Psychometric properties of the hebrew translation of the patient activation measure (PAM-13).

OBJECTIVE:"Patient activation" reflects involvement in managing ones health. This cross-sectional study assessed the psychometric properties of the Hebrew translation (PAM-H) of the PAM-13. METHODS:A nationally representative sample of 203 Hebrew-speaking Israeli adults answered the PAM-H, PHQ-9 depression scale, SF-12, and Self-efficacy Scale via telephone. RESULTS:Mean PAM-H scores were 70.7±15.4. Rasch analysis indicated that the PAM-H is a good measure of activation. There were no differences in PAM-H scores based on gender, age or education. Subjects with chronic disease scored lower than those without. Scores correlated with the Self-efficacy Scale (0.47), Total SF-12 (0.39) and PHQ-9 (-0.35, P<0.0001), indicating concurrent validity. Discriminant validity was reflected by a significant difference in the mean PAM-H score of those who scored below 10 (72.1±14.8) on the PHQ-9 (not depressed) compared to those scoring ≥10 (i.e. probable depression) (59.2±15.8; t 3.75; P = 0.001). CONCLUSION:The PAM-H psychometric properties indicate its usefulness with the Hebrew-speaking Israeli population. PRACTICE IMPLICATIONS:PAM-H can be useful for assessing programs aimed at effecting changes in patient compliance, health behaviors, etc. Researchers in Israel should use a single translation of the PAM-13 so that findings can be compared, increasing understanding of patient activation

Cigarette and Nargila (Water Pipe) Use Among Israeli Arab High School Students: Prevalence and Determinants of Tobacco Smoking

Cigarette smoking is a popular habit among Arab Israelis. Over the past decade, smoking tobacco using nargila, a water pipe, has become a popular and accepted behavior among teenagers in Israel. Although the use of a water pipe (nargila) is an old habit among Middle Eastern adult males, its emergence among youth is a new finding. A representative sample of high school students in Tayibe, Israel is the subject of this survey. The sample represents data from 326 adolescents (boys 52.5% and girls 47.5%), ages 15–18, studying in one of the largest high schools in the Arab region of Israel. Our results show that a third of the sample smoked either cigarettes (36.2%) or nargila (37.1%). The gender difference among youths smoking cigarettes was 24.8% (48.0% for boys and 23.3% for girls), in contrast to 37.6% (55.0% for boys and 17.4% for girls) for nargila. There was a statistically significant correlation between cigarette and nargila smoking in populations where there is low religious inclination, increased parental smoking, and low student academic achievement. Students’ perceptions of low academic achievement (OR 4.51, p < 0.001), students’ mothers who smoke (OR 3.57, p < 0.001), and student's fathers who smoke (OR 2.75, p < 0.01) increase the youths’ chances of using nargila. Our conclusions are that smoking cigarettes and nargila are equally popular, and patterns of smoking cigarettes and nargila parallel each other. Causes that influence cigarette smoking also influence nargila smoking. Educational efforts are needed as a public health intervention

PAM-H Item Fit Statistics (N = 193)^a.

a<p>Only participants with diversity in their answers were included.</p>b<p>Infit reflects the similarity of observed responses from model expected response, being most sensitive when the item and respondent are close together on the activation scale.</p>c<p>Outfit is reflects unexpected observations with respect to the respondent's other responses. It is most sensitive when the item location on the scale is far away from the person's location on the scale.</p><p>PAM-H Item Fit Statistics (N = 193)^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0113391#nt103" target="_blank">a</a>}.</p

Assessing the determinants of healthcare expenditures in single-person households

Abstract Background The study documents a direct relationship between individuals’ health and patterns of healthcare expenditure by isolating single-person households and creating a new reference group in which household healthcare expenditure is based on one person’s expenditure patterns in accordance with his or her own state of health. Method The study matched two surveys using Propensity Score Matching based on single-person household, age, and gender. Structural Equation Modeling (SEM) explores paths of relation between the population’s income and socioeconomic level and its health self-assessment and expenditure. Results Single-person households’ health expenditure increases with age and the differences in most expenditure categories are significant. The current study looks into the direct and indirect effects of income, gender, and SES on health insurance and other out-of-pocket health expenses among single-person households. A direct link exists between income, gender, and socioeconomic status (SES) and several aspects of health expenditure, depending on the specific age group. The indirect effects are attested via health status assessment, in which a negative correlation is found between self-assessed health status and various health-expenditure categories. Conclusions The last-mentioned result may support the general perception that single-person households who feel that they are doing better than their near-equals enjoy better health. This line of inquiry yields a better examination of how a single-person household’s state of health affects expenditure patterns without assuming ab initio that expenditure patterns attest to state of health

Mean PAM scores by demographic and health characteristics.

a<p>Not including missing values.</p>b<p>Significant for “Far below average” vs. “About average” comparison only, as self-described in comparison to the average Israeli family income level.</p><p>Mean PAM scores by demographic and health characteristics.</p

Is the patient activation measure associated with adherence to colonoscopy after a positive fecal occult blood test result?

Abstract Background Colorectal cancer (CRC) is a major cause of morbidity and mortality worldwide, but these can be reduced significantly with population screening using annual fecal occult blood tests (FOBT)A positive FOBT requires timely follow-up with colonoscopy to maximize screening benefits.. Several barriers to follow-up have been identified, with patient health behaviors and choices comprising a significant part of these. The Patient Activation Measure (PAM) assesses knowledge, skills, beliefs, and confidence in managing health. Increased patient activation is related to positive health outcomes. The aim of this study is to examine the association between patient empowerment, as reflected in the PAM, and follow-up colonoscopy within 90 days of a positive FOBT result. Methods This case-control study included 429 patients with a positive FOBT, 174 who had a colonoscopy within 90 days, and 255 who did not.. Participants completed a PAM telephone questionnaire (Cronbach’s α = 0.785). We used both univariate and multivariate analyses to examine the effect of the PAM score as on the likelihood of undergoing colonoscopy, after adjusting for the independent variables. Results In this study we did not find a significant association between PAM and adherence to colonoscopy, using both univariate and multivariate analyses (p = .334 and p = .697, whether PAM was defined as a continuous or as categorical, respectively). Conclusions This study was the first to examine the association between patient empowerment, as reflected in the patient activation measure, and adherence to colonoscopy after a positive FOBT. The findings did not support such an association. Further examination is required to clarify the relation between patient empowerment and activation and personal healthcare in general, and in the Israeli population in particular. Future policy should include specific, technical interventions to improve FOBT follow-up among all groups, until the patient-related barriers are better understood. Trial registration ClinicalTrials.gov Identifier: NCT02534142 https://clinicaltrials.gov/ct2/show/NCT0253414