DEVELOPMENT AND VALIDATION OF THE SRI LANKAN PRIMARY CARE ASSESSMENT TOOL (SL-PCAT) FOR EVALUATING PATIENTS’ EXPERIENCES IN PRIMARY CARE

Abstract Background This study developed and validated a primary care assessment tool (SL-PCAT) for evaluating patients’ experiences in the Sri Lankan healthcare setting. Methods The 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 scale’s 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 Cronbach’s 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. Results The 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 Cronbach’s 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