Skip to main content

Advertisement

SpringerLink
Log in

Measuring chronic condition self-management in an Australian community: factor structure of the revised Partners in Health (PIH) scale

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the factor structure of the revised Partners in Health (PIH) scale for measuring chronic condition self-management in a representative sample from the Australian community.

Methods

A series of consultations between clinical groups underpinned the revision of the PIH. The factors in the revised instrument were proposed to be: knowledge of illness and treatment, patient–health professional partnership, recognition and management of symptoms and coping with chronic illness. Participants (N = 904) reporting having a chronic illness completed the revised 12-item scale. Two a priori models, the 4-factor and bi-factor models were then evaluated using Bayesian confirmatory factor analysis (BCFA). Final model selection was established on model complexity, posterior predictive p values and deviance information criterion.

Results

Both 4-factor and bi-factor BCFA models with small informative priors for cross-loadings provided an acceptable fit with the data. The 4-factor model was shown to provide a better and more parsimonious fit with the observed data in terms of substantive theory. McDonald’s omega coefficients indicated that the reliability of subscale raw scores was mostly in the acceptable range.

Conclusion

The findings showed that the PIH scale is a relevant and structurally valid instrument for measuring chronic condition self-management in an Australian community. The PIH scale may help health professionals to introduce the concept of self-management to their patients and provide assessment of areas of self-management. A limitation is the narrow range of validated PIH measurement properties to date. Further research is needed to evaluate other important properties such as test–retest reliability, responsiveness over time and content validity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Goldman, M. L., Spaeth-Rublee, B., & Pincus, H. (2015). Quality indicators for physical and behavioral health care integration. JAMA, 314(8), 769–770. doi:10.1001/jama.2015.6447.

    Article  CAS  PubMed  Google Scholar 

  2. Bauer, U. E., Briss, P. A., Goodman, R. A., & Bowman, B. A. (2014). Prevention of chronic disease in the 21st century: Elimination of the leading preventable causes of premature death and disability in the USA. The Lancet, 384(9937), 45–52.

    Article  Google Scholar 

  3. AIHW (Australian Institute of Health and Welfare). (2012). Australia’s health 2012. Canberra: AIHW.

    Google Scholar 

  4. AIHW. (2011). Key indicators of progress for chronic disease and associated determinants: Data report. Canberra: AIHW.

    Google Scholar 

  5. Battersby, M. W., Beattie, J., Pols, R. G., Smith, D. P., Condon, J., & Blunden, S. (2013). A randomised controlled trial of the Flinders Program™ of chronic condition management in Vietnam veterans with co-morbid alcohol misuse, and psychiatric and medical conditions. Australian and New Zealand Journal of Psychiatry, 47(5), 451–462. doi:10.1177/0004867412471977.

    Article  PubMed  Google Scholar 

  6. Battersby, M., Harris, M., Smith, D., Reed, R., & Woodman, R. (2015). A pragmatic randomized controlled trial of the Flinders Program of chronic condition management in community health care services. Patient Education and Counseling, 98(11), 1367–1375.

    Article  PubMed  Google Scholar 

  7. Battersby, M. W., Kit, J. A., Prideaux, C., Harvey, P. W., Collins, J. P., & Mills, P. D. (2008). Research implementing the Flinders Model of Self-management Support with Aboriginal people who have diabetes: Findings from a pilot study. Australian Journal of Primary Health, 14(1), 66–74.

    Article  Google Scholar 

  8. Lorig, K. R., Sobel, D. S., Ritter, P. L., Laurent, D., & Hobbs, M. (2000). Effect of a self-management program on patients with chronic disease. Effective Clinical Practice: ECP, 4(6), 256–262.

    Google Scholar 

  9. Battersby, M. W., Ask, A., Reece, M. M., Markwick, M. J., & Collins, J. P. (2003). The Partners in Health scale: The development and psychometric properties of a generic assessment scale for chronic condition self-management. Australian Journal of Primary Health, 9(3), 41–52.

    Article  Google Scholar 

  10. Petkov, J., Harvey, P., & Battersby, M. (2010). The internal consistency and construct validity of the partners in health scale: Validation of a patient rated chronic condition self-management measure. Quality of Life Research, 19, 1079–1085.

    Article  PubMed  Google Scholar 

  11. Bodenheimer, T., Lorig, K., Holman, H., & Grumbach, K. (2002). Patient self-management of chronic disease in primary care. JAMA, 288(19), 2469–2475.

    Article  PubMed  Google Scholar 

  12. Pulvirenti, M., McMillan, J., & Lawn, S. (2014). Empowerment, patient centred care and self-management. Health Expectations, 17(3), 303–310. doi:10.1111/j.1369-7625.2011.00757.x.

