psychology Department, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States; Assertive Community Treatment Center, Indianapolis, IN, United States.
authors.forename: Michelle P
authors.initials: MP
authors.lastname: Salyers
mesh_terms: D000328:Adult; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D008875:Middle Aged; D010358:Patient Participation / Q000379:methods / Q000523:psychology*; D018802:Patient-Centered Care / Q000379:methods; D026684:Personal Autonomy; D010865:Pilot Projects; D011320:Primary Health Care / Q000379:methods; D012720:Severity of Illness Index
keywords: Autonomy; Confirmatory factor analysis; Decision-making; Patient-centered care; Severe mental illness