The structural and convergent validity of three commonly used measures of self-management in persons with neurological conditions
Self-management ability is commonly assessed in chronic disease research and clinical practice. The purpose of this study was to assess the structural and convergent validity of three commonly used self-management outcome measures in a sample of persons with neurological conditions.
We used data from a Canadian survey of persons with neurological conditions, which included three commonly used self-management measures: the Partners in Health Scale (PIH), the Patient Activation Measure (PAM), and the Self-Efficacy for Managing a Chronic Disease Scale (SEMCD). Confirmatory factor analysis was used to assess the structural and convergent validity of the three measures.
When treated as single-factor constructs, none of the measurement models provided a good fit to the data. A four-domain version of the PIH was the best fitting model. Confirmatory factor analysis suggests that the three tools measure different, but correlated constructs.
While the PAM, PIH and SEMCD scales are all used as measures of patient self-management, our study indicates that they measure different, but correlated latent variables. None, when treated as single, uni-dimensional construct, provides an acceptable fit to our data. This is probably because self-management is multi-dimensional, as is consistently shown by qualitative evidence. While these measures may provide reliable summative measures, multi-dimensional scales are needed for clinical use and more detailed research on self-management.
KeywordsSelf-management Self-care Patient activation Self-efficacy Confirmatory factor analysis Construct validity Structural validity Convergent validity
The funding was provided by Public Health Agency of Canada, Nova Scotia Health Research Foundation (Grant No. PSO-DI-2015-10083), Institute of Health Services and Policy Research.
- 1.Jonkman, N. H., Schuurmans, M. J., Groenwold, R. H. H., Hoes, A. W., & Trappenburg, J. C. A. (2016). Identifying components of self-management interventions that improve health-related quality of life in chronically ill patients: Systematic review and meta-regression analysis. Patient Education and Counselling, 99(7), 1087–1098.CrossRefGoogle Scholar
- 2.Jonkman, N. H., Westland, H., Groenwold, R. H. H., Ågren, S., Anguita, M., Blue, L., Bruggink-André de la Porte P. W. F., DeWalt, D. A., Hebert, P. L., Heisler, M., Jaarsma, T., Kempen, G. I. J. M., Leventhal, M. E., Lok, D. J. A., Mårtensson, J., Muñiz, J., Peters-Klimm, O. H., Rich, F., Riegel, M. W., Strömberg, B., Tsuyuki, A., Trappenburg, R. T., Schuurmans, J. C. A., Hoes, M. J. (2016). What are effective program characteristics of self-management interventions in patients with heart failure? An individual patient data meta-analysis. Journal of Cardiac Failure, 22(11), 861–871.CrossRefGoogle Scholar
- 3.Newham, J. J., Presseau, J., Heslop-Marshall, K., Russell, S., Ogunbayo, O. J., Netts, P., Hanratty, B., & Kaner, E. (2017). Features of self-management interventions for people with COPD associated with improved health-related quality of life and reduced emergency department visits: A systematic review and meta-analysis. International Journal of Chronic Obstructive Pulmonary Disease, 12, 1705–1720.CrossRefGoogle Scholar
- 4.Ogunbayo, O. J., Russell, S., Newham, J. J., Heslop-Marshall, K., Netts, P., Hanratty, B., & Kaner, E. (2017). Understanding the factors affecting self-management of COPD from the perspectives of healthcare practitioners: A qualitative study. NPJ Primary Care Respiritory Medicine, 27(1), 54.CrossRefGoogle Scholar
- 8.Packer, T. L., Fracini, A., Audulv, Å, Alizadeh, N., van Gaal, B. G. I., Warner, G., & Kephart, G. (2018). What we know about the purpose, theoretical foundation, scope and dimensionality of existing self-management measurement tools: A scoping review. Patient Education and Counselling, 101(4), 579–595.CrossRefGoogle Scholar
- 9.Corrigan, J. M., Adams, K., & Greiner, A. C. (2004). 1st annual crossing the quality chasm summit: A focus on communities. Washington, DC: National Academies Press.Google Scholar
