Validation of the consumer health activation index (CHAI) among community-dwelling adults in primary care clinics in Singapore.

IF 2.5 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Population Health Metrics Pub Date : 2025-08-25 DOI:10.1186/s12963-025-00402-z

Justin Guang Jie Lee, Qin Xiang Ng, Nan Luo, Gerald Choon Huat Koh, Ling Jie Cheng

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Abstract

Background: Health activation is an individual's knowledge, skills, and confidence in managing personal health and healthcare. The Consumer Health Activation Index (CHAI) is a freely available, 10-item measure originally developed in the United States. This study aimed to validate CHAI among community-dwelling adults in Singapore, examining its content validity, construct validity and test-retest reliability.

Methods: The study was conducted in two phases. In Phase 1, cognitive interviews with nine population health experts and eleven lay participants assessed face and content validity. In Phase 2, a cross-sectional survey of 572 adults, recruited via quota sampling aligned with national census distributions, was conducted. Participants completed the CHAI, EQ-5D-5L, EQ-VAS, and the Internal subscale of the Multidimensional Health Locus of Control (MHLC). Exploratory factor analysis (EFA) with principal axis factoring and varimax rotation, along with Cronbach's alpha, assessed structural validity and internal consistency respectively. Test-retest reliability was evaluated in a subsample of 32 participants, of whom 21 reported stable health status at follow-up.

Results: Content validity was acceptable, with a Scale-Level Content Validity Index (S-CVI) of 0.86, although minor wording issues were noted for CHAI items 5, 6, and 10. EFA supported a unidimensional structure, and the CHAI demonstrated strong internal consistency (α = 0.85). CHAI scores showed moderate positive correlations with the MHLC internal subscale (Pearson's r = 0.449) and weak to moderate positive correlations with EQ-5D-5 L and EQ-VAS, (r = 0.171-0.344). Known-group validity was supported by significantly higher CHAI scores among individuals with chronic diseases (p = 0.017). Test-retest reliability was good (ICC = 0.802, 95% CI = 0.544-0.911).

Conclusion: In summary, the CHAI is a reliable and valid measure of health activation for community-dwelling adults in Singapore. While overall psychometric performance was robust, minor refinements in phrasing may improve language clarity and cultural applicability. Longitudinal research is recommended to further establish CHAI's utility in both clinical and community local settings.

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查看原文本刊更多论文

验证消费者健康激活指数（CHAI）在新加坡初级保健诊所的社区居住的成年人。

背景：健康激活是个人在管理个人健康和保健方面的知识、技能和信心。消费者健康激活指数（CHAI）是一种免费的、包含10个项目的衡量标准，最初是在美国开发的。本研究旨在验证新加坡社区成人CHAI量表的内容效度、结构效度和重测信度。方法：研究分两期进行。在第一阶段，对9名人口健康专家和11名非专业参与者进行认知访谈，评估面部和内容效度。在第二阶段，通过与国家人口普查分布相一致的配额抽样，对572名成年人进行了横断面调查。被试完成CHAI、EQ-5D-5L、EQ-VAS和多维健康控制点（MHLC）内分量表。探索性因子分析（EFA）采用主轴因子分解和变量旋转，以及Cronbach's alpha分别评估结构效度和内部一致性。在32名参与者的子样本中评估了重测信度，其中21人在随访时报告健康状况稳定。结果：内容效度可接受，量表级内容效度指数（S-CVI）为0.86，尽管柴项目5、6和10存在较小的措辞问题。EFA支持一维结构，CHAI具有较强的内部一致性（α = 0.85）。CHAI得分与MHLC内部子量表呈中度正相关（Pearson’s r = 0.449），与eq - 5d - 5l和EQ-VAS呈弱至中度正相关（r = 0.171 ~ 0.344）。慢性疾病个体的CHAI得分显著高于已知组效度（p = 0.017）。重测信度良好（ICC = 0.802, 95% CI = 0.544 ~ 0.911）。结论：总的来说，CHAI是一个可靠和有效的衡量新加坡社区居住成年人健康激活的指标。虽然整体心理测试表现稳健，但措辞上的细微改进可能会提高语言的清晰度和文化适用性。建议进行纵向研究，进一步确立CHAI在临床和社区环境中的效用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Population Health Metrics PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

6.50

自引率

0.00%

发文量

审稿时长

29 weeks

期刊介绍： Population Health Metrics aims to advance the science of population health assessment, and welcomes papers relating to concepts, methods, ethics, applications, and summary measures of population health. The journal provides a unique platform for population health researchers to share their findings with the global community. We seek research that addresses the communication of population health measures and policy implications to stakeholders; this includes papers related to burden estimation and risk assessment, and research addressing population health across the full range of development. Population Health Metrics covers a broad range of topics encompassing health state measurement and valuation, summary measures of population health, descriptive epidemiology at the population level, burden of disease and injury analysis, disease and risk factor modeling for populations, and comparative assessment of risks to health at the population level. The journal is also interested in how to use and communicate indicators of population health to reduce disease burden, and the approaches for translating from indicators of population health to health-advancing actions. As a cross-cutting topic of importance, we are particularly interested in inequalities in population health and their measurement.