Article Text
Abstract
Objectives Advances in biopsychosocial science have underlined the importance of taking social history and life course perspective into consideration in primary care. For both clinical and research purposes, this study aims to develop and validate a standardised instrument measuring both material and social deprivation at an individual level.
Methods We identified relevant potential questions regarding deprivation using a systematic review, structured interviews, focus group interviews and a think-aloud approach. Item response theory analysis was then used to reduce the length of the 38-item questionnaire and derive the deprivation in primary care questionnaire (DiPCare-Q) index using data obtained from a random sample of 200 patients during their planned visits to an ambulatory general internal medicine clinic. Patients completed the questionnaire a second time over the phone 3 days later to enable us to assess reliability. Content validity of the DiPCare-Q was then assessed by 17 general practitioners. Psychometric properties and validity of the final instrument were investigated in a second set of patients. The DiPCare-Q was administered to a random sample of 1898 patients attending one of 47 different private primary care practices in western Switzerland along with questions on subjective social status, education, source of income, welfare status and subjective poverty.
Results Deprivation was defined in three distinct dimensions: material (eight items), social (five items) and health deprivation (three items). Item consistency was high in both the derivation (Kuder-Richardson Formula 20 (KR20) =0.827) and the validation set (KR20 =0.778). The DiPCare-Q index was reliable (interclass correlation coefficients=0.847) and was correlated to subjective social status (rs=−0.539).
Conclusion The DiPCare-Q is a rapid, reliable and validated instrument that may prove useful for measuring both material and social deprivation in primary care.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
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Footnotes
To cite: Vaucher P, Bischoff T, Diserens EA, et al. Detecting and measuring deprivation in primary care: development, reliability and validity of a self-reported questionnaire: the DiPCare-Q. BMJ Open 2012;2:e000692. doi:10.1136/bmjopen-2011-000692
Contributors PV designed the systematic review; PV, E-AD and PB selected articles; PV and E-AD extracted data from articles; PV, E-AD, PB and TB validated the categorisation of items and formulated the initial questionnaire. E-AD interviewed patients and hospital cleaning personnel to validate and improve questionnaire. PV, TB and PB planned and collected data for face validity with general practitioners. For the derivation study, PV, E-AD, PB, TB, CS, GM-A and BF participated to the design of the study; PV wrote the protocol; PV and E-AD recruited patients and collected data, Adelaide Rosset contacted patients over the phone 3 days after enrolment. For the validation study, PV, PB, TB, FP, LH and BF participated to the design of the study; PV wrote grant applications and the protocol; LH recruited physicians; Catherine Delafontaine trained physicians and managed data entry and quality control; Isabelle Cardoso entered data and Estelle Martin managed the forms for scanned entry. PV analysed the data; all authors discussed the results and participated to the draft outline. PV wrote the manuscript under the supervision of PB. All authors read and approved the final manuscript. The final manuscript was corrected by David Brooks's English Language Coaching service (ELCS). PV serves as guarantors of the paper and accepts full responsibility for the work and the conduct of the study.
Funding Swiss Academy of Medical Science, by the Department of Social Action and Health of the Canton of Vaud and by the Faculty of Biology and Medicine from the University of Lausanne.
Competing interests None.
Patient consent Signed consent was obtained during the derivation study. For the validation study, oral and written information were given to participants. The physician obtained oral consent before handing out the questionnaire. Patients were clearly informed that returning the questionnaire meant they approved participating.
Ethics approval Ethical approval was obtained from the official state Biomedical Ethical Committee under reference number 157/09 for the derivation study and reference number 155/10 for the validation study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The DiPCare-Q in English, French, German and Italian is made openly accessible to all on the web with a link on http://bmj.com. Instructions and STATA commands to calculate the DiPCare-Q index are also provided.
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