Psychometric properties of the Arabic version of the EUROPEP questionnaire

Background: The evaluation of quality of primary health care from the perspective of refugees is very underdeveloped. It depends mainly on the availability of instruments in the language of the refugees. The aim of this study was to translate, culturally adapt, and examine the psychometric properties especially the internal consistency and convergent construct validity of the Arabic version of the European Project on Patient Evaluation of General Practice Care (EUROPEP) questionnaire. Methods: The German version of the EUROPEP questionnaire was translated into Arabic language. In total, 619 Arabic-speaking people were invited to participate in this study. Refugees who lived in collective living quarters in the German federal state of Schleswig-Holstein were recruited. The EUROPEP questionnaire is a multidimensional instrument that comprises 23 items, each with a 5-point Likert-type response. Cronbach's alpha, descriptive statistics, and principal component analysis were used to assess a part of psychometric properties. Convergent construct validity was assessed with the validated questionnaire on satisfaction with ambulatory care - quality from the patient perspective (ZAP questionnaire) by using Spearman rank-order correlation test. Results: A total of 136 questionnaires of refugees were returned (response rate 22%). Of these respondents, 95 participants who had visited a general practitioner were included in the validation study. The exploratory factor analysis extracted four factors, namely, "medical care," "physician patient relationship," "coordination o f care," and "accessibility to care." The internal consistency ranged between alpha=0.942 for "medical care" and alpha=0.869 for "coordination of care." The convergent construct validity is supported by a significant positive correlation between the overall score of the EUROPEP questionnaire and the overall score of the ZAP questionnaire (r(rho) =0.820; p<0.01). Conclusion: The Arabic version of the EUROPEP questionnaire shows appropriate internal consistency and convergent construct validity. The availability of this instrument in Arabic language encourages further research in the field of outcome quality from refugees' perspective in other health service research projects.