Construct Validity of the Dutch Version of the 12-Item Partners in Health Scale: Measuring Patient Self-Management Behaviour and Knowledge in Patients with Chronic Obstructive Pulmonary Disease

PLoS One. 2016 Aug 26;11(8):e0161595. doi: 10.1371/journal.pone.0161595. eCollection 2016.


Objective: The 12-item Partners in Health scale (PIH) was developed in Australia to measure self-management behaviour and knowledge in patients with chronic diseases, and has undergone several changes. Our aim was to assess the construct validity and reliability of the latest PIH version in Dutch COPD patients.

Methods: The 12 items of the PIH, scored on a self-rated 9-point Likert scale, are used to calculate total and subscale scores (knowledge; coping; recognition and management of symptoms; and adherence to treatment). We used forward-backward translation of the latest version of the Australian PIH to define a Dutch PIH (PIH(Du)). Mokken Scale Analysis and common Factor Analysis were performed on data from a Dutch COPD sample to investigate the psychometric properties of the Dutch PIH; and to determine whether the four-subscale solution previously found for the original Australian PIH could be replicated for the Dutch PIH.

Results: Two subscales were found for the Dutch PIH data (n = 118); 1) knowledge and coping; 2) recognition and management of symptoms, adherence to treatment. The correlation between the two Dutch subscales was 0.43. The lower-bound of the reliability of the total scale equalled 0.84. Factor analysis indicated that the first two factors explained a larger percentage of common variance (39.4% and 19.9%) than could be expected when using random data (17.5% and 15.1%).

Conclusion: We recommend using two PIH subscale scores when assessing self-management in Dutch COPD patients. Our results did not support the four-subscale structure as previously reported for the original Australian PIH.

Publication types

  • Validation Study

MeSH terms

  • Aged
  • Comorbidity
  • Factor Analysis, Statistical
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Language
  • Male
  • Middle Aged
  • Netherlands
  • Patient Compliance
  • Patient Education as Topic
  • Psychometrics*
  • Pulmonary Disease, Chronic Obstructive / complications
  • Pulmonary Disease, Chronic Obstructive / diagnosis*
  • Pulmonary Disease, Chronic Obstructive / psychology*
  • Reproducibility of Results
  • Self Care
  • Self Report*
  • Surveys and Questionnaires

Grant support

This study was supported by the Lung Foundation Netherlands (grant number URL: The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.