Journal article
Validation of the consumer health activation index (CHAI) among community-dwelling adults in primary care clinics in Singapore
- Abstract:
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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.
MethodsThe 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.
ResultsContent 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).
ConclusionIn 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.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 1.2MB, Terms of use)
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- Publisher copy:
- 10.1186/s12963-025-00402-z
Authors
- Publisher:
- BioMed Central
- Journal:
- Population Health Metrics More from this journal
- Volume:
- 23
- Issue:
- 1
- Article number:
- 49
- Publication date:
- 2025-08-25
- Acceptance date:
- 2025-06-27
- DOI:
- EISSN:
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1478-7954
- Language:
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English
- Keywords:
- Pubs id:
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2280560
- Local pid:
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pubs:2280560
- Deposit date:
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2025-08-14
- ARK identifier:
Terms of use
- Copyright holder:
- Lee et al
- Copyright date:
- 2025
- Rights statement:
- © The Author(s), 2025. This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
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