Measuring tuberculosis patient perceived quality of care in public and public-private mix settings in India: an instrument development and validation study

Murugesan Periyasamy; Beena E Thomas; Basilea Watson; Sudha Rani; Deepalakshmi A; Vignesh Kumar J; Stephen A; Lavanya Jayabal; Jagadeesan Murugesan; Ramya Ananthakrishnan; Tiju Thomas; Sumathi G N; Karikalan Nagarajan

doi:10.1136/bmjoq-2021-001787

Measuring tuberculosis patient perceived quality of care in public and public-private mix settings in India: an instrument development and validation study

BMJ Open Qual. 2022 Jul;11(3):e001787. doi: 10.1136/bmjoq-2021-001787.

Affiliations

¹ Department Social and Behavioural Research, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India.
² DTO, National Tuberculosis Elimination Program (NTEP), Greater Chennai Corporation, Chennai, Tamil Nadu, India.
³ Greater Chennai Corporation, Chennai, Tamil Nadu, India.
⁴ Resource Group for Advocacy and Community Health, Chennai, Tamil Nadu, India.
⁵ Department of Metallurgical and Materials Engineering Indian Institute Of Technology, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India.
⁶ HR & OB Division VIT Business School Vellore Institute of Technology, VIT Business School, Vellore, Tamil Nadu, India.
⁷ Department Social and Behavioural Research, ICMR-National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India karikalan.n@icmr.gov.in.

Abstract

Background: At present, there are no validated quantitative scales available to measure patient-centred quality of care in health facilities providing services for tuberculosis (TB) patients in India and low-income and middle-income countries.

Methods: Initial themes and items reflective of TB patient's perceived quality of care were developed using qualitative interviews. Content adequacy of the items were ascertained through Content validity Index (CVI) and content validity ratio (CVR). Pilot testing of the questionnaire for assessing validity and reliability was undertaken among 714 patients with TB. Sampling adequacy and sphericity were tested by Kaiser-Meyer-Olkin and Bartlett's test, respectively. Exploratory and confirmatory factor analysis was undertaken to test validity. Cronbach's α and test-retest scores were used to test reliability.

Results: A 32-item tool measuring patient-perceived quality of TB distributed across five domains was developed initially based on a CVI and CVR cut-off score of 0.78 and cognitive interviews with patients with TB. Bartlett's test results showed a strong significance f (χ²=3756 and p<0.001) and Kaiser-Meyer-Olkin was measured to be 0.698 highlighting data adequacy and correlation between the variables. Exploratory factor analysis with varimax rotation extracted 4 factors related to 14 items with Eigen values >1 which accounted for 60.9% of the total variance of items. Correlation (z-value >1.96) between items and factors was highly significant and Cronbach's α was acceptable for the global scale (0.76) for the four factors. Intraclass correlation coefficient and the test retest scores for four factors were (<0.001) significant.

Conclusion: We validated a measurement tool for patient-perceived quality of care for TB (PPQCTB) which measured the patient's satisfaction with healthcare provider and services. PPQCTB tool could enrich quality of care evaluation frameworks for TB health services in India.

Keywords: health services research; patient satisfaction; patient-centred care; quality measurement.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Health Facilities
Humans
India
Poverty
Reproducibility of Results
Tuberculosis* / therapy