Measuring Patients' Perceptions of Health Care Encounters: Examining the Factor Structure of the Revised Patient Perception of Patient-Centeredness (PPPC-R) Questionnaire

Abstract

Purpose: Given the ongoing desire to make health care more patient-centered and growing evidence supporting the provision of patient-centered care, it is important to have valid tools for measuring patient-centered care. The patient-centered clinical method (PCCM) is a conceptual framework for providing patient-centered care. A revision to the PCCM framework led to a corresponding need to enhance the Patient Perception of Patient-Centeredness (PPPC) questionnaire. The original PPPC was aligned with the components of the PCCM conceptual framework and developed to measure patient-centeredness from the patient's perspective. The purpose of this study was to examine the factor structure of a revised version of the PPPC (ie, PPPC-R).

Methods: Eleven new items were added to the original 14 items. The modified questionnaire was administered to patients in primary health care teams in Ontario, Canada. The confirmatory factor analysis was conducted on a subset of 381 patients who had seen a family physician.

Results: The initial proposed 4-factor model first tested with a confirmatory factor analysis (CFA) did not fit adequately. Exploratory factor analysis was therefore used as a second step to modify the model and to identify weak items. A 3-factor exploratory model with 18 of the original 25 items was converted into a final hypothetical CFA model that had a good fit (χ2 (132)=176.795, P<0.01; CFI=0.991; RMSEA=0.030). The third factor contained only 2 items and so is interpreted with caution.

Conclusions: The validity of the PPPC-R is supported by some congruence between the conceptual framework (the PCCM) and the statistical analysis (CFA), but there is not a 1:1 correspondence. The components of the PCCM represent conceptually what is important when teaching, researching, and providing patient-centered care, whereas the PPPC-R represents patient-centered care as it is experienced by the patient.

Keywords: factor analysis; patient-centered; patient-centredness [sic]; questionnaires; surveys.

Conflict of interest statement

Conflicts of Interest None.

Figures

Figure 1

The 4 interactive components of the patient-centered clinical method. (Figure republished from Stewart M, Brown JB, Weston WW, McWhinney I, McWilliam CL, Freeman TR. Patient-Centered Medicine: Transforming the Clinical Method, Third Edition. London, UK, Radcliffe Publishing, 2014, p. 8, with permission from Taylor & Francis Group.)

Figure 2

Confirmatory factor analysis of 3-factor structure for the 18-item revised Patient Perception of Patient-Centeredness (PPPC-R) questionnaire. (All parameter estimates [loadings and correlations] are standardized and statistically significant.)