Monitoring Primary Health Care Experience: Validity and Reliability of a Patient-Centered Measure for Services Quality

Background: Due to the limited number of valid and reliable tools available to measure the opinions of service recipients regarding the quality of Primary Health Care (PHC), the aim of this study was to develop and validate a patient-centered questionnaire to measure the quality of PHC services. Methods: The initial questionnaire was designed through literature review, and then, nine Focus Group Discussion (FGDs) sessions with 102 participants were held. To determine the content validity of the questionnaire, two qualitative (experts’ opinions and suggestions) and quantitative (CVR & CVI) methods were used. A total of 26 experts and 650 Service Recipients (SRs) participated in the validation process of the questionnaire. To measure reliability, test-retest methods and internal consistency were utilized. Results: A total of 46 items in five dimensions were recognized as necessary, relevant and understandable by the experts. Content validity was confirmed by experts. According to the experts, the optimal model was explained in the form of five factors: “patient-centeredness”, “continuity of care”, “quality of facilities and basic amenities”, “access and availability” and “trust”. The fit of the extracted model was confirmed by confirmatory factor analysis at the desired level. The internal consistency of the constructs and all sub-constructs of the questionnaire was favorable (Cronbach’s alpha=0.942 and ICC=0.868). Also, the results of the test-retest in all constructs and all sub-constructs confirmed the reliability of the questionnaire. Conclusion: In this study, a valid and reliable questionnaire was developed to measure the quality of PHC services from the perspective of service recipients. This measure could be applied for better management of PHC centers and improving the quality of services.