Assessing continuity of care in a community diabetes program: initial questionnaire development and validation

Objective — To develop and validate a questionnaire based on agency theory to measure continuity of care in a community-based diabetes control program in Shanghai, China.

Study Design and Setting — Continuity of care was conceptualized in relation to two domains: information transfer and goal alignment. The questionnaire combined scales adopted from two validated questionnaires: the Primary Care Assessment Survey and the Summary of Diabetes Self-care Activities Measure. Patient interviews were conducted with 156 diabetes patients in the intervention group and 182 in the control group in two community health settings in Shanghai, China. The questionnaire was validated in terms of Likert-scaling assumptions, data completeness, score distribution, construct validity, and sensitivity.

Results — All scales consistently showed strong measurement properties in item reliability and validity. Requirements of data completeness and distribution were achieved in all scales. Principal components analysis of six scales provided a satisfactory explanation of the hypothesized scale-domain construction.

Conclusions — The validation results suggested that the scales in our continuity of care questionnaire are consistent with the concept of continuity of care based on agency theory.