Ahhh, you have hit upon the problem of licensing! As an alternative construct, I typically use tools to measure self-efficacy. More specifically, I am firm follower of Kate Lorig's self-efficacy for chronic illness tool, which is valid, reliable, and free!

I am attaching a link to the tool. There is also a shortened scale that retains the validity of the longer scale.

Kate Lorig recently wrote a review article on the tool. I'll dig it up and post it.

I hope this helps

Ariel

http://patienteducation.stanford.edu/research/secd32.html

Very helpful and speedy Ariel! Many thanks.

You are very welcome. Attached is the paper I was telling you about. I am also providing links to a couple of papers I wrote a few years ago that discuss the underpinnings of behavior change. I hope you find them helpful

Article Disease Management Interventions II: What Else Is in the Black Box?

Article Disease Management Interventions: What's in the Black Box?

Thanks again for this. Really helpful.

That is great to hear, David. I am glad to be helpful. I am attaching the link to a paper I just published on the measurement error using the PAM. You may find this helpful as well.

Article Estimating Measurement Error of the Patient Activation Measu...

Dear Colleague

we have validated a new scale able to measure Patient Engagement.

It is named Patient Health Engagement scale (PHE-s) and it is very functional and easy to be used by healthcare professionals and patients

The scale has been developed on the base of a deep empirical analysis of patients' engagement experience and it correlates well with Patient Activation and Patients' Adherence. You can find described in this paper the psychometrics proprieties of this new scale and its features

With colleagues across the world we are now validating the scale in other countries (such as Canada, Cina, Thailand, Spain and France)

We decided to make the scale free and usable in order to enhance the academic and pragmatic debate about patient engagement

You are thus more than welcome of using it

please contact me further if interested  

Article Measuring patient engagement: development and psychometric p...

We've also been experimenting with the Partners in Health (PIH) Scale that was developed out of the Flinders self-management program in Australia.  It seems to be conceptually very similar to the PAM, but the exact phrasing and number of items does vary depending on the version (and unfortunately I haven't found an online repository where the versions are clearly outlined with psychometric properties).  Earlier versions of the PIH used phrases that queried on self-rated knowledge/understanding and "ability", and whereas they appear to have moved towards asking about the frequency of people's performance of certain behaviours, rather than just their abilities.  You can find the items of the PIH with a google search, though the version may not be current.  

It's been interesting for me as a newcomer to this field to learn about these... I'm curious what some of the posters here think of the various scales available (recognizing Dr. Linden's positive review of Lorig's ASES/CDSES).  

It strikes me that one of the pitfalls of assessing patient activation and self-management ability with the PAM, ASES/CDSES, and earlier versions of the PIH is that you're getting at patient perceptions of their own abilities/confidence in their own abilities, which is very valuable, but may or may not correlate highly with actual abilities.  For example, an analysis I've recently done has shown (in an admittedly small sample) very weak to no relationship between PIH score (self-rated self-management ability) and objectively measured bouted moderate to vigorous physical activity time, or sedentary time.  In a sample of people who rate themselves very highly in terms of self-management, only two met recommended PA guidelines, and on average got only about 50 mins of MVPA during the measurement week. 

As an endless skeptic of human perceptions (a la my psychology/behavioural economics background), it seems to me like we need to be measuring not only perceived activation/self-management ability, but also actual undertaking of key self-management behaviours if we're to comprehensively support better self-management.  This is admittedly more challenging, but outside of strapping people with activity monitors or watching them all day, I'm curious about other tools for measuring actual self-management skill.  

Many thanks in advance for your thoughts :)

Hi Cam,

All these instruments are designed to measure latent variables - those constructs that cannot be directly measured. You mentioned direct measurement of some behavior. Generally, if you can measure something directly, you don't need to use an instrument. However, most things related to human behavior cannot be directly measured. For example, "how do you rate your health?" There is no single objective measure of this, and so there is no other way around this than getting a person's subjective response.

