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The Development of a Patient-Practitioner Nurse Self-management Questionnaire (PPN-SM-q) to Evaluate Chronic Primary Health Care

Wijnands-van Gent CJM, Stoop CH, Van der Heijden MMP, Romeijnders AC, Pop VJM

Background: Self-management is becoming a major issue in chronic primary health care. Until now, there is poor insight in patients and professional involved aspects, predominantly because properly developed instruments to assess these characteristics are lacking.

Objective: To develop and validate a user friendly selfmanagement questionnaire following a rigorous protocol of scale development.

Methods: After focus groups interviews in both patients (suffering from diabetes, asthma/COPD and cardiovascular disease) and practitioner nurses (PN), an exploratory factor analysis (SPSS-IBM, Oblimin rotation) revealed a 21-item scale with good model fit during Confirmatory Factor Analysis (AMOS-IBM: CFI of 0.94, a NFI 0.96, TLI of 0.95 and a RMSEA of 0.06 with a lower bound of 0.03). Three dimensions were discriminated: a 8-item 'patient-PN interaction sub-scale', a 9-item ‘patients self-management attitude sub-scale’ and a 4-item 'patients self-management action’ subscale with a Cronbach’s alpha of 0.87, 0.81 and 0.80, respectively. The sub-scales ’patient-PN interaction' and 'patients self-management action' showed significant correlations in the expected direction with the PHQ-4 (r=-0,11 and -0,20) while the three sub-scales correlated highly significant with the self-efficacy sub-scale: r=0.41, r=0.27 and r=0.65. A multivariate linear regression with "self-management attitude scores’’ as dependent variable and patient-PN interaction sub-scale scores as independent variable (adjusting for demographic variables sex, marital status, education and age, depression/anxiety and self-efficacy scores) showed that high self-efficacy scores (beta=0.48, p<0.001), high PN interaction scores (beta=0.28, P<0.001) and higher education (beta=0.13, P=0.004) were all significantly related to high scores on the self-management attitude scale. A similar regression with “self-management action scores” as dependent variable showed that only the patient-PN interaction scores (beta=0.48, P<0.001) and higher age (beta=-0.12, P=0.014) were significantly related.

Conclusion: The 21 item patient-practitioner nurse self-management questionnaire consists of three sub-scales measuring relevant aspects of self-management behavior. Adequate patient–PN interaction is an important predictor of adequate self-management. We recommend implementing this instrument in daily primary practice of chronic health care. Poor scores should help to focus both on patient as well as practitioner nurse characteristics that are important for optimal health care.