BMJ Open (2020-07-01)

Patient Continuity of Care Questionnaire in a cardiac sample: A Confirmatory Factor Analysis

  • Kristofer Årestedt,
  • Anna Strömberg,
  • Tiny Jaarsma,
  • Emma Säfström,
  • Lena Nasstrom,
  • Maria Liljeroos,
  • Lena Nordgren

Journal volume & issue
Vol. 10, no. 7


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Objective Even though continuity is essential after discharge, there is a lack of reliable questionnaires to measure and assess patients’ perceptions of continuity of care. The Patient Continuity of Care Questionnaire (PCCQ) addresses the period before and after discharge from hospital. However, previous studies show that the factor structure needs to be confirmed and validated in larger samples, and the aim of this study was to evaluate the psychometric properties of the PCCQ with focus on factor structure, internal consistency and stability.Design A psychometric evaluation study. The questionnaire was translated into Swedish using a forward–backward technique and culturally adapted through cognitive interviews (n=12) and reviewed by researchers (n=8).Setting Data were collected in four healthcare settings in two Swedish counties.Participants A consecutive sampling procedure included 725 patients discharged after hospitalisation due to angina, acute myocardial infarction, heart failure or atrial fibrillation.Measurement To evaluate the factor structure, confirmatory factor analyses based on polychoric correlations were performed (n=721). Internal consistency was evaluated by ordinal alpha. Test–retest reliability (n=289) was assessed with intraclass correlation coefficient (ICC).Results The original six-factor structure was overall confirmed, but minor refinements were required to reach satisfactory model fit. The standardised factor loadings ranged between 0.68 and 0.94, and ordinal alpha ranged between 0.82 and 0.95. All subscales demonstrated satisfactory test–retest reliability (ICC=0.76–0.94).Conclusion The revised version of the PCCQ showed sound psychometric properties and is ready to be used to measure perceptions of continuity of care. High ordinal alpha in some subscales indicates that a shorter version of the questionnaire can be developed.