    Article  PubMed  Google Scholar 

  13. Huber, M., Knottnerus, J. A., Green, L., van der Horst, H., Jadad, A. R., Kromhout, D., et al. (2011). How should we define health? BMJ (Clinical Research Edition),. doi:10.1136/bmj.d4163.

    Google Scholar 

  14. Sattoe, J. N., Bal, M. I., Roelofs, P. D., Bal, R., Miedema, H. S., & van Staa, A. (2015). Self-management interventions for young people with chronic conditions: A systematic overview. Patient Education and Counseling, 98(6), 704–715.

    Article  PubMed  Google Scholar 

  15. Laverack, G. (2009). Public health: Power, empowerment and professional practice. Basingstoke: Palgrave Macmillan.

    Google Scholar 

  16. Baum, F. (2003). The new public health (Vol. 2). Oxford: Oxford University Press.

    Google Scholar 

  17. Camerini, L., Schulz, P. J., & Nakamoto, K. (2012). Differential effects of health knowledge and health empowerment over patients’ self-management and health outcomes: A cross-sectional evaluation. Patient Education and Counseling, 89(2), 337–344.

    Article  PubMed  Google Scholar 

  18. Lawn, S., Battersby, M., & Pols, R. (2005). National chronic disease strategy—Self-management. Report to the Australian Government Department of Health and Ageing. Adelaide: Flinders Human Behaviour & Health Research Unit, Flinders University.

  19. Barr, P. J., Scholl, I., Bravo, P., Faber, M. J., Elwyn, G., & McAllister, M. (2015). Assessment of patient empowerment—A systematic review of measures. PLoS One, 10(5), e0126553.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bravo, P., Edwards, A., Barr, P. J., Scholl, I., Elwyn, G., & McAllister, M. (2015). Conceptualising patient empowerment: A mixed methods study. BMC Health Services Research, 15(1), 1.

    Article  Google Scholar 

  21. McCorkle, R., Ercolano, E., Lazenby, M., Schulman-Green, D., Schilling, L. S., Lorig, K., et al. (2011). Self-management: Enabling and empowering patients living with cancer as a chronic illness. CA: A Cancer Journal for Clinicians, 61(1), 50–62. doi:10.3322/caac.20093.

    Google Scholar 

  22. Funnell, M. M., & Anderson, R. M. (2004). Empowerment and self-management of diabetes. Clinical Diabetes, 22(3), 123.

    Article  Google Scholar 

  23. Funnell, M. M., Anderson, R. M., Arnold, M. S., Barr, P. A., Donnelly, M., Johnson, P. D., et al. (1991). Empowerment: An idea whose time has come in diabetes education. The Diabetes Educator, 17(1), 37–41.

    Article  CAS  PubMed  Google Scholar 

  24. Anderson, R. M., & Funnell, M. M. (2010). Patient empowerment: Myths and misconceptions. Patient Education and Counseling, 79(3), 277–282.

    Article  PubMed  Google Scholar 

  25. Barlow, J., Wright, C., Sheasby, J., Turner, A., & Hainsworth, J. (2002). Self-management approaches for people with chronic conditions: A review. Patient Education and Counseling, 48(2), 177–187.

    Article  PubMed  Google Scholar 

  26. Corbin, J. M., & Strauss, A. (1988). Unending work and care: Managing chronic illness at home. Los Angeles: Jossey-Bass.

    Google Scholar 

  27. Lorig, K. R., & Holman, H. R. (2003). Self-management education: History, definition, outcomes, and mechanisms. Annals of Behavioral Medicine, 26(1), 1–7.

    Article  PubMed  Google Scholar 

  28. Schulman-Green, D., Jaser, S., Martin, F., Alonzo, A., Grey, M., McCorkle, R., et al. (2012). Processes of self-management in chronic illness. Journal of Nursing Scholarship, 44(2), 136–144.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Maxine, A. (2006). Spirituality and quality of life in chronic illness. Journal of Theory Construction & Testing, 10(2), 42.

    Google Scholar 

  30. Rowe, M. M., & Allen, R. G. (2003). Spirituality as a means of coping with chronic illness. American Journal of Health Studies, 19(1), 62–66.

    Google Scholar 

  31. Zinnbauer, B. J., Pargament, K. I., & Scott, A. B. (1999). The emerging meanings of religiousness and spirituality: Problems and prospects. Journal of Personality, 67(6), 889–919.

