Adaptation and psychometric properties of the Norwegian version of the heart continuity of care questionnaire (HCCQ)

Irene Valaker,Heather Hadjistavropoulos,Svein Rotevatn,Tore Wentzel-Larsen,Maj-Britt Råholm,Tone M Norekvål,Jan Erik Nordrehaug,Bengt Fridlund

doi:10.1186/s12874-019-0706-z

Abstract

BackgroundContinuity of cardiac care after hospital discharge is a priority, especially as healthcare systems become increasingly complex and fragmented. There are few available instruments to measure continuity of cardiac care, especially from the patient perspective. The aim of this study was (1) to translate and adapt the Heart Continuity of Care Questionnaire (HCCQ) to conditions in Norway, and (2) to determine its psychometric properties in self-report format administered to patients after percutaneous coronary intervention (PCI).MethodsThe HCCQ was first translated into Norwegian from the original English version, following a widely used cross-cultural adaptation process. Data were collected before hospital discharge and in a follow-up after 2 months. To assess psychometric properties, a confirmatory factor analysis (CFA) was performed and three aspects of construct validity were evaluated: structural validity, hypotheses testing and cross-cultural validation. Internal consistency of the HCCQ subscales was calculated using Cronbach’s alpha, while intra-class correlation (ICC) was used to assess test-retest reliability. Additionally, socio-demographic and patient-reported data were collected to correlate with HCCQ scores.ResultsOf those included at baseline, 436 (76%) completed the questionnaires after 2 months. CFA suggested that the fit of the HCCQ data to a 3-factor model was modest (RMSEA = 0.11, CFI = 0.90, TLI = 0.90). However, convergent validity was satisfactory, based on existing research. Internal consistency was good, as indicated by its Cronbach’s alphas: total continuity of care (0.95); informational (0.93), relational (0.87), and management (0.89) continuity. The ICC for the total HCCQ score was 0.80 (95% CI [0.71, 0.87] p < 0.001). As indicated by negative care experiences (rated as 1 or 2 on the five-point scale), patients seemed to have limited knowledge about medical treatment, lifestyle modification and follow-up after PCI. Participation in cardiac rehabilitation and longer consultations with the general practitioner after hospital discharge were positively correlated with better continuity of care.ConclusionsImplementation of the HCCQ will likely support healthcare providers and researchers in identifying problem areas of continuity of cardiac care and in evaluating interventions aimed at improving continuity of care.

Highlights

Continuity of cardiac care after hospital discharge is a priority, especially as healthcare systems become increasingly complex and fragmented
It was hypothesized that patients’ cardiac rehabilitation (CR) participation would have a positive impact on Heart Continuity of Care Questionnaire (HCCQ) scores [14]; the analyses revealed that patients who engaged in CR reported more positive experiences in terms of relational and management continuity compared to those who did not participate in CR
Cross-cultural validation was performed according to international guidelines

Summary

Introduction

Continuity of cardiac care after hospital discharge is a priority, especially as healthcare systems become increasingly complex and fragmented. There are few available instruments to measure continuity of cardiac care, especially from the patient perspective. The aim of this study was (1) to translate and adapt the Heart Continuity of Care Questionnaire (HCCQ) to conditions in Norway, and (2) to determine its psychometric properties in self-report format administered to patients after percutaneous coronary intervention (PCI). Continuity of care among different healthcare providers and from one healthcare setting to another is a priority for patients, healthcare providers and policymakers. It is becoming a major concern as healthcare systems become increasingly complex and fragmented [1,2,3,4]. In a field where interventional cardiology technology continues to develop rapidly, continuity of care is a major concern for PCI patients

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