Reliability and validity of an instrument to assess pediatric inpatients’ experience of care in China

BACKGROUND: The Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) is a standard instrument to measure pediatric inpatients’ experience of care. Currently, no Chinese version of the Child HCAHPS exists for Chinese patients. Therefore, this study aimed to create a Chinese version of the Child HCAHPS and investigate its validity and reliability in a Chinese setting. METHODS: Using the approach recommended in guidelines from the Agency for Healthcare Research and Quality for translating HCAHPS surveys, we produced a Chinese version of the Child HCAHPS. A two-month field test with seven hospitals across five provinces in China was performed to assess its validity. Construct validity was assessed using confirmatory factor analysis. We evaluated convergent validity by factor loading, average variance extracted (AVE), and construct reliability (CR). Cronbach’s alpha and corrected item-total correlation (CITC) were used to reflect hospital-level unit reliabilities for the survey’s item composites. The correlation of the measure score with the overall rating was calculated to evaluate criterion validity. RESULTS: An overall response rate of 63% was achieved, and 2,258 respondents completed the questionnaire. Confirmatory factor analysis showed a comparative fit index (CFI) of 0.905, a non-normed fix index of 0.886, and a root mean square error of approximation (RMSEA) of 0.089. Most items had factor loadings over 0.7. Cronbach’s alpha coefficient on the overall level was 0.981, and all measures’ CITC exceeded 0.6, demonstrating good to excellent hospital-level reliability of the composite and single-item measures. All composite measures had good to excellent internal consistency reliability (0.716 to 0.994). Item-to-composite correlation ranged from 0.510 to 0.997. Composite-to-composite correlations ranged from 0.488 to 0.997. According to the survey result, for all the 18 composite or single-item measures, mean top-box scores ranged from 56% (“Involving teens in care”) to 87% (“Informed in Emergency Room”). CONCLUSIONS: The Chinese version of the Child HCAHPS demonstrated acceptable validity and reliability. The application of this tool can help benchmark ongoing healthcare improvement initiatives in China.