title: Measuring patient activation in Italy: Translation, adaptation and validation of the Italian version of the patient activation measure 13 (PAM13-I).
abstract: BACKGROUND
  The Patient Activation Measure (PAM13) is an instrument that assesses patient knowledge, skills, and confidence for disease self-management. This cross-sectional study was aimed to validate a culturally-adapted Italian Patient Activation Measure (PAM13-I) for patients with chronic conditions.
  
  
  METHODS
  519 chronic patients were involved in the Italian validation study and responded to PAM13-I. The PAM 13 was translated into Italian by a standardized forward-backward translation. Data quality was assessed by mean, median, item response, missing values, floor and ceiling effects, internal consistency (Cronbach's alpha and average inter-item correlation), item-rest correlations. Rasch Model and differential item functioning assessed scale properties.
  
  
  RESULTS
  Mean PAM13-I score was 66.2. Rasch analysis showed that the PAM13-I is a good measure of patient activation. The level of internal consistency was good (α = 0.88). For all items, the distribution of answers was left-skewed, with a small floor effect (range 1.7-4.5 %) and a moderate ceiling effect (range 27.6-55.0 %). The Italian version formed a unidimensional, probabilistic Guttman-like scale explaining 41 % of the variance.
  
  
  CONCLUSIONS
  The PAM13-I has been demonstrated to be a valid and reliable measure of patient activation and the present study suggests its applicability to the Italian-speaking chronic patient population. The measure has good psychometric properties and appears to be consistent with the developmental nature of the patient activation phenomenon, although it presents a different ranking order of the items comparing to the American version. PAM13-I can be a useful assessment tool to evaluate interventions aimed at improving patient engagement in healthcare and to train doctors in attuning their communication to the level of patients' activation. Future research could be conducted to further confirm the validity of the PAM13-I.
authors.affiliation: Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.
authors.forename: Guendalina
authors.initials: G
authors.lastname: Graffigna
authors.affiliation: Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy. serena.barello@unicatt.it.|Faculty of Psychology, Università Cattolica del Sacro Cuore, L.go Gemelli 1, Milan, 20123, Italy. serena.barello@unicatt.it.
authors.forename: Serena
authors.initials: S
authors.lastname: Barello
authors.affiliation: Department of Statistical Sciences, Università Cattolica del Sacro Cuore, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bonanomi
authors.affiliation: Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Lozza
authors.affiliation: Department of Planning, Public Policy, and Management, University of Oregon, Eugene, USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Hibbard
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000628:therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000706:statistics & numerical data*; D011594:Psychometrics / Q000295:instrumentation*; D015203:Reproducibility of Results; D012648:Self Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires / Q000592:standards*