Adaptation to European Spanish and psychometric properties of the Patient Activation Measure 13 in patients with chronic diseases.

Background: The 13-item Patient Activation Measure (PAM-13) is an instrument that assesses people's knowledge, skills and confidence for self-management of their health and health care. Scores on the PAM-13 have been shown to predict adherence to health behaviours, health-related outcomes and health care costs. Objectives: To develop a European Spanish adaptation of the original PAM-13 and to examine its psychometric properties in a sample of chronic patients. Methods: The PAM-13 was forward-backward translated and then completed by chronic patients attending a primary health care centre. Data were analysed with a Rasch model. We assessed the functioning of the rating scale, its reliability, the item goodness-of-fit, differential item functioning (DIF), local dependence, unidimensionality and correlation analysis. Results: A total of 208 patients (80%) completed the questionnaire. Data showed a fit to the Rasch model. More than 50% of patients endorsed all the items. Item rank for the Spanish sample was similar to the original, with few differences. We found significant differences (P < 0.05) in PAM-13 measures according to adherence to prescribed medicines and positive correlations with self-efficacy and physical quality of life. Conclusions: The European Spanish PAM-13 is a reliable and valid instrument for assessing activation in patients with chronic disease in Spain. We suggest adding new items to the instrument so as to examine patients with higher activation levels in the future. Further studies are needed to evaluate the usefulness of this new Spanish PAM-13 in different settings and populations, as well as to examine the relationship between PAM-13 scores and other health-related outcomes.

Do patients and health care professionals view the communication processes of clinical research differently? A Rasch analysis from a survey.

RATIONALE AIMS AND OBJECTIVES: The increasing amount of the clinical research conducted in the primary health care has enabled extending research beyond traditional settings, but this transfer has implied some trade-offs. Health care professionals who conduct research with trusted patients require assuming the ethical standards of research and communication skills to enable patients' autonomy and freedom of choice. This study aims to measure the opinions of health professionals and patients on issues of communication in clinical research. METHOD: A cross-sectional study with health care professionals and patients from primary health care centres in Barcelona (Spain). Each group completed a similar self-administered questionnaire. A Rasch model was fitted to data. After examination of goodness-of-fit, differences between groups were compared using analysis of variance, and patients' measures were calibrated to professionals' measures to compare overall mean measures. RESULTS: Professionals and patients found the ethical attitudes most difficult to endorse related to trust in clinical researchers and conflicts of interest. Patients' perceptions of professional ethical behaviour were significantly lower than professionals'. Different item functioning between nurses and family doctors was found in the item on seeking ethical collaboration when collaborating in clinical research. Effective knowledge of ethical norms was associated with greater perceived ethical values in clinical research and confidence in health care professionals among patients. CONCLUSIONS: Differences in the views of the communication process between patients and professionals could alert research boards, health care institutions and researchers to the need for greater transparency, trust and ethical instruction when patients are involved in clinical research.

Ethical behaviour in clinical practice: a multidimensional Rasch analysis from a survey of primary health care professionals of Barcelona (Catalonia, Spain).

PURPOSE: Normative ethics includes ethical behaviour health care professionals should uphold in daily practice. This study assessed the degree to which primary health care (PHC) professionals endorse a set of ethical standards from these norms. METHODS: Health care professionals from an urban area participated in a cross-sectional study. Data were collected using an anonymous, self-administered questionnaire. We examined the level of ethical endorsement of the items and the ethical performance of health care professionals using a Rasch multidimensional model. We analysed differences in ethical performance between groups according to sex, profession and knowledge of ethical norms. RESULTS: A total of 452 Professionals from 56 PHC centres participated. The level of ethical performance was lower in items related to patient autonomy and respecting patient choices. The item estimate across all dimensions showed that professionals found it most difficult to endorse avoiding interruptions when seeing patients. We found significant differences in two groups: nurses had greater ethical performance than family physicians (p < 0.05), and professionals who reported having effective knowledge of ethical norms had a higher level of ethical performance (p < 0.01). CONCLUSIONS: Paternalistic behaviour persists in PHC. Lesser endorsement of items suggests that patient-centred care and patient autonomy are not fully considered by professionals. Ethical sensitivity could improve if patients are cared for by multidisciplinary teams.