Psychometric assessment of the patient activation measure short form (PAM-13) in rural settings

The patient activation measure short form (PAM-13) assesses patients’ self-reported health management skills, knowledge, confidence,
and motivation. We used item response theory to evaluate the psychometric properties of the PAM-13 utilized in rural settings.

A Rasch partial credit model analysis was conducted on the PAM-13 instrument using a sample of 812 rural patients recruited
by providers and our research staff. Specially, we examined dimensionality, item fit, and quality of measures, category response
curves, and item differential functioning. Convergent and divergent validities were also examined.

The PAM-13 instrument has excellent convergent and divergent validities. It is fairly unidimensional, and all items fit the
Rasch model well. It has relatively high person and item reliability indices. Majority of the items were free of item differential
functioning. There were, however, some issues with ceiling effects. Additionally, there was a lack of responses for category
one across all items.

Patient activation measure short form (PAM-13) performs well in some areas, but not all. In general, more items need to be
added to cover the upper end of the trait. The four response categories of PAM-13 should be collapsed into three.