[Validity and reliability of the satisfaction scale for outpatient care users in Peru]. / Validez y confiabilidad de la escala de satisfacción de los usuarios de consulta médica ambulatoria en Perú.

OBJECTIVES.: To assess the psychometric properties of a scale to measure the satisfaction of individuals seeking services at outpatient clinics (ESCOMA) in public healthcare centers in Peru. MATERIALS AND METHODS.: We carried out a study based on a dataset from Questionnaire 1 of the National Health Users Satisfaction Survey (ENSUSALUD) 2016. ENSUSALUD applied an initial scale of 19 items constructed based on bibliographic review, expert judgment and a pilot study. We first performed an exploratory factor analysis (EFA) in two random subsamples to assess the scale's internal structure. We then developed a confirmatory factor analysis (CFA) using robust maximum likelihood estimation. Lastly, we analyzed measurement invariance and assessed reliability using McDonald's Omega Coefficient (ω). RESULTS: : We randomly divided 13,814 observations into two subsamples for the EFA. Based on this analysis, we selected a best-fitting CFA model, which comprised three factors and 18 items. We found acceptable goodness-of-fit indices for the CFA (CFI = 0.945, TLI = 0.937, SRMR = 0.036). The three resulting factors were a) administrative processes, b) infrastructure and c) medical care. We found strong invariance for age, sex, educational level and area of residence, and partial invariance for type of institution. All reliability coefficients indicated adequate fit (0.86<ω<0.92). CONCLUSIONS.: The ESCOMA demonstrates validity, reliability, and measurement invariance at different levels of care in a nationally representative Peruvian sample.

OBJETIVOS.: Evaluar las propiedades psicométricas de la escala para medir la satisfacción de los usuarios de consulta médica ambulatoria (ESCOMA) en Instituciones Prestadoras de Servicios de Salud (IPRESS) del sistema de salud peruano (SSP). MATERIALES Y MÉTODOS.: Llevamos a cabo un estudio de tipo instrumental con los datos del Cuestionario 1 de la Encuesta Nacional de Satisfacción de Usuarios de Salud (ENSUSALUD) del 2016; en la cual se administró una escala inicial de 19 ítems construidos por revisión bibliográfica, juicio de expertos y estudio piloto. Realizamos un análisis factorial exploratorio (AFE) para valorar la estructura interna de la escala y luego un análisis factorial confirmatorio (AFC) mediante el método de estimación de máxima verosimilitud robusta. Finalmente, desarrollamos análisis de invarianza de medición y evaluamos la confiabilidad con el coeficiente omega de McDonald. RESULTADOS.: Analizamos 13 814 observaciones en dos submuestras aleatorias para el AFE con lo cual definimos un modelo de tres dimensiones con 18 ítems. En el AFC encontramos índices de bondad de ajuste aceptables (CFI=0,945; TLI=0,937; SRMR=0,036). Las dimensiones resultantes fueron: procesos administrativos, infraestructura y atención médica. Evidenciamos invarianza fuerte para la edad, sexo, nivel educativo y región, e invarianza parcial para el tipo de institución (Ministerio de Salud, Seguro Social, Fuerzas Armadas y Policiales, y Clínicas Privadas). Todos los coeficientes de confiabilidad fueron adecuados (0,86<ω<0,92). CONCLUSIONES.: La ESCOMA presenta evidencia de validez y confiabilidad a nivel estructural y de invarianza de medición a diferentes niveles de atención y a nivel nacional en Perú.

Validez y confiabilidad de la escala de satisfacción de los usuarios de consulta médica ambulatoria en Perú / Validity and reliability of the satisfaction scale for outpatient care users in Peru

RESUMEN Objetivos. Evaluar las propiedades psicométricas de la escala para medir la satisfacción de los usuarios de consulta médica ambulatoria (ESCOMA) en Instituciones Prestadoras de Servicios de Salud (IPRESS) del sistema de salud peruano (SSP). Materiales y Métodos. Llevamos a cabo un estudio de tipo instrumental con los datos del Cuestionario 1 de la Encuesta Nacional de Satisfacción de Usuarios de Salud (ENSUSALUD) del 2016; en la cual se administró una escala inicial de 19 ítems construidos por revisión bibliográfica, juicio de expertos y estudio piloto. Realizamos un análisis factorial exploratorio (AFE) para valorar la estructura interna de la escala y luego un análisis factorial confirmatorio (AFC) mediante el método de estimación de máxima verosimilitud robusta. Finalmente, desarrollamos análisis de invarianza de medición y evaluamos la confiabilidad con el coeficiente omega de McDonald. Resultados. Analizamos 13 814 observaciones en dos submuestras aleatorias para el AFE con lo cual definimos un modelo de tres dimensiones con 18 ítems. En el AFC encontramos índices de bondad de ajuste aceptables (CFI=0,945; TLI=0,937; SRMR=0,036). Las dimensiones resultantes fueron: procesos administrativos, infraestructura y atención médica. Evidenciamos invarianza fuerte para la edad, sexo, nivel educativo y región, e invarianza parcial para el tipo de institución (Ministerio de Salud, Seguro Social, Fuerzas Armadas y Policiales, y Clínicas Privadas). Todos los coeficientes de confiabilidad fueron adecuados (0,86<ω<0,92). Conclusiones. La ESCOMA presenta evidencia de validez y confiabilidad a nivel estructural y de invarianza de medición a diferentes niveles de atención y a nivel nacional en Perú.

