A new questionnaire to assess endorsement of normative ethics in primary health care: development, reliability and validity study

Abstract

Assessing ethical endorsement is crucial to the study of professional performance and moral conduct. There are no specific instruments that verify patients and professional experiences of ethical practice in the specific area of primary health care (PHC). To study the psychometric properties of two questionnaires to identify professional and patient endorsement of normative ethics. A methodological study conducted in PHC centres from an urban area (Barcelona). A group of items from an ethical code were generated using a qualitative study with focus groups. Items underwent expert validation, item refinement and test-retest reliability. Two groups of items for PHC professionals and patients were validated. The structure of the constructs and the internal consistency were studied after participants completed the questionnaires. Principal component analysis with supplementary variables showed the utility of the validated questionnaires. The patients' questionnaire consisted of 17 general items plus 11 additional items on specific conditions, and the health professional's contained 24 general and 9 specific items. The construct of the questionnaires comprised a three-factor solution for patients and a five-factor solution for professionals. Principal component analysis with supplementary variables showed that patients with higher scores on ethical perception were associated with better opinions on health care quality and more confidence in professionals. In PHC professionals, higher scores were associated with effective knowledge of the code. Both questionnaires showed good psychometric properties and are valid to screen ethical attitudes. The instrument warrants further testing and use with culturally diverse patients and PHC professionals.