Psychometric evaluation of a patient-reported item bank for healthcare engagement

Purpose: Healthcare engagement is a core measurement target for efforts to improve healthcare systems. This construct is broadly defined as the extent to which healthcare services represent collaborative partnerships with patients. Previous qualitative work operationalized healthcare engagement as generalized self-efficacy in four related subdomains: self-management, collaborative communication, health information use, and healthcare navigation. Building on this work, our objective was to establish a healthcare engagement instrument that is sufficiently unidimensional to yield a single score. Method: We conducted cognitive interviews followed by a nation-wide mail survey of US Veteran Administration (VA) healthcare users. Data were collected on 49 candidate healthcare engagement items, as well as measures of self-efficacy for managing symptoms, provider communication, and perceived access. Items were subjected to exploratory bifactor, statistical learning, and IRT analyses. Results: Cognitive interviews were completed by 56 patients and 9552 VA healthcare users with chronic conditions completed the mail survey. Participants were mostly white and male but with sizable minority participation. Psychometric analyses and content considerations reduced the item pool to 23 items, which demonstrated a strong general factor (OmegaH of.89). IRT analyses revealed a high level of reliability across the trait range and little DIF across groups. Most health information use items were removed during analyses, suggesting a more independent role for this domain. Conclusion: We provide quantitative evidence for a relatively unidimensional measure of healthcare engagement. Despite developed with VA healthcare users, the measure is intended for general use. Future work includes short-form development and validation with other patient groups.