Translation and Validation of the Greek Version of the Patient Activation Measure-13 in Glaucoma Patients

Abstract

Introduction: The Patient Activation Measure 13 (PAM-13) questionnaire assesses patient activation levels, indicating their self-management and self-care behaviors. This instrument has been translated into various languages and utilized in numerous settings, including chronic disease care. However, till today, it has not been translated and validated in Greek.
Aim: To translate and validate the PAM-13 questionnaire into the Greek language.
Material & methods: A cross-sectional study on glaucoma patients who were attending the outpatient ophthalmological clinic of a University Hospital in Heraklion - Greece, was conducted. A convenience sampling method was employed to recruit 216 participants. Data collection occurred between April and October 2023. Two qualified independent linguistic translators performed the translation from English to Greek, followed by a reverse translation to English. Feedback from 10 Greek glaucoma patients was considered, and experts in psychometrics assessed face and content validity. Internal consistency was assessed using Cronbach’s alpha. Intra-rater reliability was assessed using the intraclass correlation coefficient (ICC) in a random subgroup of participants. Exploratory Factor Analysis (EFA) was conducted to identify the factor structure of the Greek version of the PAM-13 questionnaire. Confirmatory Factor Analysis (CFA) was used to determine model fit. Statistical analyses were performed using STATA (version 12) for CFA and IBM SPSS (version 26) for other analyses. The significance level was set at α = 0.05.
Results: Most of the study participants were male (56.5%), and the mean [±Standard Deviation] age of the sample was 63.6 (±15) years. The ICC between initial and reassessment scores for the Greek version of PAM-13 was 0.998, p<0.001. Data suitability for factor analysis was confirmed by a significant Bartlett Test of Sphericity (p <0.001) and a high Kaiser-Meyer-Olkin Measure of 0.957. EFA identified a single factor explaining 68.2% of the total variance in the 13 questionnaire items. CFA supported a one-factor model with acceptable global fit indices (SRMR = 0.07, CD = 0.98, CFI = 0.90), endorsing the adoption of the 13-item one-factor solution for the Greek version of the PAM-13 questionnaire. Finally, the internal consistency of the full PAM13-D scale, measured by Cronbach’s alpha, was 0.961.
Conclusions: The Greek-validated PAM-13 questionnaire is a reliable tool for assessing patient activation in Greek-speaking populations. Its strong internal consistency and one-factor structure make it valuable for healthcare professionals and researchers. Further research is needed to address limitations and apply the Greek PAM-13 in various settings.