    Article  Google Scholar 

  32. Peterman, A. H., Fitchett, G., Brady, M. J., Hernandez, L., & Cella, D. (2002). Measuring spiritual well-being in people with cancer: The functional assessment of chronic illness therapy—Spiritual Well-being Scale (FACIT-Sp). Annals of Behavioral Medicine, 24(1), 49–58.

    Article  PubMed  Google Scholar 

  33. Elwyn, G., Lloyd, A., May, C., van der Weijden, T., Stiggelbout, A., Edwards, A., et al. (2014). Collaborative deliberation: A model for patient care. Patient Education and Counseling, 97(2), 158–164.

    Article  PubMed  Google Scholar 

  34. Kon, A. A. (2010). The shared decision-making continuum. JAMA, 304(8), 903–904.

    Article  CAS  PubMed  Google Scholar 

  35. Scholl, I., Koelewijn-van Loon, M., Sepucha, K., Elwyn, G., Légaré, F., Härter, M., et al. (2011). Measurement of shared decision making—A review of instruments. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 105(4), 313–324.

    Article  PubMed  Google Scholar 

  36. Barry, M. J., & Edgman-Levitan, S. (2012). Shared decision making—the pinnacle of patient-centered care. New England Journal of Medicine, 366(9), 780–781.

    Article  CAS  PubMed  Google Scholar 

  37. Makoul, G., & Clayman, M. L. (2006). An integrative model of shared decision making in medical encounters. Patient Education and Counseling, 60(3), 301–312.

    Article  PubMed  Google Scholar 

  38. Singh, S., Butow, P., Charles, M., & Tattersall, M. H. (2010). Shared decision making in oncology: Assessing oncologist behaviour in consultations in which adjuvant therapy is considered after primary surgical treatment. Health Expectations, 13(3), 244–257.

    PubMed  PubMed Central  Google Scholar 

  39. Lawn, S., Delany, T., Sweet, L., Battersby, M., & C Skinner, T. (2014). Control in chronic condition self-care management: How it occurs in the health worker–client relationship and implications for client empowerment. Journal of Advanced Nursing, 70(2), 383–394.

    Article  PubMed  Google Scholar 

  40. Wilson, D., Wakefield, M., & Taylor, A. (1992). The South Australian health omnibus survey. Health Promotion Journal of Australia, 2(3), 47–49.

    Google Scholar 

  41. Australian Bureau of Statisitcs (2015). ASGS fact sheets: Statistical area level 1—Fact sheet. http://www.abs.gov.au/geography. Accessed 26 July 2015.

  42. Lawn, S., & Battersby, M. (2009). Skills for person-centered care—health professionals supporting chronic condition prevention and self-management. In H. M. D’Cruz, S. W. Jacobs, & A. Schoo (Eds.), Knowledge-in-practice in the caring professions: Multi-disciplinary perspectives (pp. 161–192). Surrey: Ashgate.

    Google Scholar 

  43. Chen, F. F., West, S. G., & Sousa, K. H. (2006). A comparison of bifactor and second-order models of quality of life. Multivariate Behavioral Research, 41(2), 189–225.

    Article  PubMed  Google Scholar 

  44. Muthen, B., & Satorra, A. (1995). Complex sample data in structural equation modeling. Sociological Methodology, 25, 267–316.

    Article  Google Scholar 

  45. Wu, J.-Y., & Kwok, O.-M. (2012). Using SEM to analyze complex survey data: A comparison between design-based single-level and model-based multilevel approaches. Structural Equation Modeling: A Multidisciplinary Journal, 19(1), 16–35.

    Article  Google Scholar 

  46. Muthén, B., & Asparouhov, T. (2012). Bayesian structural equation modeling: A more flexible representation of substantive theory. Psychological Methods, 17(3), 313.

    Article  PubMed  Google Scholar 

  47. Muthén, L. K., & Muthén, B. O. (1998–2015). Mplus User’s guide. Los Angeles, CA: Muthén & Muthén.

  48. Asparouhov, T., Muthén, B., & Morin, A. J. (2015). Bayesian structural equation modeling with cross-loadings and residual covariances: Comments on Stromeyer et al. Journal of Management, 41(6), 1561–1577.

    Article  Google Scholar 

  49. Geldhof, G. J., Preacher, K. J., & Zyphur, M. J. (2014). Reliability estimation in a multilevel confirmatory factor analysis framework. Psychological Methods, 19(1), 72.

    Article  PubMed  Google Scholar 

  50. Terwee, C. B., Bot, S. D. M., de Boer, M. R., van der Windt, D. A., Knol, D. L., Dekker, J., et al. (2007). Quality criteria were proposed for measurement properties of health status questionnaires. Journal of Clinical Epidemiology, 60(1), 34–42.

