RELIABILITY AND VALIDITY OF INSTRUMENTS FOR EVALUATION OF HEALTH MOTIVATION IN ADULT POPULATION: A SYSTEMATIC REVIEW AND NARRATIVE ANALYSIS

X. Zhao¹, P. Goodwin¹

Background: An aging population and co-existing health conditions challenge healthcare systems and cause social inequity. The need to improve rehabilitation provision for patients with chronic diseases is recognised by clinicians and policymakers. Ensuring positive health behaviour to improve rehabilitation of a chronic disease is challenging. Motivation is known to impact preferences and decision making for health-related issues. Understanding a patient’s health motivation may influence positive behavioural intentions and facilitate change when needed, which may help improve outcomes. Reliable and valid outcome measures for assessing health motivation are a prerequisite for accurate understanding of patient’s health motivation.

Purpose: This systematic review aimed to identify which patient reported outcome measure (PROM) is the most valid and reliable to determine health motivation in an adult population.

Methods: The literature was systematically searched using terms reflecting concepts of accuracy, health motivation and questionnaire in four databases, Medline, CINAHL, PsycARTICLES and Psychinfo, from inception to 29thMarch 2020. Two reviewers independently searched, extracted data and assessed risk of bias. A third reviewer moderated any discrepancies. Instrument development and evaluation studies of health motivation in the adult population were included with limits on language only. Methodological quality was assessed according to the COSMIN checklist and evaluated using GRADE principles. PROSPERO registration: CRD42020183993.

Results: The search yielded n=2,803 results, n=8 PROMs assessing health motivation were identified from n=13 studies and included in the review. Content validity were determined for n=8 PROMs (Motivation and Attitudes toward Changing Health [MATCH], Health Regulatory Focus Scale [HRFS], US Health Regulatory Focus Scale [US HRFS], Health Self-Determinism Index [HSDI], Health Salience [HS], Health Motivation Assessment Inventory [HMAI], Motivation for Change Questionnaire [MCQ], General Health Motivation Scale [GHMS]). Structure validity, internal consistency, and construct validity were determined for n=6 PROMs (MATCH, HRFS, US HRFS, HSDI, HS, HMAI); reliability was determined for n=2 PROMs (HRFS, HSDI); and criterion validity was determined for n=2 PROMs [HRFS, MCQ]. Most studies did not address questionnaire development and content validity adequately. A high level of evidence was found for sufficient content validity for the GHMS, and a high level of evidence was found for sufficient structural validity, internal consistency and construct validity for the HSDI.

Conclusion(s): None of the included questionnaires were considered to be completely reliable and valid. One PROMS is recommended for use (GHMS) as content validity is considered as the most important measurement property of a questionnaire and should be taken into account before use. Questionnaire development and content validity need to be considered when developing a new PROM, as well as internal structure in its evaluation. Clear evidence and dissemination should be provided along with cross-cultural validity for any translation.

Implications: In order to improve rehabilitation outcomes, when measuring the health motivation of patients to influence positive behavioural intentions and facilitate change when needed, clinicians should use the GHMS, but be mindful of its limitations.

Funding, acknowledgements: No funding was obtained for this study.

Keywords: Health motivation, Patient reported outcome measure, Reliability and validity

Topic: Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? No

Institution: Manchester Metropolitan University

Committee: Manchester Metropolitan University

Reason: The study did not involve human or animal subjects, so it was exempted from institutional Review Board approval.