Validation of the Maltese version of the EUROPEP instrument for patient evaluation of general practice care

Abstract

It is now accepted, both by the medical profession and by government and non government organisations dealing with health care, that patient evaluations can make an important contribution towards the improvement of health care services. EUROPEP is an internationally validated 23-item questionnaire that has been used successfully throughout Europe in national, regional and local surveys for measuring patient evaluations in primary health care. The aim of this thesis is the validation of the Maltese version of the EUROPEP instrument for patient evaluation of general practice care. It will attempt to measure patient satisfaction using a methodology that has been specifically developed for this purpose. This is the first such study in Malta. In addition, the thesis aims to establish a reliable, verifiable and unambiguous Maltese text of the 23-item questionnaire of the EUROPEP instrument. It will also seek to establish the validity of the translation and the reliability of the EUROPEP questionnaire when applied to Maltese patients by conducting a pilot study for this purpose. Finally, the thesis will attempt to prove the reliability and consistency of the Maltese version of the EUROPEP instrument by comparing the results obtained from its application in Malta with those obtained from EUROPEP's application in other European countries. This comparison is extended to the results obtained by the European Health Interview Survey carried out in Malta in 2008. The EUROPEP questionnaire was translated, forward and backward, by two independent professional translators. The Maltese version was then tested for possible ambiguities and misunderstandings using a pilot group of fifteen persons. The final Maltese version was agreed and validation of the translation was completed. The reliability of the Maltese EUROPEP questionnaire was tested using the Intra Class Correlation Coefficient test. All questions scored 0.8 or more on this scale. The reliability of the Maltese EUROPEP was also tested with a group of twenty-three persons. These were interviewed by telephone individually, on two occasions with an interval of four weeks between each interview. Transcripts of the replies to both interviews were compared and found to correspond perfectly. Taking into account the objectives of the study and various statistical assumptions, the sample population was established at 239 randomly selected Maltese nationals over the age of eighteen. The sample was obtained from the latest edition of the Maltese electoral register. Telephone interviews were carried out by five professionally trained public relations officers, who were especially trained over a three- week period to conduct telephone interviews, and who had the objectives and contents of the EUROPEP instrument clearly explained to them. In addition to the 23-item questionnaire of EUROPEP, those interviewed were asked 9 additional questions concerning gender, age, health status, chronic illnesses, location and frequency of visits to general practitioner, in order to facilitate the analysis of the results. Once all the interviews were carried out, the results of the EUROPEP were pooled together and compared using the Cronbach α (alpha). This revealed internal consistency of the scales. The response rate was 74.45%, which compares well with the response rates obtained by EUROPEP in various European countries, and with the response rate of the European Health Interview Survey that was carried out in Malta between June and August 2008. The gender distribution of the respondents, their educational attainment, their perceived health status, their chronic condition, and the distribution by general health care provider, were analysed. The results obtained by the Maltese version of EUROPEP were found to tally with corresponding distributions in the Health Interview Survey 2008. There was also a high level of correlation between these results and those obtain by EUROPEP in ten other European countries. These results confirmed the reliability of the Maltese version of EUROPEP. The scores obtained by the Maltese version of EUROPEP for patient evaluation in the five dimensions of primary health care covered by the EUROPEP questionnaire could be confirmed by comparisons with the scores for similar dimensions in ten European countries where the EUROPEP questionnaire was used. These results could also be confirmed by comparisons with the statistics provided by the Health Interview Survey 2008. Thus the study confirmed the validation of the Maltese version of EUROPEP.