I hope this helps

Ariel

Thanks Dr. Linden.  I'll look more into the work around measuring adherence behaviour beyond my immediate field of physical activity.

You may like to look at the Health Confidence Score.  Paper on development and validation is in peer review.

http://www.r-outcomes.com/health-confidence.html

We are presenting in the coming EULAR conference, London June 2016, a new patient motivation questionnaire, which was developed using  Using Rasch analysis and 76 questions item pool; content analysis and semi structured group discussion, the questionnaire was developed including: 10-items scale (0-10 on VAS scale). Reliability and comprehensibility and sensitivity to change were also assessed. Results revealed that The Patient Motivation Measure is a patient-reported tool that is valid, reliable, comprehensible and unidimensional scale that reflects the patients’: (1) awareness of their role in their disease management, (2)  confidence and knowledge necessary to take action, (3) actual ability of taking action to maintain and improve one’s health, and (4) staying the course even under stress, (5) ability to find reliable resources. The measure has good psychometric properties indicating that it can be used at the individual patient level to tailor management and monitor changes. Happy to share the questionnaire with you after the conference.

the fully published manuscript:

Implementing Shared Decision Making In Clinical Practice: Outcomes of a New Shared Decision Making Aid for Chronic Inflammatory Arthritis Patients

Yasser et al., J Pat Care 2016, 2:2

http://www.omicsonline.org/open-access/implementing-shared-decision-making-in-clinical-practice-outcomes-ofa-new-shared-decision-making-aid-for-chronic-inflammatory-arth-.pdf

Thanks for the answers! Does anyone know of an alternative for the parent-PAM?

PAM is  a COMMERCIAL measure, as is Johns Hopkins', but Dartmouth and  Stanford have developed no fee measures.

Here's an article comparing some measures doi: 10.3389/fpsyg.2015.00274

though their PHE tool is also commercial.  

Stanford- search on 'efficacy' at http://patienteducation.stanford.edu/materials/  Their scale is free to use without permission.

I particularly like John Wasson's Hows Your Health scale, which has been validated for low-literacy patients, and is particularly person-centered. It's been in use 20-30 years. For over 3000 uses a year, he charges a small fee, and solicits donations.  Here's the page with the references: https://howsyourhealth.com/static/html/whereWhy.html

I guess it depends on whether people want to commercialize their research, or they're driven by other motives.  Lots of research on patient activation, and everybody seems to want to develop their own scale....

https://howsyourhealth.com/static/html/whereWhy.html

Hi there,

I've found this really interesting. PAM is the subject of NHS Englands CQUIN initiative and the use is advocated for patients with long term conditions. I'm currently trying to do a REA of the effectiveness of PAM 13 in predicting self management ability in patients with IBD, unfortunately there is little evidence of the use of PAM in IBD and the evidence I've found looking at the correlation between PAM scores and self management outcomes has all been written by Hibbard et al therefore carries a high degree of bias. There's plenty of research regarding the effect of interventions on the patients PAM score but not a lot of quality evidence (unbiased) that reports on the PAMs ability to predict self management behaviours.

I suspect the real correlation is with features of primary care that have been shown to  improve outcomes. The PAM measures an intermediary effect of good care, with essential primary care features.

http://ocw.jhsph.edu/courses/starfieldcourse/PDFs/Starfield09_Effectiveness%20of%20PC%20FINALSlides.pdf

http://www.aafp.org/fpm/2014/0900/p8.html#fpm20140900p8-bt1 Patient Confidence

http://patienteducation.stanford.edu/

So patient confidence, reflecting good primary care, predicts good outcomes.  What a surprise!!

