title: Validation of the Patient Activation Measure (PAM-13) among adults with cardiac conditions in Singapore.
abstract: The Patient Activation Measure (PAM-13) measures patients' knowledge, skill, and confidence in chronic condition self-management. The purpose of this study was to assess the validity of PAM-13 (English version) among English-speaking adults with cardiac conditions in Singapore.
  
  
  
  A cross-sectional study was conducted in a convenient sample of 270 heart clinic patients. Using the unitary concept of validity, evidence of (1) internal structure via data quality, unidimensionality, differential item functioning, and internal consistency, (2) response process through item difficulty and item fit using Rasch modeling, and (3) relationship to other variables via correlations with depression and self-efficacy were examined.
  
  
  
  The item response was high with only one missing answer. All items had a small floor effect, but nine out of 13 items had a ceiling effect larger than 15 %. Cronbach's α was 0.86, and average inter-item correlations was 0.324. Results suggested unidimensionality; however, differences in item difficulty ranking were found. A low, negative correlation was found with depression, while a moderate, positive correlation was found with self-efficacy.
  
  
  
  Evidence in all three areas of validity were mixed. Caution should be exercised when using categorical activation "level" to inform clinical decisions.
authors.affiliation: Department of Rehabilitation, National University Hospital, 5 Lower Kent Ridge Road, Main Building 1, Level 1, Singapore, 119074, Singapore. Bi_Xia_NGOOI@nuhs.edu.sg.|School of Occupational Therapy, Dalhousie University, Room 214 Forrest Building, 5869 University Ave, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada. Bi_Xia_NGOOI@nuhs.edu.sg.
authors.forename: Bi Xia
authors.identifier: 0000-0002-2528-181X
authors.initials: BX
authors.lastname: Ngooi
authors.affiliation: School of Occupational Therapy, Dalhousie University, Room 214 Forrest Building, 5869 University Ave, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada.
authors.forename: Tanya L
authors.initials: TL
authors.lastname: Packer
authors.affiliation: Department of Community Health and Epidemiology, Dalhousie University, Centre for Clinical Research, Room 416, 5790 University Ave, Halifax, NS, B3H 1V7, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Kephart
authors.affiliation: School of Occupational Therapy, Dalhousie University, Room 214 Forrest Building, 5869 University Ave, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada.
authors.forename: Grace
authors.initials: G
authors.lastname: Warner
authors.affiliation: Department of Nursing, National University Hospital, 5 Lower Kent Ridge Wing, Singapore, 119074, Singapore.
authors.forename: Karen Wei Ling
authors.initials: KW
authors.lastname: Koh
authors.affiliation: Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Wing, Singapore, 119074, Singapore.
authors.forename: Raymond Ching Chiew
authors.initials: RC
authors.lastname: Wong
authors.affiliation: Department of Rehabilitation, National University Hospital, 5 Lower Kent Ridge Road, Main Building 1, Level 1, Singapore, 119074, Singapore.
authors.forename: Serene Peiying
authors.initials: SP
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006331:Heart Diseases / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D011594:Psychometrics; D011788:Quality of Life; D015203:Reproducibility of Results; D012648:Self Care; D012846:Singapore; D012959:Socioeconomic Factors
keywords: Cardiac; Chronic disease; Patient Activation Measure; Self-management; Singapore; Validation