Wehrli Susanne, Dwyer Andrew A, Landolt Markus A
Department of Psychosomatics and Psychiatry, University Children's Hospital, University of Zurich, 8032 Zurich, Switzerland.
Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, 8032 Zurich, Switzerland.
Healthcare (Basel). 2024 Mar 15;12(6):661. doi: 10.3390/healthcare12060661.
Access to healthcare is multifaceted and poses significant challenges for individuals with chronic and rare diseases (RDs). This study aimed to conduct a psychometric evaluation of the German version of the Perception of Access to Healthcare Questionnaire (PAHQ) among individuals with RDs. We conducted an evaluation of the PAHQ using a sample of 271 adults with an RD diagnosis. The 31-item instrument underwent evaluation including a comparison of three different confirmatory factor models (CFA). Subsequent steps involved item removal, reliability analysis (computation of Cronbach's alpha), and analysis of criterion-related validity. The six-factor model showed the best fit to the data and was selected for further examination. Subsequently, six items were removed. Fit indices for the final model were acceptable. Cronbach's alpha ranged from 0.75 to 0.91 for the six subscales, except for the availability subscale which exhibited the lowest value (0.64). In terms of criterion-related validity, different skills relating to the navigation of access dimensions were significantly correlated with corresponding PAHQ subscales, thus confirming validity. The capacity of the PAHQ to guide targeted interventions and facilitate cross-population comparisons positions it as a valuable instrument for advancing healthcare access research and promoting equitable access to care, particularly for individuals with rare and chronic diseases.
获得医疗保健服务是多方面的，对患有慢性病和罕见病（RDs）的个人构成了重大挑战。本研究旨在对德国版医疗保健服务可及性感知问卷（PAHQ）在患有罕见病的个体中进行心理测量学评估。我们使用271名被诊断患有罕见病的成年人样本对PAHQ进行了评估。这个包含31个条目的工具进行了评估，包括对三种不同验证性因素模型（CFA）的比较。后续步骤包括项目删除、信度分析（计算克朗巴哈系数）以及效标关联效度分析。六因素模型显示出对数据的最佳拟合，并被选作进一步检验。随后，删除了六个项目。最终模型的拟合指数是可接受的。六个子量表的克朗巴哈系数范围从0.75到0.91，除了可及性子量表的值最低（0.64）。在效标关联效度方面，与医疗保健服务可及性维度导航相关的不同技能与相应的PAHQ子量表显著相关，从而证实了效度。PAHQ指导针对性干预和促进跨人群比较的能力使其成为推进医疗保健服务可及性研究和促进公平获得医疗服务的有价值工具，特别是对于患有罕见病和慢性病的个体。
