Quality of Life Research

, Volume 26, Issue 4, pp 1071–1080

Validation of the Patient Activation Measure (PAM-13) among adults with cardiac conditions in Singapore

  • Bi Xia Ngooi
  • Tanya L. Packer
  • George Kephart
  • Grace Warner
  • Karen Wei Ling Koh
  • Raymond Ching Chiew Wong
  • Serene Peiying Lim

DOI: 10.1007/s11136-016-1412-5

Cite this article as:
Ngooi, B.X., Packer, T.L., Kephart, G. et al. Qual Life Res (2017) 26: 1071. doi:10.1007/s11136-016-1412-5



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.


Patient Activation Measure Cardiac Singapore Chronic disease Self-management Validation 

Funding information

Funder NameGrant NumberFunding Note
Singapore Association of Occupational Therapists
  • SAOT/RG01/2015

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of RehabilitationNational University HospitalSingaporeSingapore
  2. 2.School of Occupational TherapyDalhousie UniversityHalifaxCanada
  3. 3.Department of Community Health and EpidemiologyDalhousie UniversityHalifaxCanada
  4. 4.Department of NursingNational University HospitalSingaporeSingapore
  5. 5.Department of CardiologyNational University Heart CentreSingaporeSingapore

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