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

PurposeTo 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.MethodsA 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.ResultsBoth 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.ConclusionThe 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.

[1]  Wei Pan,et al.  Recalculation of the Critical Values for Lawshe’s Content Validity Ratio , 2012 .

[2]  K. Lorig,et al.  Effect of a self-management program on patients with chronic disease. , 2001, Effective clinical practice : ECP.

[3]  M. Battersby,et al.  Chronic disease self-management in Aboriginal Communities: Towards a sustainable program of care in rural communities , 2003 .

[4]  H. Pincus,et al.  Quality Indicators for Physical and Behavioral Health Care Integration. , 2015, JAMA.

[5]  Oi-Man Kwok,et al.  Using SEM to Analyze Complex Survey Data: A Comparison between Design-Based Single-Level and Model-Based Multilevel Approaches , 2012 .

[6]  R. Bal,et al.  Self-management interventions for young people with chronic conditions: A systematic overview. , 2015, Patient education and counseling.

[7]  S. Haynes,et al.  Content validity in psychological assessment: A functional approach to concepts and methods. , 1995 .

[8]  Kristopher J Preacher,et al.  Reliability estimation in a multilevel confirmatory factor analysis framework. , 2014, Psychological methods.

[9]  D. Cella,et al.  Measuring spiritual well-being in people with cancer: The functional assessment of chronic illness therapy—spiritual well-being scale (FACIT-Sp) , 2002, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[10]  S. West,et al.  A Comparison of Bifactor and Second-Order Models of Quality of Life , 2006, Multivariate behavioral research.

[11]  K. Steven,et al.  Shared Decision Making , 2012, Onkologische Welt.

[12]  Gregory Makoul,et al.  An integrative model of shared decision making in medical encounters. , 2006, Patient education and counseling.

[13]  Gwen Moulster.  Public health: Power, empowerment and professional practicePublic health: Power, empowerment and professional practice Glenn Laverack Palgrave Macmillan Edition: 1127£17.9914039456081403945608 , 2006 .

[14]  Jörg Dirmaier,et al.  Measurement of shared decision making - a review of instruments. , 2011, Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen.

[15]  C. Abrams,et al.  Predictive models of the risk of hospital admission and re-admission: current and future development , 2015, BMC Health Services Research.

[16]  Richard L. Reed,et al.  A pragmatic randomized controlled trial of the Flinders Program of chronic condition management in community health care services. , 2015, Patient education and counseling.

[17]  Herbert W Marsh,et al.  Exploratory structural equation modeling: an integration of the best features of exploratory and confirmatory factor analysis. , 2014, Annual review of clinical psychology.

[18]  Jacob Cohen,et al.  A power primer. , 1992, Psychological bulletin.

[19]  Bengt Muthén,et al.  Bayesian structural equation modeling: a more flexible representation of substantive theory. , 2012, Psychological methods.

[20]  C. Wright,et al.  Self-management approaches for people with chronic conditions: a review. , 2002, Patient education and counseling.

[21]  C. Terwee,et al.  The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study , 2010, Quality of Life Research.

[22]  C. Terwee,et al.  Quality criteria were proposed for measurement properties of health status questionnaires. , 2007, Journal of clinical epidemiology.

[23]  M. Battersby,et al.  Implementing the Flinders Model of self-management support with Aboriginal people who have diabetes : findings from a pilot study , 2008 .

[24]  D. A. Kenny,et al.  Effect of the Number of Variables on Measures of Fit in Structural Equation Modeling , 2003 .

[25]  Fran Baum,et al.  The New Public Health , 1998 .

[26]  Lynn Chenoweth,et al.  Self-management in older patients with chronic illness. , 2008, International journal of nursing practice.

[27]  G. Elwyn,et al.  Assessment of Patient Empowerment - A Systematic Review of Measures , 2015, PloS one.

[28]  Sharon Lawn,et al.  Empowerment, patient centred care and self‐management , 2014, Health expectations : an international journal of public participation in health care and health policy.

[29]  Rex B. Kline,et al.  Principles and Practice of Structural Equation Modeling , 1998 .

[30]  Alexander A Kon,et al.  The shared decision-making continuum. , 2010, JAMA.

[31]  P. Briss,et al.  Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA , 2014, The Lancet.

