Abstract
BackgroundMajority of patients with chronic illnesses such as diabetes, receive care at primary care setting. Efforts have been made to restructure diabetes care in the Malaysian primary care setting in accordance with the Chronic Care Model (CCM). The Patient Assessment on Chronic Illness Care (PACIC) is a validated self-report tool to measure the extent to which patients with chronic illness receive care that aligns with the CCM. To date, no validated tool is available to evaluate healthcare delivery based on the CCM in the Malay language. Thus, the study aimed to translate the PACIC into the Malay language and validate the questionnaire among patients with diabetes in the Malaysian public primary care setting.MethodsThe English version of the PACIC questionnaire is a 20-item scale measuring five key components, which are patient activation, decision support, goal setting, problem solving and follow-up care. The PACIC underwent forward - backward translation and cross cultural adaptation process to produce the PACIC-Malay version (PACIC-M). Reliability was tested using internal consistencies and test-retest reliability analyses, while construct validity was tested using the exploratory factor analysis (EFA).ResultsThe content of PACIC-M and the original version were conceptually equivalent. Overall, the internal consistency by Cronbach’s α was .94 and the intra-class correlation coefficient was .93. One item was deleted (item 1) when the factor loading was < 0.4. The factor analyses using promax identified three components (‘Goal Setting/Tailoring and Problem solving/Contextual’, ‘follow-up/coordination’ and ‘patient activation and delivery system design/ decision support’); explaining 61.2% of the variation. The Kaiser-Meyer-Olkin (KMO) was 0.93 and Bartlett’s test of sphericity was p = .000. Therefore, the final version of the PACIC-M consisted of 19 items, framed within three components.ConclusionThe findings demonstrated that the PACIC-M measured different dimensions from the English version of PACIC. It is however; highly reliable and valid to be used in assessing three CCM model subscales. Further confirmatory factor analysis of PACIC-M should be conducted to confirm this new model.
Highlights
Majority of patients with chronic illnesses such as diabetes, receive care at primary care setting
The content validation, translation, adaptation and face validation of Patient Assessment on Chronic Illness Care (PACIC)-M A group of five family physicians found that the content of all 20 items of the PACIC English version were relevant to the conceptual framework
The patients might be in contact with a diabetes healthcare team but many may not be aware of this term as the team members may change regularly due to constraints in staffing faced by the public primary care clinics
Summary
Majority of patients with chronic illnesses such as diabetes, receive care at primary care setting. The Chronic Care Model (CCM) is being widely used to assess and improve chronic illness care in the primary care setting [1, 2] This model represents a conceptual framework based on well documented gaps between clinical research findings and real practice [2, 3]. It recommends a proactive and planned care approach than of reactive and unplanned care, in order to deliver high quality and patient-centred chronic disease care to the population [2]. With the increasing burden of chronic diseases in developing countries, measures to restructure chronic illness care using multifaceted interventions based on the CCM are required to improve delivery and quality of chronic care over time
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