Development, validity and reliability of instrument to evaluate implementation fidelity of the Family Doctor Concept (FDC) programme in public primary care clinics in Malaysia.

Introduction: The Family Doctor Concept (FDC) programme was introduced to public primary care clinics in late 2013 as part of the reform agenda in the primary healthcare delivery system. The study aimed to develop a validated and reliable instrument to evaluate the FDC implementation fidelity in primary care clinics. Methods: The instrument, which adapted the concept of patient-centred care (PCC), resulted from a series of expert discussions, a literature search, an FDC guideline, and a review of meeting minutes. A 2-step process was conducted with experts to achieve content and face validity. Consequently, the instrument was piloted in 5 public primary care clinics in Selangor involving 8 trained raters. Inter-rater reliability was estimated using intraclass correlation (ICC), while internal consistency was measured using Kuder-Richardson Formula 20 (KR-20). Results: The final instrument comprises 3 sections (instructions, clinic's characteristics and assessment items), with Section 3 containing 15 items divided into four components - population registration, formation of a primary care team, integrated treatment, and monitoring and evaluation. The ICC for total score was excellent, 0.981, while the ICCs of the individual component scores were good to excellent (population registration: 0.937, formation of primary care team: 0.742, integrated treatment: 0.996, and monitoring and evaluation: 0.996). The value of KR-20 was 0.615, which was considered adequate. Conclusion: The instrument developed was found to be valid in terms of face and content validity and reliable in measuring the fidelity of FDC implementation with excellent inter-rater reliability.

Cross-cultural adaptation and exploratory factor analysis of the Person-centred Practice Inventory - Staff (PCPI-S) questionnaire among Malaysian primary healthcare providers.

BACKGROUND: The Person-centred Practice Inventory-Staff (PCPI-S) instrument was developed to measure healthcare providers' perception towards their person-centred practice. The study aimed to explore the influence of culture, context, language and local practice towards the PCPI-S instrument adaptation process for use among public primary care healthcare providers in Malaysia. METHODS: The original PCPI-S was reviewed and adapted for cultural suitability by an expert committee to ensure conceptual and item equivalence. The instrument was subsequently translated into the local Malay language using the forward-backward translation by two independent native speakers, and modified following pre-tests involving cognitive debriefing interviews. The psychometric properties of the corresponding instrument were determined by assessing the internal consistency, test-retest reliability, and correlation of the instrument, while the underlying structure was analysed using exploratory factor analysis. RESULTS: Review by expert committee found items applicable to local context. Pre-tests on the translated instrument found multiple domains and questions were misinterpreted. Many translations were heavily influenced by culture, context, and language discrepancies. Results of the subsequent pilot study found mean scores for all items ranged from 2.92 to 4.39. Notable ceiling effects were found. Internal consistency was high (Cronbach's alpha > 0.9). Exploratory factor analysis found formation of 11 components as opposed to the original 17 constructs. CONCLUSION: The results of this study provide evidence regarding the reliability and underlying structure of the PCPI-S instrument with regard to primary care practice. Culture, context, language and local practice heavily influenced the adaptation as well as interpretation of the underlying structure and should be given emphasis when translating person-centred into practice.

Protocol for a cross-sectional study measuring person-centredness among healthcare providers in Malaysian primary care clinics: the adaptation and validation of the Person-Centred Practice Inventory-Staff (PCPI-S) Questionnaire.

INTRODUCTION: Person-centred care (PCC) has become a global movement in healthcare. Despite this, the level of PCC is not routinely assessed in clinical practice. This protocol describes the adaptation and validation of the Person-Centred Practice Inventory-Staff (PCPI-S) tool that will be used to assess person-centred practices of primary healthcare providers in Malaysia. METHODS AND ANALYSIS: To ensure conceptual and item equivalence, the original version of the PCPI-S will be reviewed and adapted for cultural context by an expert committee. The instrument will subsequently be translated into Malay language using the forward-backward translation method by two independent bilingual speaking individuals. This will be pretested in four primary care clinics and refined accordingly. The instrument will be assessed for its psychometric properties, such as test-retest reliability, construct and internal validity, using exploratory and confirmatory factor analysis. ETHICS AND DISSEMINATION: Study findings will be disseminated to healthcare professionals and academicians in the field through publication in peer-reviewed journals and conference presentations, as well as at managerial clinic sites for practice improvement. The study was approved by the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia (KKM/NIHSEC/ P18-766 (14) and Monash University Human Research Ethics Committee (2018-14363-19627).