title: Development and Validation of a Questionnaire to Assess Multimorbidity in Primary Care: An Indian Experience.
abstract: Multimorbidity remains an underexplored domain in Indian primary care. We undertook a study to assess the prevalence, correlates, and outcomes of multimorbidity in primary care settings in India. This paper describes the process of development and validation of our data collection tool "Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC)." An iterative process comprising desk review, chart review, and expert consultations was undertaken to generate the questionnaire. The MAQ-PC contained items on chronic conditions, health care utilization, health related quality of life, disease severity, and sociodemographics. It was first tested with twelve adults for comprehensibility followed by test-retest reliability with 103 patients from four primary care practices. For interrater reliability, two interviewers separately administered the questionnaire to sixteen patients. MAQ-PC displayed strong internal consistency (Cronbach's alpha: 0.69), interrater reliability (Cohen's Kappa: 0.78-1), and test-retest reliability (ICC: 0.970-0.741). Substantial concordance between self-report and physician diagnosis (Scott Kappa: 0.59-1.0) was observed for listed chronic conditions indicating strong concurrent validity. Nearly 54% had one chronic condition and 23.3% had multimorbidity. Our findings demonstrate MAQ-PC to be a valid and reliable measure of multimorbidity in primary care practice and suggest its potential utility in multimorbidity research in India.
authors.affiliation: Indian Institute of Public Health, Bhubaneswar, Public Health Foundation of India, Bhubaneswar, Odisha 751024, India.
authors.forename: Sanghamitra
authors.initials: S
authors.lastname: Pati
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, The University of Queensland, Brisbane, QLD 4006, Australia.
authors.forename: Mohammad Akhtar
authors.initials: MA
authors.lastname: Hussain
authors.affiliation: Indian Institute of Public Health, Bhubaneswar, Public Health Foundation of India, Bhubaneswar, Odisha 751024, India.
authors.forename: Subhashisa
authors.initials: S
authors.lastname: Swain
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Salisbury
authors.affiliation: Department of Family Medicine, School Caphri, Maastricht University, 6200 MD Maastricht, Netherlands.
authors.forename: Job F M
authors.initials: JF
authors.lastname: Metsemakers
authors.affiliation: Department of Family Medicine, School Caphri, Maastricht University, 6200 MD Maastricht, Netherlands.
authors.forename: J André
authors.initials: JA
authors.lastname: Knottnerus
authors.affiliation: Department of Family Medicine, School Caphri, Maastricht University, 6200 MD Maastricht, Netherlands; Department of General Practice, KU Leuven, 3000 Leuven, Belgium.
authors.forename: Marjan
authors.initials: M
authors.lastname: van den Akker
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000145:classification / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care; D011594:Psychometrics; D011795:Surveys and Questionnaires