Abstract
Framework: This study aims to validate the IEXPAC scale for assessing patient experiences among chronic disease patients in Portugal, where over 40% of adults are affected by such conditions (OECD, 2021). Effective management of chronic illness requires understanding the experiences of patients and their caregivers to improve quality, integrated care. The IEXPAC, based on the Chronic Care Model, focuses on communication, care continuity, and emotional support.
Validating the IEXPAC in Portugal addresses a gap in standardized tools for assessing patient-centered care, highlighting critical areas like digital literacy and care coordination. This tool’s insights into patient experiences support improved care practices, influencing patient well-being and adherence to treatment plans, and providing valuable guidance for healthcare policy and practice.
Approach: A cross-sectional study was conducted, with data collected through online and paper questionnaire. A sample of 168 participants, aged 20-95 and predominantly female, completed the IEXPAC scale along with a subjective well-being measure. A split-sample approach with cross-validation was used to determine the scale's factor structure. Exploratory Factor Analysis (EFA) was conducted on one sub-sample, followed by Confirmatory Factor Analysis (CFA) on the second.
Results : The EFA identified a two-factor structure: Integrated and Empowering Care (F1) and Digital and Social Health Empowerment (F2). The CFA confirmed this structure with good model fit and reliability. Significant positive correlations were found between the IEXPAC scale and subjective well-being, with a large correlation for the first factor and a moderate correlation for the second. This two-factor structure differs from the original three-factor model but aligns with recent studies on similar scales.
Exploratory factor analysis (EFA) identified a two-factor model, which confirmatory factor analysis (CFA) validated. This two-factor structure – Integrated and Empowering Care and Digital and Social Health Empowerment – which demonstrated strong reliability, was consistent with findings from Guilabert et al. (2021) and aligns partially with the original three-factor model Mira et al. (2016). While the original factor structure identified by Mira et al. (2016) emphasizes distinct dimensions of productive interactions and patient self-management, the current study suggests a more integrated experience in chronic disease management. The sample patients seem to perceive a more holistic approach, where healthcare provider support and patient empowerment are more closely intertwined. This finding reflects evolving healthcare practices and the context of the Portuguese healthcare system, where care coordination and patient engagement might be perceived as unified elements of patient-centered care (Hickmann et al., 2022).
Implications : The validation of the IEXPAC scale provides essential insights for advancing patient-centered care across healthcare settings. The factors identified – Integrated and Empowering Care and Digital and Social Health Empowerment – highlight critical elements that enhance patient well-being, including communication, coordination, and self-management. Social workers play a vital role in this process by using patient-centered approaches to support timely treatment and appropriate referrals, particularly by empowering patients through literacy and self-care skills. This study emphasizes the importance of adapting measurement tools to different contexts and integrating findings into training programs to improve patient-provider interactions.