Detecting and measuring deprivation in primary care: development, reliability and validity of a self-reported questionnaire: the DiPCare-Q

Abstract

ObjectivesAdvances in biopsychosocial science have underlined the importance of taking social history and life course perspective into consideration in primary care. For both clinical and research purposes, this study aims to develop and validate a standardised instrument measuring both material and social deprivation at an individual level.MethodsWe identified relevant potential questions regarding deprivation using a systematic review, structured interviews, focus group interviews and a think-aloud approach. Item response theory analysis was then used to reduce the length of the 38-item questionnaire and derive the deprivation in primary care questionnaire (DiPCare-Q) index using data obtained from a random sample of 200 patients during their planned visits to an ambulatory general internal medicine clinic. Patients completed the questionnaire a second time over the phone 3 days later to enable us to assess reliability. Content validity of the DiPCare-Q was then assessed by 17 general practitioners. Psychometric properties and validity of the final instrument were investigated in a second set of patients. The DiPCare-Q was administered to a random sample of 1898 patients attending one of 47 different private primary care practices in western Switzerland along with questions on subjective social status, education, source of income, welfare status and subjective poverty.ResultsDeprivation was defined in three distinct dimensions: material (eight items), social (five items) and health deprivation (three items). Item consistency was high in both the derivation (Kuder-Richardson Formula 20 (KR20) =0.827) and the validation set (KR20 =0.778). The DiPCare-Q index was reliable (interclass correlation coefficients=0.847) and was correlated to subjective social status (rs=−0.539).ConclusionThe DiPCare-Q is a rapid, reliable and validated instrument that may prove useful for measuring both material and social deprivation in primary care.

Validity and Reliability of Turkish Version of Deprivation in Primary Care Questionnaire (DiPCare–Q)

“…Sosyal eşitsizliklerle tanımlanan sosyal yoksunluğun özellikle dışlanma, izolasyon ve endişe gibi yarattığı sonuçların sağlık üzerindeki etkileri birçok çalışma ile ortaya konulmuştur. 13,18,19 Bu bakış açısıyla sosyal yoksunluk, yoksulluğun önemli bir boyutudur ve maddi yoksunluktan ayrılması gerekmektedir. DiPCare-Q'nun geleneksel yoksulluk ve maddi yoksunluk ölçümleri Birinci basamak sağlık hizmetlerinde yoksul bireylerin belirlenmesi, sağlıkta eşitsizliklerinin giderilmesine yönelik çalışmalar geliştirmenin ilk adımıdır.…”

Psychosocioeconomic Precariousness, Cognitive Decline and Risk of Developing Dementia: A 25-Year Study

“…Among these studies, Lee et al [18] reported a cumulative socioeconomic risk for cognitive impairment in elderly. In line with this cumulative approach, we meant to focus on the association between multiple vulnerabilities (the concept of ‘psychosocioeconomic precariousness') and cognitive ageing, using psychosocial variables in addition to occupation, education and income, as it has been recently proposed [19,20]. Therefore, the novelty of this research is that we combined a cumulative approach of precariousness (each item is scored 1 point and considered as providing additional precariousness) with a multidimensionality definition of precariousness including indicators of poor socioeconomic status and psychosocial vulnerability.…”

“…Lee et al [18] measured socioeconomic status with four indicators, i.e., education, income, wealth and occupation in 4,155 subjects aged ≥65 years, and showed that the combined effect of such factors on cognitive decline was stronger than the effect of each factor considered separately. Moreover, the use of psychosocial variables in addition to occupation, education and income has been recently proposed [19,20]. Indeed, numerous authors have underlined the multidimensional nature of precariousness, and the necessity to consider not only markers of individual's economic resources but also markers of social support, such as ‘living with a partner' or ‘whether an individual goes on holiday' [19,20].…”

“…Moreover, the use of psychosocial variables in addition to occupation, education and income has been recently proposed [19,20]. Indeed, numerous authors have underlined the multidimensional nature of precariousness, and the necessity to consider not only markers of individual's economic resources but also markers of social support, such as ‘living with a partner' or ‘whether an individual goes on holiday' [19,20]. …”

General Practitioners Can Evaluate the Material, Social and Health Dimensions of Patient Social Status

“…Patients' occupation, educational level, or income are often used as proxies for socioeconomic status [2]. More rarely a dedicated questionnaire is used to obtain a deprivation score [3], [4]. Social inequalities in health are found worldwide and have consequences for morbidity and mortality [5].…”