Zhongguo quanke yixue (Sep 2022)
Reliability and Validity of the Chinese Version of the People-Centered Primary Care Measure
Abstract
Background The People-Centered Primary Care Measure (PCPCM) scale has proven to be able to evaluate the quality of primary care measures in a accurate, all-round and rapid manner in foreign studies. And after being translated and revised, its Chinese version has been developed by Hong Kong scholars. However, there is not yet any report on the applicability and metrological performance concerning the Chinese version of the PCPCM (PCPCM-C) in the culture and healthcare settings in Chinese mainland. Objective To evaluate the reliability and validity of the PCPCM-C scale, providing evidence for its feasibility in evaluating primary care measures in Chinese mainland. Methods By use of convenience sampling, patients were consecutively selected from six primary care settings (community health center, community health station, township health center and village clinic) located in Henan Province, Shanghai, and Heilongjiang Province from December 8th to 20th, 2021. They received a survey using the General Information Questionnaire developed by us, and the PCPCM-C. Then the PCPCM-C was revised in accordance with the survey results, and the assessment results by 10 Chinese professionals (public health managers, general practice experts and administrators of primary care settings) invited nationwide. After that, the PCPCM-C was analyzed using item, reliability and validity analyses. Results Altogether, 683 cases who handed in responsive questionnaires were included for final analysis. The item-total correlation coefficients of the scale ranged from 0.843 to 0.923 (P<0.001) . The CR values of items ranged from 28.270 to 36.055 (P<0.001) . Leave-one-out analysis demonstrated that the Cronbach's α of the PCPCM-C ranged from 0.970 to 0.973 (<0.974) . The reliability analysis of the Cronbach's α, Guttman Split-half coefficient and test-retest reliability of the PCPCM-C was 0.974, 0.952, and 0.874, respectively. The inter-item correlation coefficients ranged from 0.667 to 0.913. The test-retest reliability of every item ranged from 0.724 to 0.886. The expert evaluation showed that content validity index (CVI) of every item was 0.800-1.000, the S-CVI/UA was 0.818, and the S-CVI/Ave was 0.973, the K* was 0.79-1.00. The value of KMO (0.960) and result of Bartlett's test of sphericity (χ2=4 538.461, P<0.001) derived from the exploratory factor analysis, suggested that the data sample was appropriate for factor analysis. One common factor with an eigenvalue >1.000 was extracted, and the cumulative variance explained by which was 78.715%, with the load value of each item of 0.826-0.925. The results of confirmatory factor analysis (CFA) showed that the fitting indicators of the initial model were undesirable. After the establishment of a covariance correlation between error variables e1 and e2, e3 and e9, and e10 and e11 according to the indication, the fitting indicators of the model were modified to be acceptable (modified CMIN: χ2/df=2.983, GFI=0.934, AGFI=0.894, RMSEA=0.081, NFI=0.966, RFI=0.954, IFI=0.977, TLI=0.969, CFI=0.977, standardized regression coefficients ranged from 0.790 to 0.900) . The results of known-group validity analysis showed that the total score of PCPCM-C among patients varied significantly by age, rural or urban hukou, household monthly income per person, self-rated health, and chronic disease prevalence, and region (P<0.05) . Conclusion This PCPCM-C has proven to be with good psychometric quality in Chinese mainland. But further research is needed to test the cross-cultural applicability and residents' conceptualization of the scale.
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