Rademakers et al. BMC Public Health 2012, 12:577 http://www.biomedcentral.com/1471-2458/12/577 Page 6 of 7 Table 3 Reliability of the Dutch 13-item PAM compared to the Danish and American version PAM13 95% CI Dutch Level 1 Level 2 Level 3 Level 4 Overall 314 359 590 574 1837 41.1 50.3 59.9 79.7 61.3 Overall Overall Sample (N) 344 454 Mean activation score 60.6-62.0 64.2 61.9 Gender Male (N = 804) 12.6% 19.8% 32.6% 35.1% 62.9 61.8-63.9 63.8 60.2 Female (N = 1033) 20.6% 19.4% 31.8% 28.3% 60.0 59.1-61.0 64.7 62.8 Age groups (years) 63.91 -54 (N = 625) 19.2% 18.1% 28.0% 34.7% 61.5 60.3-62.8 62.5 55-64 (N = 476) 17.0% 17.2% 31.5% 34.2% 62.4 60.9-63.8 63.9 61.7 65-74 (N = 428) 13.1% 25.0% 35.1% 26.9% 60.5 59.1-61.9 65.6 61.9 58.21 75+ (N = 308) 18.5% 18.5% 37.3% 25.7% 60.0 58.3-61.7 56.6 Educational level Low (N = 544) 19.5% 22.1% 36.0% 22.4% 58.42 57.2-59.7 65.03 58.54 Middle (N = 731) 17.7% 18.7% 28.3% 35.3% 62.32 61.1-63.5 62.83 61.84 High (N = 430) 12.8% 18.4% 34.7% 34.2% 62.52 61.1-63.9 65.43 61.64 Self-reported health Excellent (N = 36) 5.6% 8.3% 25.0% 61.1% 74.2 68.2-80.2 76.3 68.7 Very good (N = 195) 4.1% 9.7% 30.8% 55.4% 71.6 69.4-73.9 66.6 64.3 Good (N = 1010) 12.4% 19.4% 34.8% 33.5% 62.3 61.4-63.2 62.6 59.3 Fair (N = 525) 28.8% 23.2% 29.5% 18.5% 55.8 54.4-57.0 62.5 57.3 Poor (N = 65) 36.9% 27.7% 21.5% 13.9% 52.6 49.4-55.8 57.4 54.3 Only questionnaires with at least 7 items answered were included 1 Extreme age group was 45-54 and 75-84. 2 Education in the Netherlands was divided in three groups; low (no, primary school, or vocational training), middle (secondary or vocational education) or high (professional higher education or university). 3 Education in Danish analyses was categorised as: unskilled, short (1-3 years) and higher (>3 years). 4 Education in American analyses was categorised as: high school or less, some college and college graduate+. PAM13 Danish PAM13 USA Table 4 Test - retest reliability of the PAM between study A and study B Item N Mean PAM Mean PAM Pearson’s r P-value score score (study A) (study B) 1 475 3.31 3.30 0.35 <0.001 2 357 3.23 3.17 0.25 <0.001 3 448 3.12 3.09 0.31 <0.001 4 471 3.24 3.22 0.36 <0.001 5 490 3.22 3.25 0.32 <0.001 6 484 3.30 3.33 0.42 <0.001 7 393 3.36 3.43 0.41 <0.001 8 482 3.33 3.31 0.32 <0.001 9 467 3.11 3.03 0.42 <0.001 10 383 3.04 2.94 0.44 <0.001 11 448 2.98 2.90 0.40 <0.001 12 415 2.62 2.59 0.47 <0.001 13 427 2.83 2.83 0.49 <0.001 Total score 499 61.94 60.48 0.47 <0.001 The stability and construct validity of the PAM-13 Dutch was measured by establishing the test-retest reli- ability and cross-validation with the scores on the SBSQ-D, a self report measure of Health literacy. The test-retest reliability was moderate. As in earlier studies in the USA [7-9] the association between the PAM and Health literacy in this study in the Netherlands was weak to moderate. Given the fact that the SBSQ-D only mea- sures functional Health literacy, the lack of correlation in our study is understandable since patient activation is a broader theoretical concept. Unfortunately, as in the United States, validated and feasible self report instru- ments that measure Health literacy in a more compre- hensive way, including communicative/interactive and critical skills, are not available in the Netherlands [15]. The Dutch mean PAM score (61.3) is comparable to the American (61.9) but lower than the Danish (64.2). This may be due to cultural differences. However, since Denmark and its social and health care system resembles the Netherlands more than the United States do, it would have been likely that contrasts would be most be- tween the Netherlands and the United States. Though in