For our impact evaluation, patient-level measures across projects will assess patient activation, experiences of care, social support, health-related quality of life, mental health symptoms (anxiety, depression), and CV risk. Patient engagement and retention will be assessed specifically in each project per the parameters of their respective interventions. Patient activation will be assessed using a 6-item version of the
Patient Activation Measure (
PAM) [
33,
34]. PAM items are rated on a 4-point Likert scale ranging from 1 (strongly agree) to 4 (strongly disagree). The measure yields an activation score from 0 (least activated) to 100 (most activated), which is transformed into an ordinal indicator of four levels of activation ranging from level 1 (least) to level 4 (most activated). Items from the
Consumer Assessment of Healthcare Providers and Systems (
CAHPS)
Patient-Centered Medical Home (
PCMH)
Survey [
35] will be used to measure patient experience with care (e.g., communication). The short-form
Interpersonal Support Evaluation List (
ISEL) [
36,
37] is a widely used 12-item instrument that assesses perceptions of social support. The ISEL has been subjected to extensive psychometric testing and has shown to be internally consistent and valid [
38]. Health-related quality of life will be measured using the
Healthy Days measure [
39]. The measure consists of a four-item core module assessing health status, four items measuring activity limitation, five symptom-related items that assess the days in the past month the respondent experienced symptoms related to pain, depression, anxiety, and sleep problems, and one vitality item. The five-item
Overall Anxiety Severity and Impairment Scale (
OASIS) [
40] will be used to assess anxiety. OASIS scores demonstrate robust correlations with global and disorder-specific measures of anxiety, and this scale is the only available measure that captures severity and impairment
across anxiety disorders [
41]. The
Patient Health Questionnaire (
PHQ) is the depression module of the PRIME-MD diagnostic instrument, which scores each of the nine DSM-IV criteria as “0” (not at all) to “3” (nearly every day). The PHQ-9 is also a reliable and valid measure of depression severity [
42]. To assess
cardiovascular risk, we will use items from the CV project patient worksheet regarding traditional CV risk factors, family history of CV disease, pregnancy and gestational history, and smoking status.