title: Cross-cultural validation of the parent-patient activation measure in low income Spanish- and English-speaking parents.
abstract: (1) To measure healthcare activation among low-income parents by language (English/Spanish); and (2) to assess the psychometrics of the Parent-Patient Activation Measure (P-PAM) in the study population.
  
  
  
  We surveyed parents/guardians of publicly-insured children who were established patients at a pediatrics clinic for ≥6months. Surveys included the Parent-Patient Activation Measure (P-PAM), a 13-item measure adapted from the well-validated Patient Activation Measure (PAM).
  
  
  
  Of 316 surveys, 68% were completed in Spanish. Mean activation score in the English-language survey group was 79.1 (SD 16.2); mean score in the Spanish-language group was 70.7 (SD 17.9) (p<0.001). Scale reliability was high (English α=0.90; Spanish α=0.93). The P-PAM had acceptable test-retest reliability, but no previously reported PAM factor structure fit the study data adequately for either language.
  
  
  
  Healthcare activation among low-income parents was greater for parents surveyed in English compared with those surveyed in Spanish. The P-PAM has acceptable reliability and validity in English and Spanish, but a different factor structure than the PAM.
  
  
  
  Activation as measured by the P-PAM may not have the same associations with or impact on health/healthcare outcomes in pediatrics compared with adults owing to possible measure differences between the P-PAM and PAM.
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: ldecamp1@jhmi.edu.
authors.forename: Lisa Ross
authors.initials: LR
authors.lastname: DeCamp
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: kleifhe1@jhmi.edu.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Leifheit
authors.affiliation: Johns Hopkins University School of Medicine Baltimore, MD, USA. Electronic address: hshah15@jhmi.edu.
authors.forename: Harita
authors.initials: H
authors.lastname: Shah
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: dvalenz1@jhmi.edu.
authors.forename: Doris
authors.initials: D
authors.lastname: Valenzuela-Araujo
authors.affiliation: Johns Hopkins University School of Nursing Baltimore, MD, USA. Electronic address: esloand1@jhu.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sloand
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: spolk@jhmi.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Polk
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: tcheng2@jhmi.edu.
authors.forename: Tina L
authors.initials: TL
authors.lastname: Cheng
mesh_terms: D000328:Adult; D002648:Child; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005260:Female; D057220:Health Literacy; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D007802:Language; D008297:Male; D010290:Parents / Q000523:psychology*; D010358:Patient Participation; D011203:Poverty; D011594:Psychometrics / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards*; D014505:Urban Population
keywords: Disparities; Latino; Limited english proficiency; Patient engagement; Pediatrics; Primary care