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Title: Development and validation of the patient evaluation scale (PES) for assessing the quality of primary health care in Nigeria
Author: Ogaji, Daprim
ISNI:       0000 0004 7657 1432
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2018
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Background: Patient evaluation of primary health care (PHC) as a recognised means of obtaining important information for quality improvement can be enhanced with the availability and use of acceptable, reliable and valid questionnaires. This research reports the development and validation of the patients' evaluation scale (PES) for assessment of the quality of primary health care in Nigeria. Methods: Mixed methods design was used to develop and validate items, response scale and domains in the Patients' Evaluation Scale. Items were derived from literature review and content analysis of interviews with patients. Face and content validity were established with primary health care experts and patients while quantitative pilots were conducted to determine questionnaire's acceptability across groups and appropriate response format. The conduct of a large multi-centre psychometric validation survey was used to determine the internal structure (exploratory factor analysis), reliability (internal consistency), construct, criterion and discriminative validities (Pearson's correlation coefficient, structural equation modelling using regression equation method) and acceptability (scale and item response pattern) of the questionnaire. The discriminatory properties were assessed by questionnaire's ability to differentiate population groups' scores in line with 'a priori' hypotheses. Results: The development resulted in the long and shortened forms of PES containing 27 and 18-items respectively. Both showed good indices for validity and acceptability among various population groups in Nigeria. PES-SF resulted from the deletion of items in PES that didn't meet recommended Eigen value < 1, factor loading < 0.5, item-total, item-domain correlation < 0.4 and item-item correlation within domains of < 0.2. PES-SF has Cronbach's alpha of 0.87 for entire questionnaire and 0.78, 0.79 and 0.81 respectively for the three domains (codenamed 'facility', 'organisation', and 'health care'). The three components solution from the Scree plot explained 56.6% of the total variance of perceived quality. Items correlated significantly higher with domain identified through factor analysis than with other domains. In line with 'a priori' hypothesis, scale and domains scores of PES-SF could differentiate population groups based on patients' clinical and socio-demographic characteristics. PES-SF scores also showed significant correlation with patient general satisfaction and likelihood of returning or recommending others to the PHC centres. Conclusion: The patient evaluation scale designed for exit assessment of patients' experiences with PHC in Nigeria shows good measurement properties. It will be useful to clinicians, researchers and policy makers for patient-focused quality improvement activities in Nigeria. Further research will involve translation to major Nigerian languages and to assess PES validity against observed quality criteria.
Supervisor: Bower, Peter ; Giles, Sally ; Daker-White, Gavin Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Nigeria ; Quality assessment ; Psychometric validation ; Primary health care ; Patient evaluation ; Questionnaire development