[32]  J. Walters,et al.  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 , 2013, BMJ Open.

[33]  J. Petkov,et al.  The internal consistency and construct validity of the partners in health scale: validation of a patient rated chronic condition self-management measure , 2010, Quality of Life Research.

[34]  R. Kline.  Principles and practice of structural equation modeling, 3rd ed. , 2011 .

[35]  R. Vandenberg,et al.  A Review and Synthesis of the Measurement Invariance Literature: Suggestions, Practices, and Recommendations for Organizational Research , 2000 .

[36]  Bengt Muthén,et al.  Bayesian Structural Equation Modeling With Cross-Loadings and Residual Covariances , 2015 .

[37]  Elizabeth Ercolano,et al.  Self‐management: Enabling and empowering patients living with cancer as a chronic illness , 2011, CA: a cancer journal for clinicians.

[38]  T. Skinner,et al.  Control in chronic condition self-care management: how it occurs in the health worker-client relationship and implications for client empowerment. , 2014, Journal of advanced nursing.

[39]  Anselm L. Strauss,et al.  Unending work and care: Managing chronic illness at home. , 1989 .

[40]  G. Waverijn,et al.  Functional, communicative and critical health literacy of chronic disease patients and their importance for self-management. , 2015, Patient education and counseling.

[41]  David Smith,et al.  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 , 2013, The Australian and New Zealand journal of psychiatry.

[42]  K. Pargament,et al.  The emerging meanings of religiousness and spirituality : Problems and prospects , 1999 .

[43]  Robert M. Anderson,et al.  Patient empowerment: myths and misconceptions. , 2010, Patient education and counseling.

[44]  Kent Nakamoto,et al.  Differential effects of health knowledge and health empowerment over patients' self-management and health outcomes: a cross-sectional evaluation. , 2012, Patient education and counseling.

[45]  Lynn Chenoweth,et al.  Self-management and symptom monitoring among older adults with chronic obstructive pulmonary disease. , 2010, Journal of advanced nursing.

[46]  G. Laverack.  Public Health: Power, Empowerment and Professional Practice , 2005 .

[47]  M. Battersby,et al.  The Partners in Health scale: The development and psychometric properties of a generic assessment scale for chronic condition self-management , 2003 .

[48]  E. Lesaffre,et al.  Bayesian Multilevel MIMIC Modeling for Studying Measurement Invariance in Cross-group Comparisons , 2017, Medical care.

[49]  P. Butow,et al.  Shared decision making in oncology: assessing oncologist behaviour in consultations in which adjuvant therapy is considered after primary surgical treatment , 2010, Health expectations : an international journal of public participation in health care and health policy.

[50]  T. Bodenheimer,et al.  Patient self-management of chronic disease in primary care. , 2002, JAMA.

[51]  M. Barry,et al.  Shared decision making--pinnacle of patient-centered care. , 2012, The New England journal of medicine.

[52]  Glyn Elwyn,et al.  Conceptualising patient empowerment: a mixed methods study , 2015, BMC Health Services Research.

[53]  J. Knottnerus,et al.  How should we define health? , 2011, BMJ : British Medical Journal.

[54]  M. Rowe.  Spirituality as a Means of Coping with Chronic Illness , 2004 .

[55]  Maxine A. Adegbola.  Spirituality and Quality of Life in Chronic Illness , 2006 .

[56]  Trudy van der Weijden,et al.  Collaborative deliberation: a model for patient care. , 2014, Patient education and counseling.

[57]  A. Satorra,et al.  Complex Sample Data in Structural Equation Modeling , 1995 .

[58]  M. Funnell,et al.  Empowerment: An Idea Whose Time Has Come in Diabetes Education , 1991, The Diabetes educator.

[59]  Margaret Grey,et al.  Processes of self-management in chronic illness. , 2012, Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing.

[60]  K. Lorig,et al.  Self-management education: History, definition, outcomes, and mechanisms , 2003, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[61]  David J. D. Wilson,et al.  The South Australian Health Omnibus Survey 15 years on: has public health benefited? , 2006 .

[62]  Robert M. Anderson,et al.  Empowerment and Self-Management of Diabetes , 2004 .

[63]  C. H. Lawshe.  A QUANTITATIVE APPROACH TO CONTENT VALIDITY , 1975 .