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Background <p>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.</p> Methods <p>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.</p> Results <p>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 <i>r</i> = 0.449) and weak to moderate positive correlations with EQ-5D-5&#xa0;L and EQ-VAS, (<i>r</i> = 0.171–0.344). Known-group validity was supported by significantly higher CHAI scores among individuals with chronic diseases (<i>p</i> = 0.017). Test-retest reliability was good (ICC = 0.802, 95% CI = 0.544–0.911).</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月25日

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

摘要

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.