Development and validation of an instrument to measure patient engagement in Hong Kong Special Administrative Region, China

Objective: The objective of this study was to develop, pilot test, and psychometrically validate a patient engagement questionnaire, called Patient Engagement Index (PEI), in Hong Kong, China. Method: The method employed was based on a patient engagement framework and literature review and expert panel discussion. A new measure named PEI with 20 items divided into five factors was developed. A pilot study of 40 patients was used to confirm the clarity of PEI. Explored factor analysis was used to confirm the construct validity. Cronbach's alpha, intercorrelation coefficients (ICCs), and weighted kappa were used to assess the internal consistency reliability and test-retest reliability separately. Rasch model and differential item functioning were also used to further confirm the fit of the instrument. Results: In all, 324 participants successfully completed the survey. Based on the evaluation of exploratory factor analysis and theoretically considerations, a four-factor structure comprising 20 items was identified. Rasch analysis also confirmed that the model has a good fit (ranging from 0.662 to 1.294). All domains were considered internally consistent (alpha >0.7). Test-retest showed both ICC (>0.6) and weighted kappa (>0.4) meeting the minimum recommended standard. No ceiling or floor effect was found. Furthermore, Spearman's correlation coefficient confirmed that PEI had good internal validity. Conclusion: PEI was shown to have good reliability and validity. This is a short, quick, and appropriate tool to assess the extent of patient engagement in both clinical and research settings.