- 20.Versnel, J., Packer, T., Weeks, L. E., Brown, J., Godwin, M., Hutchinson, S., Kephart, G., MacKenzie, D., Roger, K., Stadnyk, R., Villeneuve, M., & Warner, G. (2013). The everyday experience of living with and managing a neurological condition (the LINC study): Study design. BMC Neurology, 13, 30.CrossRefGoogle Scholar
- 22.Canada, P. H. A. O. (2014). Mapping Connections: An understanding of the neurological conditions in Canada. Ottawa: Government of Canada.Google Scholar
- 23.Raghunathan, T. E., Lepkowski, J. M., & Hoewyk, J. V. (2001). A multivariate technique for multiply imputing missing values using a sequence of regression models. Survey Methodology, 27(1), 85–96.Google Scholar
- 24.StataCorp. (2017). Stata Statistical Software: Release 15. College Station: StataCorp LP.Google Scholar
- 29.Brenk-Franz, K., Hibbard, J. H., Herrmann, W. J., Freund, T., Szecsenyi, J., Djalali, S., Steurer-Stey, C., Sönnichsen, A., Tiesler, F., Storch, M., Schneider, N., & Gensichen, J. (2013). Validation of the German version of the patient activation measure 13 (PAM13-D) in an international multicentre study of primary care patients. PLoS ONE, 8(9), e74786.CrossRefGoogle Scholar
- 32.Moreno-Chico, C., González-de Paz, L., Monforte-Royo, C., Arrighi, E., Navarro-Rubio, M. D., & Gallart Fernández-Puebla, A. (2017). Adaptation to European Spanish and psychometric properties of the patient activation measure 13 in patients with chronic diseases. Family Practice, 34(5), 627–634.CrossRefGoogle Scholar
- 35.Moljord, I. E. O., Lara-Cabrera, M. L., Perestelo-Pérez, L., Rivero-Santana, A., Eriksen, L., & Linaker, O. M. (2015). Psychometric properties of the patient activation measure-13 among out-patients waiting for mental health treatment: A validation study in Norway. Patient Education and Counselling, 98(11), 1410–1417.CrossRefGoogle Scholar
- 41.Brown, T. A. (2015). Confirmatory factor analysis for applied research. New York: Guilford.Google Scholar
- 44.Satorra, A.. Bentler, P. M. (1994). Corrections to test statistics and standard errors in covariance structure analysis. In von Eye A. & C. C. Clogg (Eds.), In Latent variables analysis: Applications for developmental research (pp. 399–419). Thousand Oaks: SageGoogle Scholar
- 48.Lenferink, A., Effing, T., Harvey, P., Battersby, M., Frith, P., van Beurden, W., et al. (2016). Construct validity of the Dutch version of the 12-item partners in health Scale: Measuring patient self-management behaviour and knowledge in patients with chronic obstructive pulmonary disease. PLoS ONE, 11(8), e0161595.CrossRefGoogle Scholar
- 50.Corbin, J. M., & Strauss, A. (1988). Unending work and care: Managing chronic illness at home. San Fransisco, CA: Jossey-Bass.Google Scholar
- 54.Jamieson, N. J., Hanson, C. S., Josephson, M. A., Gordon, E. J., Craig, J. C., Halleck, F., Budde, K., & Tong, A. (2016). Motivations, challenges, and attitudes to self-management in kidney transplant recipients: A systematic review of qualitative studies. American Journal of Kidney Diseases, 67(3), 461–478.CrossRefGoogle Scholar
- 55.Boehmer, K. R., Gionfriddo, M. R., Rodriguez-Gutierrez, R., Dabrh, A. M., Leppin, A. L., Hargraves, I., May, C. R., Shippee, N. D., Castaneda-Guarderas, A., Palacios, C. Z., Bora, P., Erwin, P., & Montori, V. M. (2016). Patient capacity and constraints in the experience of chronic disease: A qualitative systematic review and thematic synthesis. BMC Family Practice, 17, 127.CrossRefGoogle Scholar
- 56.Roberts, N. J., Kidd, L., Dougall, N., Patel, I. S., McNarry, S., & Nixon, C. (2016). Measuring patient activation: The utility of the patient activation measure within a UK context-results from four exemplar studies and potential future applications. Patient Education and Counselling, 99(10), 1739–1746.CrossRefGoogle Scholar
- 59.Smith, D., Lawn, S., Harvey, P., & Battersby, M. (2017). Concurrent validity of the Partners in Health scale against general self-rated health in chronic conditions: A short report. Chronic Illness. https://doi.org/10.1177/1742395317743559.