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

Laura Elizabeth Bedford; Maegan Hon Yan Yeung; Chi Ho Au; Emily Tsui Yee Tse; Wing Yee Yim; Esther Yee Tak Yu; Carlos King Ho Wong; Cindy Lo Kuen Lam

doi:10.1093/fampra/cmaa102

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

Fam Pract. 2021 Jun 17;38(3):339-345. doi: 10.1093/fampra/cmaa102.

Authors

Laura Elizabeth Bedford¹, Maegan Hon Yan Yeung¹, Chi Ho Au¹, Emily Tsui Yee Tse¹, Wing Yee Yim¹, Esther Yee Tak Yu¹, Carlos King Ho Wong^{1

2}, Cindy Lo Kuen Lam¹

Affiliations

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

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.

Keywords: Health enablement; patient-centred care; primary care; questionnaire; reliability; validity.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Factor Analysis, Statistical
Humans
Prospective Studies
Psychometrics
Quality of Life*
Reproducibility of Results
Surveys and Questionnaires