Development of the patient motivation questionnaire: conceptualizing and measuring motivation in patients with inflammatory arthritis

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<span style="font-size: 10pt;">Background: Motivation is literally the desire to do things, and patient motivation was reported to play an important role in determining the outcome of therapy. Measuring patients' motivation reflects their proactivity, engagement and activation to self-manage their disease which is of value both at the individual level (e.g. tailoring management and interventions) and at the educational program evaluation (e.g. monitor efficacy in enhancing activation). Objectives: to develop a questionnaire for evaluating the patient's "motivation" and assess the psychometric properties of that measure in patients with chronic inflammatory arthritis. Methods: the conceptualization stage identified that inflammatory arthritic patients who are likely to have better health outcomes are those who: (1) Understand the nature of their disease, 2. Are involved in treatment and diagnostic choices through a shared decision process; 3. Are aware of the patient's health-engagement role; 4. Able to self-manage symptoms/problems; 5. Able to collaborate with providers; 6. Can find solutions; 7. Able to maintain functioning and reduce health declines; 8. Can engage in activities; 9. Able to administer medications; 10. Able to find resources and select providers based on performance or quality. Using Rasch analysis and 76 questions item pool; content analysis and semi structured group discussion, the questionnaire was developed including: 10-items scale (0-10 on VAS scale). Construct validity was assessed by correlating the score of the questionnaire to parameters of disease activity (DAS-28, ASDAS and DAPSA scores), functional disability, quality of life, patient self-helplessness measure [1] as well as the patients' compliance to therapy [2]. Reliability and comprehensibility and sensitivity to change were also assessed. Results: The questionnaire was assessed in 432 RA, 415 Psoriatic arthritis patients, and 232 Ankylosing spondylitis patients. Dimensionality analysis revealed a 1-factor solution, explaining 98% of the total variance. It showed acceptable validity as it correlated significantly with disease activity measures: DAS-28: r = -0.85; ASDAS: r = -0.86, DAPSA: r= -0.89. It also correlated significantly with Functional disability score: r= -0.91, and QoL: r= -0.90 as well as patient self-helplessness r= -0.88. The questionnaire was reliable (Cronbach's alpha 0.958) and had no misfitting items. In addition, it was comprehensible (9.4) and sensitive to change (p<0.01). The patient motivation score showed significant (p<0.01) variation with the medication compliance. Conclusions: The Patient Motivation Measure is a patient-reported tool that is valid, reliable, comprehensible and unidimensional scale that reflects the patients': (1) awareness of their role in their disease management, (2) confidence and knowledge necessary to take action, (3) actual ability of taking action to maintain and improve one's health, and (4) staying the course even under stress, (5) ability to find reliable resources. The measure has good psychometric properties indicating that it can be used at the individual patient level to tailor management and monitor changes. (Conference abstract)</span>