Socioeconomic status assessment in Lebanese primary health care centers: development and validation of the SES-PHC scale

Socioeconomic status (SES) is a major determinant of health outcomes among patients with chronic diseases, yet validated context-specific tools for primary health care centers (PHCCs) remain limited. In Lebanon, overlapping crises have exacerbated socioeconomic vulnerability, prompting this validation study among Lebanese patients with chronic diseases attending PHCCs. This cross-sectional study enrolled 370 adults with at least one chronic disease from eight PHCCs operated by the Order of Malta Lebanon between June and August 2024. Participants completed the SES Composite (SES-C), the Arabic-translated InCharge Financial Distress-Financial Well-Being (IFDFW) scale, and the WHO-5 Well-Being Index. Because the SES-C showed poor sampling adequacy (KMO = 0.546) and low internal consistency (Cronbach's α = 0.579), a new scale, the SES-PHC, was developed using iterative principal component analysis. The final seven-item instrument, comprising four IFDFW items and three SES-C items, demonstrated good internal consistency (Cronbach's α = 0.755), strong structural validity (KMO = 0.838; two factors explaining 61.491% of the variance), and strong convergent validity with the IFDFW (r = 0.852, p < 0.001). Higher SES was associated with older age, better psychological well-being, and private insurance, supporting the SES-PHC as a valid tool for identifying vulnerable patients in Lebanese PHCCs.