ABSTRACT Objectives. To assess the psychometric properties of a scale to measure the satisfaction of individuals seeking services at outpatient clinics (ESCOMA) in public healthcare centers in Peru. Materials and Methods. We carried out a study based on a dataset from Questionnaire 1 of the National Health Users Satisfaction Survey (ENSUSALUD) 2016. ENSUSALUD applied an initial scale of 19 items constructed based on bibliographic review, expert judgment and a pilot study. We first performed an exploratory factor analysis (EFA) in two random subsamples to assess the scale's internal structure. We then developed a confirmatory factor analysis (CFA) using robust maximum likelihood estimation. Lastly, we analyzed measurement invariance and assessed reliability using McDonald's Omega Coefficient (ω). Results : We randomly divided 13,814 observations into two subsamples for the EFA. Based on this analysis, we selected a best-fitting CFA model, which comprised three factors and 18 items. We found acceptable goodness-of-fit indices for the CFA (CFI = 0.945, TLI = 0.937, SRMR = 0.036). The three resulting factors were a) administrative processes, b) infrastructure and c) medical care. We found strong invariance for age, sex, educational level and area of residence, and partial invariance for type of institution. All reliability coefficients indicated adequate fit (0.86<ω<0.92). Conclusions. The ESCOMA demonstrates validity, reliability, and measurement invariance at different levels of care in a nationally representative Peruvian sample.

A secondary analysis examining the concordance of self-perception of weight and actual measurement of body fat percentage: The CRONICAS Cohort Study.

BACKGROUND: Individuals' self-perceptions of weight often differ from objective measurements of body fat. This study aimed to 1) measure agreement between self-perceptions of weight and objective measurement of body fat by bioelectric impedance analysis (BIA) among Peruvian adults; and 2) quantify the association between body fat and a) baseline self-perceptions of weight and b) whether a participant underestimated their weight status. METHODS: Longitudinal data from the CRONICAS Cohort Study of 3181 Peruvian adults aged 35-years and older were used. BIA measurements of body fat were categorized across four nominal descriptions: low weight, normal, overweight, and obese. Kappa statistics were estimated to compare BIA measurements with baseline self-perceptions of weight. To quantify the association between body fat over time with both baseline self-perceptions of weight and underestimation of weight status, random effects models, controlling for socioeconomic and demographic covariates, were employed. RESULTS: Of the 3181 participants, 1111 (34.9%) were overweight and 649 (20.4%) were obese at baseline. Agreement between self-perceived and BIA weight status was found among 43.1% of participants, while 49.9% underestimated and 6.9% overestimated their weight status. Weighted kappa statistics ranged from 0.20 to 0.31 across settings, suggesting poor agreement. Compared to perceiving oneself as normal, perceiving oneself as underweight, overweight, or obese was associated with - 4.1 (p < 0.001), + 5.2 (p < 0.001), and + 8.1 (p < 0.001) body fat percentage points, respectively. Underestimating one's weight status was associated with having 2.4 (p < 0.001) body fat percentage points more than those not underestimating only after adjusting for demographic and socioeconomic covariates. CONCLUSIONS: Half of study participants were overweight or obese. There was poor agreement between self-perceptions of weight with BIA measurements of body fat, indicating that individuals often believe they weigh less than they actually do. Underestimating one's weight status was associated with having more body fat percentage points, but was only statistically significant after adjusting for demographic and socioeconomic characteristics. Further research should be conducted to investigate how self-perceptions of weight can support clinical and public health interventions to curb the obesity epidemic.

Addressing post-stroke care in rural areas with Peru as a case study. Placing emphasis on evidence-based pragmatism.

Stroke is a major cause of death and disability, with most of its burden now affecting low- and middle-income countries (LMIC). People in rural areas of LMIC who have a stroke receive very little acute stroke care and local healthcare workers and family caregivers in these regions lack the necessary knowledge to assist them. Intriguingly, a recent rapid growth in cell-phone use and digital technology in rural areas has not yet been appropriately exploited for health care training and delivery purposes. What should be done in rural areas, at the community setting-level, where access to healthcare is limited remains a challenge. We review the evidence on improving post-stroke outcomes including lowering the risks of functional disability, stroke recurrence, and mortality, and propose some approaches, to target post-stroke care and rehabilitation, noting key challenges in designing suitable interventions and emphasizing the advantages mHealth and communication technologies can offer. In the article, we present the prevailing stroke care situation and technological opportunities in rural Peru as a case study. As such, by addressing major limitations in rural healthcare systems, we investigate the potential of task-shifting complemented with technology to utilize and strengthen both community-based informal caregivers and community healthcare workers.