Rademakers et al. BMC Public Health 2012, 12:577 http://www.biomedcentral.com/1471-2458/12/577 R E S E A R C H A R T I C L E Open Access Measuring patient activation in the Netherlands: translation and validation of the American short form Patient Activation Measure (PAM13) Jany Rademakers*, Jessica Nijman, Lucas van der Hoek, Monique Heijmans and Mieke Rijken Abstract Background: The American short form Patient Activation Measure (PAM) is a 13-item instrument which assesses patient (or consumer) self-reported knowledge, skills and confidence for self-management of one’s health or chronic condition. In this study the PAM was translated into a Dutch version; psychometric properties of the Dutch version were established and the instrument was validated in a panel of chronically ill patients. Methods: The translation was done according to WHO guidelines. The PAM 13-Dutch was sent to 4178 members of the Dutch National Panel of people with Chronic illness or Disability (NPCD) in April 2010 (study A) and again to a sub sample of this group (N = 973) in June 2010 (study B). Internal consistency, test-retest reliability and cross-validation with the SBSQ-D (a measure for Health literacy) were computed. The Dutch results were compared to similar Danish and American data. Results: The psychometric properties of the PAM 13-Dutch were generally good. The level of internal consistency is good (α = 0.88) and item-rest correlations are moderate to strong. The Dutch mean PAM score (61.3) is comparable to the American (61.9) and lower than the Danish (64.2). The test-retest reliability was moderate. The association with Health literacy was weak to moderate. Conclusions: The PAM-13 Dutch is a reliable instrument to measure patient activation. More research is needed into the validity of the Patient Activation Measure, especially with respect to a more comprehensive measure of Health literacy. Background In 2004 Hibbard et al. developed and tested the Patient Activation Measure (PAM), a 22-item instrument which assesses patient (or consumer) self-reported knowledge, skills and confidence for self-management of one’s health or chronic condition [1]. In 2005 a 13-item Short Form of the PAM was developed, which has the same psychometric properties as the longer version and is both reliable and valid – see Table 1 [2]. Both versions of the instrument measure the level of activation of a specific individual. The PAM divides consumers and patients into one of four progressively higher activation levels, which are associated with specific self-care and other health related behaviours. Research has repeatedly * Correspondence: j.rademakers@nivel.nl NIVEL – Netherlands Institute for Health Services Research, PO Box 1568, 3500, BN Utrecht, The Netherlands shown that a higher score on the PAM is positively asso- ciated with various health related behaviours, such as preventive care and lifestyle behaviours, information seeking and use of health information, health outcomes and healthcare use, monitoring and medication adher- ence, conduct in the patient-provider encounter and self-management [3,4]. These effects have been demon- strated both in a clinical setting with chronically ill patients but also in other populations (e.g. company employees, senior citizens in community centres) [5,6]. Though the concept of patient activation has a high face validity and was carefully constructed using experts consensus and patient focus groups [1], an important question remains what construct the instrument is actu- ally measuring. Studies on the construct validity of the PAM predominantly focus on the possible overlap with the concept of health literacy. In some studies the rela- tive contribution of health literacy and patient activation © 2012 Rademakers et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.