Development of patient-centered care scales of dentists in primary health care of Thailand: A multigroup analysis
Authors:   , Khamnil Yutthana 
Published: September 2023

Purposes: 1. to develop a conceptual construct of patient-centered dental care for primary care dentists in Thailand. 2. to create reliable and valid instruments to measure patient-centered care from both the patient's and dentist's perspectives. 3. to test the measurement invariance of the two scales 4. To examine the effect of personal attributes of patients and dentists on the level of patient-centered care. Materials and Methods: In Phase 1, preliminary questionnaires were developed through a comprehensive process involving a literature review, in-depth interviews, content validity tests, cognitive interviews, and pre-tests. Exploratory factor analysis (EFA) was used to identify the constructs. In phase 2, confirmatory factor analysis (CFA) was performed. The reliability of the instruments was tested. A multi-group analysis was conducted to test measurement invariance between large and small community hospitals. Additionally, multiple linear regression was performed to examine the effect of personal attributes on the level of patient-centered care. The two newly developed tool were administered to test-retest reliability with a one-week interval A multistage sampling strategy was employed to recruit dental patients and dentists from community hospitals across Thailand. Self-administered questionnaires were utilized, and the response data were divided for EFA and CFA. Results: The analysis of the interviews yielded 12 attributes. The Patient-Centered Care of Dentist Scale (PCCDS-P Version) underwent validation through EFA and CFA (χ2= 10.113, χ2/df = 1.448, df=7, p=.181, CFI=.999, TLI=.998, RMSEA=.020). The final scale consisted of 42 items across seven domains: dentist-patient relationship, disease-illness, integrated care, communication, shared information and decision-making, holistic care, and empathy and anxiety management. The findings indicated that the scale was metric measurement invariant across patient groups. The second instrument developed, the Patient-Centered Care of Dentist Scale (PCCDS-D version), also underwent validation through EFA and CFA (χ2= 10.770, χ2/df = 1.346, df=8, p=.215, CFI=.998, TLI=.996, RMSEA=.021). This scale consisted of 36 items across the same seven domains as the PCCDS-P version. The findings indicated residual invariance across dentist groups. The scales exhibited excellent reliability and stability. The analysis revealed significant effects of hospital size on PCCD-P version (β = 0.999, p < 0.015) Additionally, the number of dental visits within 24 months emerged as a significant predictor of P-PCCD (β = 1.364, p < 0.003). Dentists who rotated to primary care units 1-3 times per week exhibited a significant effect on PCCD-D version (β = 2.863, p < 0.001). Conclusions: This study provides evidence that the newly developed P-PCCDS, consisting of seven domains and 42 items, and the PCCDS, consisting of seven domains and 36 items, demonstrate excellent reliability and validity. The PCCDS-P version was metric invariance, and the PCCDS-D version was residual invariance. The study demonstrated that hospital size and the frequency of dental visits significantly affect the level of patient perception of PCCD. Additionally, the rotation of dentists to primary care units showed a significant effect on the level of PCCD. Overall, this comprehensive study contributes to the understanding and implementation of patient-centered dental care in primary care dentistry in Thailand.