Examining the Factorial Validity of Selected Modules from the Canadian Survey of Experiences with Primary Health Care

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by Cameron N. McIntosh

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Executive summary

The Canadian Survey of Experiences with Primary Health Care (CSE-PHC) was conducted by Statistics Canada in January and February 2007, on behalf of the Health Council of Canada. The purpose of CSE-PHC was to measure Canadians' experiences with the health care system: more specifically, their experiences with various types of physicians, access to health care, and use of different health care services including emergency rooms, clinics and prescription medications. CSE-PHC also assessed a number of attitudinal variables, such as Canadians' confidence in the health care system and their perceptions of their role in managing their own health care.

Many of the CSE-PHC modules use multiple items to measure a smaller number of primary health care concepts. Therefore, researchers working with these data may wish to combine subsets of items into summary indices, in order to facilitate reporting of descriptive statistics as well as multivariate modelling. The purpose of this study is to examine whether the multiple items in each module have factorial validity, that is, whether they measure common dimensions or factors. Verification that a group of observed items measures a single latent factor is an important first step in constructing a summary or global index based on those items. Here, I focus on the factorial validity of the following four CSE-PHC modules: Patient Assessment of Chronic Illness Care (PACIC), Patient Activation (PA), Managing Own Health Care (MOHC) and Confidence in the Health Care System (CHCS).

I conducted a series of confirmatory factor analyses on the above modules to assess the degree to which multiple-observed items reflected the presence of common latent factors. A four-factor model was initially specified for the PACIC instrument on the basis of prior theory and research, but it did not fit the data well. Rather, a revised two-factor model was found to be most appropriate. These two factors were labelled: "Whole Person Care" and "Coordination of Care." The remaining modules studied here—PA, MOHC and CHCS—were all well represented by single-factor models.

The results suggest that the original factor structure of PACIC, developed within studies using clinical samples, does not hold in general populations. However, the precise reasons for this are not clear, and further empirical investigation will be required to shed more light on this discrepancy. The two factors identified here for PACIC-as well as the single factors produced for PA, MOHC and CHCS-could be used as the basis of summary indices for use in further analyses with CSE-PHC.

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