Evaluation of the Health Education Impact Questionnaire (heiQ), a Self-Management Skill Assessment Tool, in Italian Chronic Patients

Andrea Pozza,1 Richard H Osborne,2,3 Gerald R Elsworth,2 Giacomo Gualtieri,4 Fabio Ferretti,1 Anna Coluccia1 1Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy; 2Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Australia; 3Department of Public Health, University of Copenhagen, Copenhagen, Denmark; 4Legal Medicine Unit, Santa Maria alle Scotte University Hospital, Siena, Siena, ItalyCorrespondence: Fabio FerrettiDepartment of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale Bracci 16, Siena 53100, ItalyTel +39 0577 586409Fax +39 0577 233222Email ferrefa@unisi.itBackground: The Health Education Impact Questionnaire (heiQ) aims to evaluate eight self-management skills in people with chronic conditions. Knowledge about the relations between these self-management skills and different quality of life (QoL) outcomes has received little attention. It is also important to provide further evidence on its properties in non-English healthcare contexts, as the questionnaire is being used in cross-cultural research. Furthermore, in the Italian healthcare context, the relationship between the medical staff and the patients remains asymmetrical, with the latter having the role of passive recipients of medical prescriptions and services. The current study provided further evidence about the psychometric properties of the heiQ among Italian people with chronic conditions, specifically by assessing the factor structure, reliability, convergent/divergent and criterion validity (ie, the specific contribution of each of the self-management skills to QoL outcomes).Methods: Two hundred ninety-nine individuals with a chronic condition (mean age = 61.4 years, 50% females) completed the heiQ and the Medical Outcomes Study-Short Form (MOS SF-36). Confirmatory factor analyses, Composite Reliability Indices (CRI), bivariate correlations and linear regression analyses were computed.Results: A model with 8 correlated factors showed good fit, in a similar way to previous studies. CRI values were acceptable to good for all the subscales. Associations between some of the heiQ subscales and some of the MOS SF-36 subscales supported criterion validity. In particular, it was confirmed by the moderate associations between the constructive attitudes and approaches subscale and the MOS SF-36 vitality and perceived mental health and by the moderate correlations between the health directed activities subscale and the MOS SF-36 Vitality. In linear regressions, higher emotional distress predicted higher physical and mental QoL, while higher mental QoL was also associated with stronger constructive attitudes and approaches.Conclusion: The heiQ has robust properties across translations and it can also be used routinely in Italian healthcare contexts. The evidence that all the other self-management skills did not predict either physical or mental QoL could suggest that the self-management model of chronic diseases is still not sufficiently developed in the Italian context, where patients are passive recipients of medical instructions.Keywords: chronic diseases, self-management, health education, psychometric properties, health status, quality of life, diabetes, cardiovascular diseases