Abstract

Objectives

Existing personal health agency (ability to manage health on one’s own) measures focus on adherence to disease-modifying treatments rather than accommodation of disease on one’s own with optional visits, tests, and treatments as effective health strategy. This study aimed to develop a personal health agency measure with themes more relevant for discretionary care (taking control in self-management rather than adherence).

Methods

In this three-stage, cross-sectional study among 801 people seeking discretionary musculoskeletal specialty care, we performed sequential exploratory and confirmatory factor analyses starting with 33 items derived from legacy measures. We retained items that contributed to model fit (root mean square error of approximation 0.05) accounting for favorable item discrimination, item difficulty, internal consistency, local dependencies, and differential item functioning. The findings were internally validated using 2 cohorts. We also assessed external validity (correlation with Patient Activation Measure [PAM]-13) and consistency (factors associated with new measure vs PAM-13).

Results

We identified 1 underlying theme and selected 9 items to represent the new Agency for Navigating Challenges, Health Ownership, and Resiliency (ANCHOR) measure. The 3-item, 6-item, and 9-item versions displayed excellent model fit (root mean square error of approximation 0.001-0.035) and internal consistency (Cronbach alpha = 0.82-0.93) in internal validation. The floor effects were 2% to 3% and ceiling effects were 9% to 17%. The ANCHOR measures had moderate-to-strong correlations with PAM-13 (rho = 0.61-0.73) with similar external correlates, supporting external validity and consistency.

Conclusions

Enhancement of personal health agency—an important element of effective accommodation of symptoms over a lifetime—can be facilitated by routine measurement using ANCHOR. Agency-enhancing health strategies have the potential to support health while limiting discretionary use of resources.