MEASURING LAY PEOPLES PERCEPTIONS OF THE QUALITY OF PRIMARY HEALTH-CARE SERVICES IN DEVELOPING-COUNTRIES - VALIDATION OF A 20-ITEM SCALE

Introduction. Methodologies that have been developed and validated in accordance with accepted scientific standards are needed to monitor an d assess the quality of primary health care in developing countries. O bjective. To present the results of reliability and validity testing o f a new instrument of measurement intended to document the user's opin ion on the quality of primary health care services. Methods. The 20-it em scale includes three subscales related to health care delivery, per sonnel and facilities. There were 241 people in one city and two villa ges in Upper Guinea who responded to the questionnaire. An item analys is preceded the test of psychometric properties of the three subscales and of the total score. Reliability was estimated by analyses of inte rnal consistency and the Cronbach's alpha coefficient. A variety of st atistical procedures were used to test factorial validity, trait valid ity (convergent and discriminant) and nomological validity. Results. T he reliability of the subscales ranged from 0.71 to 0.88. The validity analyses supported the initial dimensionality and suggested good cons truct validity. Conclusion. Results confirm the value of the use of th e scale developed and highlight the need to take into account the dive rsity of how quality is perceived by lay people in developing countrie s. It is suggested that the process of formalization of this type of m easurement scale be pursued.