Development and Validation of an Instrument for Assessing Patient Experience of Chronic Illness Care

Sample Description	N	%
Male	178	52.7
Female	160	47.3
Age (mean, SD)	66.5	14.1
16-30 years	7	2.1
31-45 years	24	7.1
46-65 years	102	30.2
≥66 years	205	60.7
Marital Status
Single	46	13.6
Married	223	66.0
Widowed	69	20.4
Patients living alone	83	24.6
Educational level
No studies	67	19.8
Basic studies	153	45.3
Grade education	50	14.8
University degree	68	20.1
Prescribed drugs (mean, SD)	4.1	3.8
Prescribed drugs grouped
1-2 drugs	117	34.6
3-4 drugs	108	32.0
≥5 drugs	113	33.4
Who manages the medication
The patient	306	90.5
The patient’s partner, another family member or caregiver	32	9.5
Disorders (a patient may suffer from more than one)
Diabetes	72	21.3
Insulin-dependent diabetes	16	4.7
Arterial hypertension	190	56.2
COPD	68	20.1
Other cardiovascular diseases	97	28.7
Comorbidity
1 disease	163	48.2
2 diseases	125	37.0
≥3 diseases	50	14.8
Months from the diagnosis
Diabetes (mean, SD)	144.6	147.4
Arterial hypertension (mean, SD)	114.8	126.0
COPD (mean, SD)	116.9	137.0
Other cardiovascular diseases (mean, SD)	89.6	78.0
No hospitalisation in the last three years	197	58.3
No hospitalisation in the last year	253	74.9
No emergency visit in the last year	190	56.2
No general practitioner appointment in the last year	6	1.8
Hospitalisation in the last three years (mean, SD)	0.7	1.1
Hospitalisation in the last year (mean, SD)	0.3	0.6
Emergency visits in the last year (mean, SD)	0.9	1.8
General practitioner’ appointments last year (mean, SD)	7.4	11.5

Table 2

Exploratory factorial analysis.

Item Abbreviation	Items	Communalities	Item-total Correlation	Alpha if item deleted	Mean*	SD	PI	NRM	PSM
P24	I review the adherence to my treatment and care plan with the professionals who care for me.	0.70	0.60	0.73	4.0	1.2	0,78
P26	The professionals who care for me are concerned with my quality of life and I feel they are committed to my wellbeing.	0.64	0.53	0.73	4.1	1.2	0,77
P22	Health and social care services are coordinated to improve my wellbeing and quality of life in my environment (family, neighbourhood, town).	0.62	0.9	0.74	4.0	1.2	0,77
P9	The professionals who care for me listen to me and ask me about my needs, habits and preferences to adapt my treatment and care plan.	0.50	0.40	0.75	4.0	1.2	0,70
P13	I can consult my clinical record, tests results, programmed visits and access to other services through the internet or the mobile app of my health service.	0.64	0.23	0.77	1.4	1.0		0.83
P8	The professionals who care for me inform me about trustful webpages and internet forums that I can consult to better know my disease, its treatment and the consequences they may have on my life.	0.69	0.31	0.76	1.6	1.1		0.83
P12	The professionals who care for me invite me to participate in patients groups to share information and experiences on how to care for ourselves and improve our health.	0.53	0.42	0.75	2.1	1.4		0.56
P17	I’ve been able to agree with the professionals who care for me on specific objectives regarding diet, physical exercise and medication to get better control of my health problems.	0.61	0.47	0.74	3.6	1.4			0.74
P1	The professionals who care for me inform me about the health and social resources available in my neighbourhood or town that I can use to improve my health problems and take better care of myself.	0.46	0.31	0.77	3.1	1.6			0.68
P6	The professionals who care for me review with me all of the medication I take, how I take it and how it suits me.	0.49	0.41	0.75	4.0	1.3			0.51
P11	I feel that my confidence in my ability to take care of myself, manage my health problems and keep my autonomy has improved.	0.43	0.44	0.75	4.1	1.1			0.43
	Percentage of explained common variance (57%)						24%	17%	16%

[i] N=338

*Scores 1 to 5

Extraction method: Principal Components. Rotation method: Varimax with Kaiser Normalization.

Table 3

Confirmatory factorial index.

			N= 338	N= 115
Absolute fit indices	SRMR	Value<0.08	0.05	0.06
GFI	Value ≈1	0.96	0.89
Relative fit indices	NFI	Value ≈1	0.92	0.91
CFI	0.9< Value <0.95	0.96	0.95

[i] SRMR - Standardised Root Mean Square Residual; GFI- Jöreskog-Sörbom Fit Index-Goodness of Fix Index; NFI- Normed Fix Index; NNFI- Non Normed Fix Index; CFI- Comparative Fix Index; IFI- Incremental Fix Index.

