As primary health care (PHC) renewal progresses in Canada, it is critical to measure the impacts of change from all perspectives—especially from the point of view of the public and patients, who are most likely to be affected by changes.
However, we know little about what British Columbians expect of their PHC system, and no single questionnaire meaningfully measures aspects of care of interest to the policy, management and practice communities, while also taking into account public perspectives. While questionnaires have been developed and validated in other countries, differences in values and health system structures mean that existing tools are likely to need modification to evaluate PHC in Canada.
In 2005, the British Columbia Ministry of Health identified the development and validation of a survey regarding adults’ experiences with primary health care (PHC) as an important step toward monitoring, evaluating and reporting on this sector in the province.
Developing a Sector-Specific Survey
Understanding British Columbians' Experiences with PHC describes Ministry-responsive work underway at CHSPR to develop and validate items and scales for just such a survey. The resulting instrument is unique in that it is designed to measure dimensions (or aspects) of PHC identified through focus groups held with patients across the province, a review of relevant scientific literature, and input from government stakeholders.
This report lays out broad findings based on the survey development and validation—a more detailed analysis of the items, index and scales is available upon request.
The pilot survey was administered to a random sample of 500 adult British Columbians—stratified by gender and community size—using computer assisted telephone interviews. We examined variability, including item-scale correlations and normality of distributions, and assessed internal consistency reliability and construct validity. Psychometric analysis was completed across the total sample, and by gender, age group and community size.
The majority of items and scales tested revealed acceptable reliability, variability and validity in the total sample, and by gender, age group and community size. Items measuring five of six dimensions important to focus group participants can be reliably used in future surveys. With some exceptions, most of the single items and scales measuring other important dimensions of PHC can also be used in future surveys. More work is required to improve the usability of the survey and to provide more comprehensive measurement of PHC dimensions such as continuity, interpersonal communication and chronic disease management.
Results suggest that most of the survey content, with additional refinement, is robust enough to be administered through future telephone survey work in the province. Two Canadian Institutes of Health Research-funded projects are underway at the Centre to advance this work.
- Contact: Sabrina Wong
- Diane Watson
- Charlyn Black
- BC Ministry of Health