Validation of the primary care experiences survey developed with Indigenous patients with type 2 diabetes in Canada
Bibliographic record
Abstract
Abstract Background Health disparities experienced among Indigenous populations in Canada arise from complex historical and social causes. Addressing health disparities requires a multi-sectoral approach, including measures for Indigenous patient healthcare experiences. The Canadian Institute for Health Information published Measuring Patient Experiences in Primary Health Care Survey to evaluate care experiences among general populations; it is not known whether this survey tool is appropriate to measure Indigenous people’s experiences of healthcare. As part of a large research project known as Educating for Equity (E4E), we developed an Indigenous patient experiences with diabetes care survey from existing validated primary care assessment tools, adapting items to the domains of the E4E Care Framework that addresses social and cultural factors that impact Indigenous health. This study describes the development of this Indigenous patient experiences survey, assessing the tool’s validity and reliability.Method A consensus approach was used to establish the face validity of the survey and ease of completion. The survey was administered in three on- and off-reserve practices in Northern Ontario during 2015 and 2016. In total, 154 completed surveys were collected for data analysis. Exploratory factor analysis was performed to assess the survey’s structure. Internal consistency, item convergent validity and discriminant validity were assessed to determine internal reliability and correlation of items within each scale and between scales.Results The Indigenous patient experiences survey consists of two sections: a patient demographic section of eight items and healthcare experience section of 36 items on Likert scales. Exploratory factor analysis identified seven main and sub-scales that align with the survey’s conceptual domains. Two items were removed due to insufficient loading scores. All main and sub-scales obtained acceptable internal reliability (Cronbach’s α: 0.7-0.957), item convergent validity (AVE: 0.4-0.7; CR: 0.78-0.99), and discriminant validity (√ AVE: 0.66-0.85).Conclusion The Indigenous patient experiences survey maps out the construct concepts of the E4E Care Framework: provider-patient relationship, provider cultural competence and social sensitivity, patient diabetic-related psychosocial self-efficacy, and patient-centred continuity of care. Study results indicate this culturally-tailored instrument is reliable and valid for measuring primary care experiences of Indigenous patients with diabetes in Ontario, Canada.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.002 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".