Validation of the Consumer Health Activation Index (CHAI) in general population samples of older Australians

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To validate the 10-item Consumer Health Activation Index (CHAI), developed in the United States, as an activation measure for interventions targeted at the Australian older general population.

The study was a cross sectional design. Exploratory factor analysis (EFA) was conducted on survey data from a community sample of participants (n = 250), aged 55–75 years. Confirmatory factor analysis (CFA) was used to evaluate dimensionality among a second sample of participants randomly sampled from the electoral roll (n = 571), aged 50–75 years. Associations between the CHAI and self-reported health behaviours were examined.

EFA revealed a 7-item, two-factor structure (‘Health self-management’ and ‘Patient-provider engagement’). CFA indicated optimum model fit was obtained with this structure. Subscale reliability and validity were confirmed, with significant correlation to age, functional health literacy and health screening.

In contrast to the original structure, optimum model fit was obtained with a two-factor solution and retention of seven items. The subscales have utility as a measure of health activation for tailoring of information in this group.

A freely-available, unidimensional health activation measure has demonstrated an underlying two-scale structure that will enable tailored approaches toward the enhancement and maintenance of self- and externally-managed health behaviours in an Australian population.
Original languageEnglish
Article number100224
Number of pages8
JournalPEC Innovation
Early online date1 Oct 2023
Publication statusPublished - 15 Dec 2023


  • Health activation
  • Health literacy
  • Validation study
  • Consumer participation
  • Health promotion
  • Australia


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