Development And Validation Of The Sri Lankan Primary Care Assessment Tool (Sl-Pcat) For Evaluating Patients' Experiences In Primary Care

BackgroundThis study developed and validated a primary care assessment tool (SL-PCAT) for evaluating patients experiences in the Sri Lankan healthcare setting. MethodsThe study was conducted from April 2021 to August 2023 inside a medical faculty and selected communities in the Anuradhapura District. The tool was validated through item development, scale development, and scale evaluation processes. Items were selected through focused-group interviews, a literature review, and an expert review. Two language experts translated the tool into the Sinhala language. The scales construct was evaluated parallel to a cross-sectional household survey in 32 villages. First, 633 valid data were randomly split into two groups (Subsample-1 [n=320] and Subsample-2 [n=313]). Exploratory factor analysis was performed in Subsample-1 with principal component analysis (PCA), followed by reliability assessment with Cronbachs alpha. A confirmatory factor analysis (CFA) was performed on Subsample-2. Likert scale assumption testing and descriptive statistics were performed in the final factor structure. ResultsThe four factor solution from PCA explained 66.8% variance in data. Domains identified were contextual care at family and community with continuity, accessibility, patient-centred care, and comprehensive and coordinated care. The domains reported Cronbachs alpha values between 0.719 and 0.859. The goodness of fit index of the CFA improved after allowing a few modifications (X2=199, p<0.001, RMSEA= 0.079, GFI=0.916, SRMR=0.066, CFI=0.916). The corresponding convergent and discriminant validity of the Likert scale assumptions was optimum, with Item-scale correlations between 0.346 and 0.830 and scaling success rates over 70%. Three domains, except contextual care at family and community with continuity, reported positively skewed scores, indicating more positive responses. ConclusionsSL-PCAT is a feasible, valid, and reliable tool for assessing patients experiences of primary care in Sri Lanka.