Patient Motivation questionnaire

Please use this link to view and download the study:

 http://rdcu.be/qEpu

Patient motivation reflects the degree to which the patient will consider the target of health behavior as their own self-chosen personal goal; therefore, patient motivation reflects the goal ownership. 

http://rdcu.be/qEpu

The Partners in Health Scale which is part of the Flinders Program is a validated12-item Likert self-rated tool for the patient with chronic conditions that covered the medical and psychosocial domains important for chronic condition self-management. it is easy to use, takes between 2-5 minutes to complete, can be done by the patient alone or with support if there are cognitive or other issues where they might need assistance to read, write or understand the questions. It is part of a suite of care planning tools but can be used in its own right as a measure of change in self-management capacity. It has been translated into several languages - Dutch, German, Chinese, Spanish, etc. Used as a generic self-management assessment tool across diverse populations, settings and conditions.

See more http://www.flinders.edu.au/medicine/sites/fhbhru/programs-services/

I hope there are some people still following this thread? We are also looking for an appropriate tool for patient activation. The biggest pull of the PAM is the correlation to health care costs. Has any work been done on economics and activation using a activation measure other than the PAM?

You may be interested to see a new paper about the Health Confidence Score: https://bmjopenquality.bmj.com/content/8/2/e000411.

You may be interested in an update re validation of the Partners in Health Scale Article Concurrent validity of the Partners in Health scale against ...

and Article Measuring chronic condition self-management in an Australian...

and one of the most recent RCTs Article A self-management support program for older Australians with...

I think "Patient Activation" is another term for "Health Confidence," and yes, there's an excellent, free, validated, patient completed measure for this. However the problem with well designed tools for low literacy patients is they sound simple-minded and don't get the respect they deserve.

Low Health Confidence correlates to all sorts of bad things including higher costs.

from http://healthconfidence.org/static/html/whereWhy.html

Health Confidence and Collaborative Care Between Clinicians and Patients

- Wasson JH, Johnson DJ, and Mackenzie T. The Impact of Primary Care Patients’ Pain and Emotional Problems on their Confidence with Self-Management. Jamb Care Mngmnt. 2008;31: 120-127.

- Wasson JH, Johnson DJ, Benjamin R, Phillips J, et al. Patients Report Positive Impacts of Collaborative Care. J Ambulatory Care Manage. 2006; 29(3): 199-206.

- Lynn Ho, MD; John Watt Haresch, MD; Mark Nunlist, MD; Adam Schwarz, MD; John H. Wasson, MD. Improvement of Patients’ Health Confidence: A Comparison of 15 Primary Care Practices and a National Sample. 2013. J Ambulatory Care Manage. Vol. 36, No. 3, pp. 235–240

- Wasson JH, Benjamin R, Johnson D, Moore LG, and Mackenzie T. Patients Use the Internet to Enter the Medical Home. J.Amb.Care.Mgmt. 2011; 34:38-46

- Wasson JH. A Patient-Reported Spectrum of Adverse Health Care Experiences: Harms, Unnecessary Care, Medication Illness, and Low Health Confidence. 2013. J Ambulatory Care Manage: Vol. 36, No. 3, pp. 245–250

- Wasson JH and Coleman EA. Health Confidence: A simple, essential measure for patient engagement and better practice. Family Practice Management Sept.-Oct 2014.Pages 8-12.

Health confidence as a simple, actionable measure should be a central focus for health care; when health confidence is high patient outcomes are good and wasteful care can is avoided; at practice level information quality is the strongest driver of health confidence.

http://healthconfidence.org/static/html/whereWhy.html

And Dr Benson has created and tested a short, simple scale to measure John Wassons's concept of Health Confidence, his HCS referenced in his post above.

Health Confidence predicts costs, but also depends on medical status (sicker people feel less) so you need to adjust for morbidity.

I'm not sure what license it's under and what you might have to do to use it.

May I have the link for Health Confidence score tool?

https://bmjopenquality.bmj.com/content/bmjqir/8/2/e000411.full.pdf

Patient Motivation questionnaire

Please use this link to view and download the study:

http://rdcu.be/qEpu