## 4 Discussion  
A healthcare organization is and has always been known as a place to relieve human suffering. However, assessments of medical care have traditionally been conducted based on technical and physiological reports of outcomes rather than from a patient's perspective [21]. However, it is comforting to see that more healthcare systems all over the world have sought to achieve balance in the services that offer clinically effective and evidence-based care and that are also perceived by patients as acceptable and beneficial [21]. To properly assess a patient's perception of the relational aspect of care that they experience, a valid measurement tool must be available, as suggested by a well-known report [11]. Reviews showed that most of the available patient-reported experience measures are still lacking in their psychometric properties [23]. Compassionate care is one of Malaysia's MOH pillars. However, no tool has been psychometrically developed in order to assess whether this aspect of care is properly embedded among all healthcare workers. Therefore, in this study, we aimed to validate and translate the RAC-Q into the Malay language to enable its use in Malaysia. Although there are many other tools available that can be used to measure compass, the RAC-Q was primarily chosen because it has very good psychometric properties, and the  
Figure 2: Path diagram of RAC-QM showing factor loadings and variance errors of each item. background of the original study population was similar to the targeted population of our study, that is, inpatients. Furthermore, the RAC-Q was developed on the basis of the relational aspect of care, based on evidence gathered from a wide selection of existing surveys, namely, the PEECH measure, NHS Adult Inpatient Survey, 2012 NHS Emergency Department Survey, CARE measure, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) questionnaire, and General Practice Patient Survey (GPPS), and also from a qualitative study [11]. It incorporates 22 elements of the relational aspect of care. Even though the original paper did not provide details about the specific themes that each question represented, the committee members tried to identify these during the cognitive debriefing and agreed that the questionnaire represented the 22 themes. Model 1 contained all 12 original items, with good indices (x2/df = 1.43, SRMR = 0.07, RMSE = 0.06, CFI = 0.92, and TLI = 0.90) and a good reliability, with a Cronbach's alpha of 0.86. All factor loadings were also acceptable, with a value of >0.40, except for question number eight, the item that asks \"have you had enough time to discuss your health or medical problem with a doctor or nurse?\". Therefore, Model 2 was built and tested by removing question number eight in order to decide which model has the better goodness of fit. Compared with model 1, model 2 has no significant difference in terms of the indices, although it leads to lower AIC (1006.14 vs. 1137.52) and BIC (1070.54 vs. 1207.77)). Therefore, model 1 was retained. According to [PERSON] et al., a factor loading of >0.3 is still acceptable [17]. In addition, removing an important item from the questionnaire affects the intended functionality of the questionnaire. The reliability of the RAC-QM in assessing the compassionate care offered by healthcare providers was ascertained based on a good Cronbach's alpha of \(\geq\)0.7. The overall consistency of the items in the questionnaire indicates that all the items measure the same constructs. The convergent validity of the questionnaire is also adequate, with a composite ratio of 0.857 and AVE of 0.344. Even though many studies suggested that the AVE should be more than 0.5, many lines of evidence also showed that a measurement model with a composite ratio of more than 0.6 is still adequate even if the AVE is less than 0.5 [24; 25]. This means that similar results can be expected even if the testing process is repeated.