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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.

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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.

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Correspondence to George Kephart.



See Tables 8, 9, 10 and 11.

Table 8 Item wordings for the PAM, PIH and SEMCD
Table 9 Distribution of PIH Item Scores
Table 10 Distribution of PAM Item Scores
Table 11 Distribution of SEMCD Item Scores

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Kephart, G., Packer, T.L., Audulv, Å. et al. The structural and convergent validity of three commonly used measures of self-management in persons with neurological conditions. Qual Life Res 28, 545–556 (2019).

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  • Self-management
  • Self-care
  • Patient activation
  • Self-efficacy
  • Confirmatory factor analysis
  • Construct validity
  • Structural validity
  • Convergent validity