    Article  PubMed  Google Scholar 

  51. Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155.

    Article  CAS  PubMed  Google Scholar 

  52. Warwick, M., Gallagher, R., Chenoweth, L., & Stein-Parbury, J. (2010). Self-management and symptom monitoring among older adults with chronic obstructive pulmonary disease. Journal of Advanced Nursing, 66(4), 784–793.

    Article  PubMed  Google Scholar 

  53. Kit, J. A. (2003). Chronic disease self-management in Aboriginal communities: Towards a sustainable program of care in rural communities. Australian Journal of Primary Health, 9(3), 168–176.

    Article  Google Scholar 

  54. Gallagher, R., Donoghue, J., Chenoweth, L., & Stein-Parbury, J. (2008). Self-management in older patients with chronic illness. International Journal of Nursing Practice, 14(5), 373–382.

    Article  PubMed  Google Scholar 

  55. Walters, J., Cameron-Tucker, H., Wills, K., Schüz, N., Scott, J., Robinson, A., et al. (2013). Effects of telephone health mentoring in community-recruited chronic obstructive pulmonary disease on self-management capacity, quality of life and psychological morbidity: A randomised controlled trial. BMJ Open, 3(9), e003097.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Heijmans, M., Waverijn, G., Rademakers, J., van der Vaart, R., & Rijken, M. (2015). Functional, communicative and critical health literacy of chronic disease patients and their importance for self-management. Patient Education and Counseling, 98(1), 41–48.

    Article  PubMed  Google Scholar 

  57. Kline, R. B. (2011). Principles and practice of structural equation modeling (3rd ed.). New York: The Guilford Press.

    Google Scholar 

  58. Kenny, D. A., & McCoach, D. B. (2003). Effect of the number of variables on measures of fit in structural equation modeling. Structural Equation Modeling, 10(3), 333–351.

    Article  Google Scholar 

  59. Bruyneel, L., Li, B., Squires, A., Spotbeen, S., Meuleman, B., Lesaffre, E., et al. (2014). Bayesian multilevel MIMIC Modeling for studying measurement invariance in cross-group comparisons. Medical Care. doi:10.1097/MLR.0000000000000164.

  60. Mokkink, L. B., Terwee, C. B., Patrick, D. L., Alonso, J., Stratford, P. W., Knol, D. L., et al. (2010). The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: An international Delphi study. Quality of Life Research, 19(4), 539–549.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Haynes, S. N., Richard, D., & Kubany, E. S. (1995). Content validity in psychological assessment: A functional approach to concepts and methods. Psychological Assessment, 7(3), 238.

    Article  Google Scholar 

  62. Lawshe, C. H. (1975). A quantitative approach to content validity. Personnel Psychology, 28(4), 563–575.

    Article  Google Scholar 

  63. Wilson, F. R., Pan, W., & Schumsky, D. A. (2012). Recalculation of the critical values for Lawshe’s content validity ratio. Measurement and Evaluation in Counseling and Development, 45(3), 197–210.

    Article  Google Scholar 

  64. Vandenberg, R. J., & Lance, C. E. (2000). A review and synthesis of the measurement invariance literature: Suggestions, practices, and recommendations for organizational research. Organizational Research Methods, 3(1), 4–70.

    Article  Google Scholar 

  65. Marsh, H. W., Morin, A. J., Parker, P. D., & Kaur, G. (2014). Exploratory structural equation modeling: An integration of the best features of exploratory and confirmatory factor analysis. Annual Review of Clinical Psychology, 10, 85–110.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank the reviewers for their detailed and helpful comments to the manuscript.

Author information

Authors and Affiliations

  1. Flinders Human Behaviour and Health Research Unit, Flinders University, GPO Box 2100, Adelaide, SA, 2001, Australia

    David Smith, Peter Harvey, Sharon Lawn, Melanie Harris & Malcolm Battersby

Authors
  1. David Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Harvey
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sharon Lawn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Melanie Harris
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Malcolm Battersby
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David Smith.

Ethics declarations

Conflict of interest

As the developer of the Partners in Health (PIH) scale, Author MB has a potential conflict of interest. He has no commercial interests in the PIH.

Ethical approval

The study was approved by the University of Adelaide Human Research Ethics and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

The study used a cross-sectional population-based survey methodology and did not require formal written consent. All data were de-identified.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 21 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Smith, D., Harvey, P., Lawn, S. et al. Measuring chronic condition self-management in an Australian community: factor structure of the revised Partners in Health (PIH) scale. Qual Life Res 26, 149–159 (2017). https://doi.org/10.1007/s11136-016-1368-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-016-1368-5

Keywords

Search

Navigation