Validity and reliability of the Thai version Consumer Assessment of Healthcare Providers and Systems In-Centre Hemodialysis (Thai CAHPS-ICH) survey for maintenance hemodialysis patients.

BACKGROUND

Patient-reported experience measures (PREMs) are important tools for evaluating the quality of care from patients' perspectives. Nevertheless, no validated PREMs exist for maintenance hemodialysis (MHD) patients in Thailand. This study aimed to develop a Thai version of the Consumer Assessment of Healthcare Providers and System In-center Hemodialysis (CAHPS-ICH) survey and assess its psychometric properties, specifically its validity and reliability.

METHOD: We conducted the cross-sectional study, using Total Population Sampling among adult patients (≥ 18 years) receiving MHD at the Chiang Mai University Hospital hemodialysis center. The original English version CAHPS-ICH® survey was translated into Thai using the forward-backward translation method and cognitive debriefing. Confirmatory Factor Analysis (CFA) was employed to evaluate construct validity. Correlation analysis (using Pearson's and Spearman's coefficients) was used to assess the relationship between each domain (Nephrologists' communication and caring [NCC], quality of dialysis center cares and operation [QoC], and providing information to patients [PI]) and the global rating scales. Internal consistency and test-retest reliability were assessed using Cronbach's alpha coefficient (α) and intraclass correlation coefficient (ICC), respectively.

RESULTS

A total of 189 patients were recruited. The NCC domain CFA model showed a mixed fit (RMSEA = 0.137; CFI = 0.945; SRMR = 0.041). In contrast, the QoC and PI domain CFA models demonstrated an acceptable fit (RMSEA = 0.098; CFI = 0.844; SRMR = 0.071 and RMSEA = 0.066; CFI = 0.843; SRMR = 0.070, respectively). The NCC domain exhibited the strongest correlation with the doctor global rating scale (r = 0.60) and displayed good internal consistency (α = 0.86). The QoC domain indicated positive correlations with the staff and center rating scales (r = 0.65 and 0.58, respectively) and demonstrated acceptable internal consistency (α = 0.78). The PI domain showed a moderate association with the center global rating scales (r = 0.31), but its internal consistency was not demonstrated (α = 0.53). Most multi-item scale questions showed satisfactory test-retest reliability (ICC = 0.50-0.85).

CONCLUSION

Despite the mixed fit observed in the NCC domain CFA, the overall "Thai CAHPS-ICH" survey demonstrates acceptable reliability and concurrent validity among MHD patients at Chiang Mai University Hospital. This validation is a crucial first step toward establishing a patient-centered quality metric for hemodialysis centers in Thailand.

TRIAL REGISTRATION: This study was reviewed and approved by the Ethics Committee of Chiang Mai University (Ethical approval number: MED-2565-09133).