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The mental-health patient-activation measure: assessing validity, reliability, and responsiveness in outpatient
Tatiana Skliarova1, Mariela L Lara-Cabrera2,3, Mathias Forsberg Brobakken4,5
1Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, NO-7491, Norway. tatiana.skliarova@ntnu.no.
Introduction:
The patient activation measure-mental health (PAM-MH) scale, adapted from the Patient Activation Measure-13 Items (PAM-13) developed in the United States, was designed to assess patient engagement and activation in mental health care. Despite initial validation of the PAM-MH in its original context, its applicability in other settings and its comparison to the gold standard PAM-13 remain unexplored. Furthermore, research addressing the face and construct validity of the PAM-MH is limited. This multi-phase study evaluated the face validity, construct validity, reliability and responsiveness of the PAM-MH in a Norwegian outpatient setting.
Methods:
A participatory approach was adopted to actively involve user representatives in validating the scale. The validation process consisted of four interconnected studies. In the first sub-study, user representatives were invited to contribute to establish face validity by providing quantitative feedback on the perceived value and burden of completing the PAM-MH. The second sub-study examined the construct validity. It was hypothesised that the PAM-MH measures the construct of patient activation and would therefore correlate with the PAM-13. This hypothesis was tested using Pearson's r in a sample of 55 outpatients. The third sub-study evaluated test-retest reliability (via ICC) and internal consistency (using Cronbach's α), in a sample of 27 outpatients who completed the PAM-MH on two separate occasions. The final sub-study explored the responsiveness of the scale to change, guided by predefined hypotheses, in a sample of 11 outpatients.
Results:
Adequate acceptability was established from users' views of the value and burden of the scale (overall mean "value" score was 59.7% and mean "burden" was 39.6%). All hypotheses, established a priori for construct validity, reliability, and responsiveness-to-change, were confirmed.
Conclusion:
This multi-phase study employed a participatory approach to validate the PAM-MH in a Norwegian outpatient context. Preliminary results demonstrated satisfactory face validity and construct validity, along with good reliability and responsiveness-to-change. The findings suggest that the PAM-MH is both valid and reliable, making it a suitable questionnaire to measure patient activation in a Norwegian outpatient setting.
