The validity, reliability, sensitivity and responsiveness of a modified Patient Enablement Instrument (PEI-2) as a tool for serial measurements of health enablement

Author:

Bedford Laura Elizabeth1ORCID,Yeung Maegan Hon Yan1ORCID,Au Chi Ho1ORCID,Tse Emily Tsui Yee1ORCID,Yim Wing Yee1,Yu Esther Yee Tak1ORCID,Wong Carlos King Ho12ORCID,Lam Cindy Lo Kuen1ORCID

Affiliation:

1. Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China

2. Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China

Abstract

Abstract Background Patient enablement is a core tenet of patient-centred and holistic primary care. The Patient Enablement Instrument (PEI) is a transitional measure limited in its ability to measure changes over time. A modified version, PEI-2, has been developed to measure enablement at a given time-point without comparison to a recalled baseline. Objective To assess the validity, reliability, sensitivity and responsiveness of PEI-2. Methods PEI-2 was modified from the Chinese PEI to assess enablement over 4 weeks in a prospective cohort study nested within a community support programme [Trekkers Family Enhancement Scheme (TFES)] in Hong Kong. Construct validity was assessed by factor analysis and convergent validity by Spearman’s correlations with health-related quality of life and depressive symptoms. Internal reliability was assessed using Cronbach’s alpha. Test–retest reliability was assessed by intraclass correlation (ICC), responsiveness by 12–24-month change in PEI-2 score and sensitivity by differences in change of PEI-2 score between TFES participants and a control group. Results PEI-2 demonstrated construct validity with all items loading on one factor (factor loadings >0.7). Convergent validity was confirmed by significant correlations with 12-item Short Form Questionnaire, version 2 (r = 0.1089–0.1919) and Patient Health Questionnaire-9 (r = −0.2030). Internal reliability was high (Cronbach’s alpha = 0.9095) and test–retest reliability moderate (ICC = 0.520, P = 0.506). Significant improvements in PEI-2 scores among the TFES group suggested good responsiveness (P < 0.001). The difference in change of PEI-2 scores between TFES and control was significant (P = 0.008), indicating good sensitivity. Conclusions This study supports the validity, reliability, sensitivity and responsiveness of PEI-2 in measuring changes in enablement, making it a promising tool for evaluating enablement in cohort and intervention studies.

Funder

University of Hong Kong

Kerry Group Kuok Foundation (Hong Kong) Limited

Publisher

Oxford University Press (OUP)

Subject

Family Practice

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