Adaptation of clinician support for patient activation measure into Turkish: Reliability and validity study

Background and aim: The increasing burden of non-communicable diseases makes effective control of chronic diseases even more important. For this purpose, patient self-management and activation are emerging as complementary concepts. Management of chronic diseases requires planned care from a holistic perspective. Regular medical follow-up and clinician support are important to increase the responsibility that patients should take in self-care and self-management. In our country, there is no tool that evaluates the opinions of clinicians quantitatively about the importance of self-management skills of patients with chronic health problems. The main purpose of this study is to evaluate the validity and reliability of the Turkish version of the Clinician Support for Patient Activation Measure (CS-PAM). Material and method: This is a validation study carried out among clinicians working in Primary Health Care Centers in Maltepe district of Istanbul and Pendik Training and Research Hospital of Marmara University between June and July 2019. Convenient sampling was used and 210 clinicians were recruited. A questionnaire including sociodemographic characteristics and questions about the concept of self-management as well as the Clinician Support for Patient Activation Measure (CS-PAM) were used as data collection tools. The language adaptation of the instrument was performed by the translation and back-translation method proposed by World Health Organisation. Test-retest reliability, item-total correlation coefficients, internal consistency reliability coefficient, item analysis based on lower-upper group averages, and Rasch analysis (person reliability, person separation index and item reliability) were used to evaluate the reliability. Exploratory factor analysis, known-groups comparison, and Rasch Analysis (item difficulty structure and item fit statistics) were used to evaluate the validity. This research has been approved by the Marmara University Medical Faculty Clinical Research Ethics Committee, Istanbul Provincial Health Directorate and Insignia Health. Results: The correlation coefficient of the test-retest reliability of the CS-PAM was 0.79. Item-total correlation coefficients ranged from 0.45 to 0.71. Cronbach's alpha internal consistency reliability coefficient was 0.90. With the item analysis based on the lower-upper group averages, it was seen that all items in the measurement tool could distinguish 56 clinicians with the highest total scores and 56 clinicians with the lowest total scores. The person reliability was 0.86; the person separation index was 2.45; the item reliability was 0.99. There was a relationship between the scores obtained from the CS-PAM and age, duration of professional experience, workplace, and awareness of the patient self-management concept (p˂0.05). According to the Bartlett test obtained by the exploratory factor analysis, the chi-square value was 1170.62 and p˂0.001; the KMO value was 0.90. After the rotation, the eigenvalues of the two sub-dimensions were 4.62 and 2.87, respectively. The variance explained by the first sub-dimension was 35.53%, the variance explained by the second sub-dimension was 22.06%, and the total explained variance was 57.59%. The factor loads of the items in the first sub-dimension (items 1 to 8) were between 0.88 and 0.48; the factor loads of the items in the second sub-dimension (items 9 to 13) were between 0.79 and 0.60. The Cronbach alpha values calculated for the sub-dimensions were 0.88 and 0.80, respectively. When the sub-dimensions were evaluated conceptually, the first sub-dimension was referred to as "Patient Responsibility" and the second sub-dimension was referred to as "Shared Decision Making". The item difficulty structure values determined by Rasch analysis ranged between 34-69. The INFIT values were between 0.76-1.57 and the OUTFIT values were between 0.62-1.79. Conclusion: The Turkish version of the Clinician Support for Patient Activation Measure (CS-PAM) was a valid and reliable instrument that can be used to evaluate the opinions of clinicians working in our country about self-management of patients with chronic health conditions.