Validation of the Patient Activation Measure (PAM-13) among adults with cardiac conditions in Singapore.

PURPOSE: The Patient Activation Measure (PAM-13) measures patients' knowledge, skill, and confidence in chronic condition self-management. The purpose of this study was to assess the validity of PAM-13 (English version) among English-speaking adults with cardiac conditions in Singapore. METHODS: A cross-sectional study was conducted in a convenient sample of 270 heart clinic patients. Using the unitary concept of validity, evidence of (1) internal structure via data quality, unidimensionality, differential item functioning, and internal consistency, (2) response process through item difficulty and item fit using Rasch modeling, and (3) relationship to other variables via correlations with depression and self-efficacy were examined. RESULTS: The item response was high with only one missing answer. All items had a small floor effect, but nine out of 13 items had a ceiling effect larger than 15 %. Cronbach's α was 0.86, and average inter-item correlations was 0.324. Results suggested unidimensionality; however, differences in item difficulty ranking were found. A low, negative correlation was found with depression, while a moderate, positive correlation was found with self-efficacy. CONCLUSION: Evidence in all three areas of validity were mixed. Caution should be exercised when using categorical activation "level" to inform clinical decisions.

Exploring the use of activity-based group therapy in increasing self-efficacy and subjective well-being in acute mental health.

Background/Objectives: Self-efficacy is a key component in mental health recovery and improvement in well-being. Mental illness is often resultant of environmental stressors, highlighting the importance of coping skills. Occupational therapists commonly utilise activity-based group therapy to encourage use of activities as coping strategies. However, there has been little research concerning these groups and their role in enhancing self-efficacy in behavioural-based coping skills. This study aimed to explore factors that affect behavioural-based coping self-efficacy during activity-based group therapy in an acute mental health ward. It investigates the relationships between (1) behavioural-based coping self-efficacy with overall mental health self-efficacy and (2) mental health self-efficacy and subjective well-being. Methods: Immediately after the first group, participants completed a post-group questionnaire. Participation level was also rated. At discharge, the participants were asked to complete the UK Office of National Statistics subjective well-being tool and the Mental Health Self-Efficacy Scale. Descriptive statistics, independent sample t-tests and one-way analysis of variance were done to examine possible covariates and confounders of all outcome variables. General linear models were then conducted. Results: Post-group questionnaire reflected moderate-high self-efficacy (M = 6.92, SD = 2.48) and positive well-being with higher happiness scores (M = 7.42, SD = 2.20) and lower anxiety scores (M = 3.79, SD = 2.85). Coping self-efficacy significantly predicted overall mental health self-efficacy (p = .014), which in turn significantly predicted positive domains of well-being. Conclusions: Performing behavioural-based coping strategies in groups can enhance coping self-efficacy and positive well-being, with possible positive influence on mental health self-efficacy and well-being at discharge.

How adults with cardiac conditions in Singapore understand the Patient Activation Measure (PAM-13) items: a cognitive interviewing study.

PURPOSE: Validation studies of the PAM-13 have found differences in scale performance, suggesting that health beliefs embedded in different cultures and/or self-management needs of different client groups influence how people respond to the items. The purpose of this study was to examine how adults with cardiac conditions in Singapore interpreted and responded to the PAM-13, to investigate possible reasons for differences in responses and to propose solutions to overcome them. METHODS: We conducted retrospective cognitive interviews with 13 participants in an out-patient heart center. Interviews were transcribed and analyzed based on the framework approach to qualitative analysis. The four stages from Tourangeau's cognitive model were used as a framework to index the data from each item. RESULTS: There was variation in comprehension of questions leading to variation in responses. Comprehension issues were due to terms perceived by participants to be vague and the use of English terms uncommon in Singapore. Cultural influences impacted decision processes and problems with response processes of the self-rating Likert scale surfaced. CONCLUSIONS: This study reinforces the need to culturally adapt the tool, even when language translation is not necessary. Providing Likert scales with a larger number of may widen the relevance of PAM-13 in Singapore. Implications for rehabilitation Need to culturally adapt assessment tool, even when language translation is not necessary. Consider using Likert scales with a larger number of categories when using in Asian countries such as Singapore. Caution must be taken when using PAM-13 levels to decide interventions for each individual.

Effects of a Stress-Management Program for Inpatients With Mental Disorders: A Feasibility Study.

Stress-management interventions have been integrated into treatments for people with mental disorders. Nevertheless, most studies on these interventions have been conducted on patients with schizophrenia in Western countries, and limited studies have used objective measurements of stress. We developed a group-based, four-session stress-management (S-Manage) program for people with mental disorders, consisting of two major components: psychoeducation and relaxation practice. This single-group, pretest-posttest, quasi-experimental study was undertaken to test the initial effects and determine the effect sizes of the program. A convenience sample of 55 inpatients were recruited from a mental health ward at a tertiary hospital in Singapore. Self-report questionnaires and physiological measures of stress (skin temperature and salivary immunoglobulin A [SIgA]) were used for data collection. Data were analyzed by descriptive statistics and repeated-measures analysis of variance. Most participants were Singaporean, female, single, and employed. Diagnoses included schizophrenia, depression, bipolar disorder, anxiety disorder, and mixed diagnoses. All received standard care provided by the hospital. Participants had significant reductions in objective stress, measured by skin temperature (effect size = 0.54) and SIgA (effect size = 0.16), and subjective stress (effect size = 0.16) as well as improved psychological health (effect size = 0.40) in response to the intervention. This study provides preliminary evidence to support the positive effects of the S-Manage program on people with mental disorders. Future studies should further test the efficacy of the program using more rigorous methods such as randomized controlled trial and multicenter study.