Optimised model of the questionnaire factorial structure based on confirmatory factor analysis from the validation study carried out.

Table 4

Reliability, dimensionality, and convergent validity of each factor of the questionnaire.

Factor (abbreviation)	Items	Standardized loads^a
Productive Interactions (PI)	P22	0.895 (12.106)
	P26	0.886 (11.907)
	P24	0.918 (12.630)
P9	0.727 (8.838)
		CR=0.918
		AVE=0.739
New Relational Model (NRM)	P13	0.960 (13.244)
	P8	0.873 (11.406)
	P12	0.790 (9.880)
		CR=0.909
		AVE=0.769
Patient Self-management (PSM)	P17	0.762 (9.060)
	P1	0.742 (8.735)
	P6	0.805 (9.788)
P11	0.754 (8.928)
		CR=0.950
		AVE=0.587

[i] a Data represents Student t-test values and differences were significant at P = 0.05.

b CR: composite reliability.

c AVE: average variance extracted.

Table 5

Inter-correlations between the latent factors.

	PI	NRM	PSM	Total Score
Productive Interactions (PI)	1.00	0.20	0.47	0.78
New relational model (NRM)		1.00	0.31	0.61
Person’s self-management (PSM)			1.00	0.82
Total Score				1.00

[i] N=338

P<0.01

Table 6

IEXPAC factors scores.

	N	%	PI	NRM	PSM
Male	178	52.7	3.96	1.58	3.63
Female	160	47.3	4.04	1.77	3.72
			P = 0.321	P = 0.033	P = 0.079
Age
16-45	31	9.2	4.0	2.6	3.6
46-65	102	30.2	4.0	1.9	3.6
≥66	205	60.7	4.0	1.4	3.7
			P = 0.925	P = 0.001	P = 0.556
Educational level
No studies	67	19.8	4,00
	1.28	3.52
Basic studies	153	45.3	4,00	1.48	3.72
Grade education	50	14.8	4,12	1.96	3.65
University degree	68	20.1	3,91	2.30	3.75
			P = 0.696	P = 0.000	P = 0.394
Who they live with
Alone	83	24.6	4,04	1.51	3.63
In family	252	74.6	4,00	1.74	3.69
			P = 0.467	P = 0.021	P = 0.463
Chronic diseases
1	163	48.2	4.2	1.8	3.7
2	125	37.0	3.8	1.6	3.6
≥3	50	14.8	3.8	1.5	3.6
			P = 0.001	P = 0.068	P = 0.707
Prescribed drugs
1-2	117	34.6	4.1	1.9	3.6
3-4	108	32.0	3.9	1.6	3.8
≥5	113	33.4	4.0	1.5	3.7
			P = 0.306	P = 0.001	P = 0.351

Number of hospitalisations in last 3 years
0	197	58.3	4.0	1.7	3.6
1-2	119	35.2	4.0	1.6	3.7
3 or more	22	6.5	4.1	1.6	3.9
			P = 0.947	P = 0.657	P = 0.401

Emergency visits in the last year
0	191	56.5	4.1	1.7	3.7
1-2	116	34.3	3.9	1.6	3.6
3 or more	31	9.2	3.8	1.5	3.6
			P = 0.179	P = 0.281	P = 0.468
General practitioner appointments in the last year
0	9	2.1
1-3	133	39.3	4.0	1.9	3.7
4-5	51	15.1	3.8	1.6	3.4
6 or more	145	42.9	4.1	1.4	3.8
			P = 0.255	P = 0.001	P = 0.085

Autonomous Health Service
1	84	24.9	4.1	2.6	3.9
2	84	24.9	4.3	1.4	3.3
3	85	25.1	3.5	1.3	3.6
4	85	25.1	4.1	1.4	3.9
			P = 0.001	P = 0.001	P = 0.001

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DOI: https://doi.org/10.5334/ijic.2443 | Journal eISSN: 1568-4156

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Language: English

Submitted on: Feb 6, 2016

Accepted on: Aug 16, 2016

Published on: Aug 31, 2016

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

patient-centred care,

© 2016 José Joaquín Mira, Roberto Nuño-Solinís, Mercedes Guilabert-Mora, Olga Solas-Gaspar, Paloma Fernández-Cano, María Asunción González-Mestre, Joan Carlos Contel, Marío del Río-Cámara, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 16 (2016): Issue 3

Development and Validation of an Instrument for Assessing Patient Experience of Chronic Illness Care

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