title: Measurement properties of the Client-centered Care Questionnaire (CCCQ): factor structure, reliability and validity of a questionnaire to assess self-reported client-centeredness of home care services in a population of frail, older people.
abstract: BACKGROUND
  The increasing and specific use of home care services by frail, older people asks for the evaluation of the client-centeredness of these services. To our knowledge, no instrument that measures client-centeredness of home care from this group's unique perspective exists. We therefore tested the factor structure, reliability, content validity and acceptability of the Client-centered Care Questionnaire (CCCQ), an existing instrument developed for general home care users, in a population of frail, older people in the Netherlands.
  
  
  METHODS
  We used data from a 2-year clinical trial.
  
  
  METHODS
  frail, older people who received home care. Data were collected at baseline (n = 600) and 24-month measurements (n = 389); retest data (n = 67) were collected 7-14 days after the 24-month measurements.
  
  
  METHODS
  We performed confirmatory factor analysis, investigated reliability and validity parameters and assessed acceptability.
  
  
  RESULTS
  The factor analysis yielded a bifactor model with essential unidimensionality. Internal consistency was high (omega total .88). We found a test-retest reliability of total test scores of .81; the standard error of measurement was 2.61 (total score range 15-75) and the limits of agreement were -7.03 and 7.86. We rejected three out of four hypotheses for construct validity.
  
  
  CONCLUSIONS
  The CCCQ is sufficiently unidimensional to permit the use of total test scores. We found acceptable reliability values, but considered our results on construct validity inconclusive. Respondents found the CCCQ questions challenging to answer, which is indicative of a high degree of respondent burden. Future instruments that measure client-centeredness of home care from the frail, older client's perspective should therefore be tailored to the specific circumstances of this population.
authors.affiliation: Department of General Practice and Elderly Care Medicine/EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands, m.muntinga@vumc.nl.
authors.forename: M E
authors.initials: ME
authors.lastname: Muntinga
authors.forename: L B
authors.initials: LB
authors.lastname: Mokkink
authors.forename: D L
authors.initials: DL
authors.lastname: Knol
authors.forename: G
authors.initials: G
authors.lastname: Nijpels
authors.forename: A P D
authors.initials: AP
authors.lastname: Jansen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005163:Factor Analysis, Statistical; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D006699:Home Care Services / Q000592:standards*; D006801:Humans; D008297:Male; D009426:Netherlands; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D011788:Quality of Life; D015203:Reproducibility of Results; D057566:Self Report; D011795:Surveys and Questionnaires