Adaptation and cross-cultural validationof the United States Primary Care Assessment Tool (expanded version) for use in South Africa

Abstract

BackgroundMeasuring primary care is important for health sector reform. The Primary Care Assessment Tool (PCAT) measures performance of elements essential for cost-effective care. Following minor adaptations prior to use in Cape Town in 2011, a few findings indicated a need to improve the content and cross-cultural validity for wider use in South Africa (SA).AimThis study aimed to validate the United States of America-developed PCAT before being used in a baseline measure of primary care performance prior to major reform.SettingPublic sector primary care clinics, users, practitioners and managers in urban and rural districts in the Western Cape Province.MethodsFace value evaluation of item phrasing and a combination of Delphi and Nominal Group Technique (NGT) methods with an expert panel and user focus group were used to obtain consensus on content relevant to SA. Original and new domains and items with > = 70% agreement were included in the South African version – ZA PCAT.ResultsAll original PCAT domains achieved consensus on inclusion. One new domain, the primary healthcare (PHC) team, was added. Three of 95 original items achieved < 70% agreement, that is consensus to exclude as not relevant to SA; 19 new items were added. A few items needed minor rephrasing with local healthcare jargon. The demographic section was adapted to local socio-economic conditions. The adult PCAT was translated into isiXhosa and Afrikaans.ConclusionThe PCAT is a valid measure of primary care performance in SA. The PHC team domain is an important addition, given its emphasis in PHC re-engineering. A combination of Delphi and NGT methods succeeded in obtaining consensus on a multi-domain, multi-item instrument in a resource- constrained environment.

Estructura y funciones de la Atención Primaria de Salud según el Primary Care Assessment Tool para prestadores en la comuna de Conchalí - Santiago de Chile

“…Los cuestionarios PCAT fueron adaptados para diversos países y contextos socioculturales 8,[10][11][12] . Brasil fue el primer país latinoamericano en evaluar su consistencia interna y confiablidad 13 , seguido por Uruguay 14 y Argentina 15 .…”

Development and validation of the ExPRESS instrument for primary health care providers’ evaluation of external supervision

“…Additionally, three instruments were found where respondents assessed an external event [18,72,73], and one instrument related to the primary health care field [74]. Over 400 items were identified, and 122 were retained in the item pool.…”

Primary health care attributes assessment: children and adolescents living with HIV

“…17 On the other hand, in the experience of health professionals from the city São Luiz (Maranhão) the attribute 'family guidance' obtained low score for FHS. 11 This indicates the importance to evaluate the health care in the FHS in the experience of those that care and others that seek it, comprehending different perspectives, even if they don't converge, but to complement in order to potentialize the interaction of PHC staff with users and community. In a study developed in Piracicaba (São Paulo), the evaluation of professionals also resulted in higher scores for FHS in the attributes 'family guidance' and 'community guidance', in relation with PHU scores.…”

“…9 Among instruments that aim to evaluate quality of PHC, 6 the Primary Care Assessment Tool (PCATool) enables to measure the presence and extention of PHC attributs in different sceneries in Brazil and abroad. [9][10][11] Attributes are defined by an inseparable group of structural elements present in health services, denominated essential and derivatives. The first ones are: access and first contact with health services, longitudinality, coordenation and integrality.…”