Portuguese translation, cultural adaptation and validation of the Primary Care Outcomes Questionnaire
TL;DR
The PCOQ-PT showed evidence of cultural appropriateness, internal consistency, and construct validity in this sample of Portuguese PHC users, but further validation studies are warranted before its implementation in routine primary health care practice, particularly given the single-center design, the presence of ceiling effects, and the lack of testing for sensitivity to change.
Abstract
Patient-reported Outcomes Measures (PROMs) stand out within innovative Primary Health Care (PHC) models and promote patient-centred care. The Primary Care Outcomes Questionnaire (PCOQ) was translated, culturally adapted, and psychometrically evaluated in a sample of PHC users in Portugal. This PROM has a multidimensional structure, that uniquely integrates constructs assessed separately in other instruments, enabling the evaluation of the main outcomes among adult PHC users, regardless of chronic disease status. The translation and cultural adaptation process followed the steps recommended by Beaton et al . The Portuguese version was completed in 2025, by 407 patients aged 18 years or older who attended a Family Health Unit (FHU) within the PHC in Greater Lisbon. Some questionnaires were administered in person and others online. Sociodemographic and clinical data were collected from participants. The psychometrics of the PCOQ-PT were analyzed by assessing reliability and construct validity. The presence of ceiling effects was also evaluated. Confirmatory factor analysis was performed using X 2 (df), the Comparative Fit Index (CFI), the Tucker-Lewis Index (TLI), the Root Mean Square Error of Approximation (RMSEA), and the Standardized Root Mean Square Residual (SRMR) as fit indices. Construct validity was assessed using confirmatory factor analysis (CFA). Convergent validity was evaluated using the average variance extracted (AVE), while composite reliability (CR) was estimated for each factor. Discriminant validity was assessed using the Fornell–Larcker criterion. Internal consistency was evaluated using Cronbach’s alpha and corrected item–total correlations. The respecified four-factor CFA model showed satisfactory overall fit, with CFI = 0.993, TLI = 0.992, RMSEA = 0.088 (90% CI: 0.081–0.094), and SRMR = 0.063. Standardized factor loadings ranged from 0.598 to 0.956. Convergent validity was supported by AVE values ranging from 0.635 to 0.859, while composite reliability ranged from 0.932 to 0.964. Discriminant validity was supported by the Fornell–Larcker criterion. Ceiling effects were observed for all 21 retained items. The PCOQ-PT showed evidence of cultural appropriateness, internal consistency, and construct validity in this sample of Portuguese PHC users. However, further validation studies are warranted before its implementation in routine primary health care practice, particularly given the single-center design, the presence of ceiling effects, and the lack of testing for sensitivity to change.