Health system reform from the people's point of view: Development of reliable and valid questionnaire

Saad Ahmed Ali Jadoo*, Syed Mohamed Aljunid, Seher Nur Sulku, Sami Abdo Radman Al-Dubai, Sharifa Ezat Wan Puteh, Zafar Ahmed, Mohd Rizal Abdul Manaf, Saperi B. Sulong, Amrizal Muhammad Nur

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Health system reform has been a major concern for different countries. The aim of this research was to develop a reliable and valid questionnaire suitable to assess the consequences of health reform process from people's perspective. An extensive literature review used to extract a set of statements as possible indicators for health system reform. Expert panel used to determine the content validity rate (CVR) and the content validity index (CVI). The first version produced in Turkish language and pre-piloted with 20 heads of household. Qualified committee used to translate the Turkish version to English version. Group of eighteen academics and graduate students recruited to tests both versions for parallel test validity. The construct validity of the questionnaire was determined using principal components analysis with Varimax rotation method (PCA). Internal consistency and questionnaire's reliability were calculated by Cronbach's alpha and the test-retest reliability test. A 17- items questionnaire was developed through the qualitative phase. The Bartlett's test was significant (p < 0.001), and the KMO value (0.842) showed that using principal component analysis (PCA) was suitable. Eigenvalues equal or higher than 1 were considered significant and chosen for interpretation. By PCA, 4 factors were extracted (accessibility, attitude and preference, quality of care and availability of resources) that jointly accounted for 85.2% of observed variance. The Cronbach's alpha coefficient showed excellent internal consistency (alpha=0.97), and test-retest of the scale with 2-weeks intervals indicated an appropriate stability for the scale (Intra-class coefficient = 0.96). The findings showed that the designed questionnaire was valid and reliable and can be used easily to assess the consequences of health reform process by comparing the situation before and after the reform from people's perspective.

Original languageEnglish
JournalMalaysian Journal of Public Health Medicine
Issue number2
Publication statusPublished - 2013
Externally publishedYes


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