# Evaluating the Development, Reliability, and Validation of the Tele-Primary Care Oral Health Clinical Information System Questionnaire: Cross-Sectional Questionnaire Study

## TL;DR

This study developed and validated a questionnaire to assess the implementation of a digital health system for maternal and child care in primary health settings.

## Contribution

The study introduces a validated TPC-OHCIS questionnaire for evaluating digital health system implementation in primary care.

## Key findings

- The TPC-OHCIS questionnaire demonstrated strong content validity, reliability, and construct validity.
- Principal component analysis identified 13 subscales explaining 76.07% of the total variance.
- The questionnaire can assess healthcare workers' performance and job acceptance in digital health systems.

## Abstract

Evaluating digital health service delivery in primary health care requires a validated questionnaire to comprehensively assess users’ ability to implement tasks customized to the program’s needs.

This study aimed to develop, test the reliability of, and validate the Tele-Primary Care Oral Health Clinical Information System (TPC-OHCIS) questionnaire for evaluating the implementation of maternal and child digital health information systems.

A cross-sectional study was conducted in 2 phases. The first phase focused on content item development and was validated by a group of 10 experts using the content validity index. The second phase was to assess its psychometric testing for reliability and validity.

A structured questionnaire of 65 items was constructed to assess the TPC-OHCIS delivery for primary health care use based on literature and has been validated by 10 experts, and 319 respondents answered the 65-item TPC-OHCIS questionnaire, with mean item scores ranging from 1.99 (SD 0.67) to 2.85 (SD 1.019). The content validity, reliability, and face validity showed a scale-level content validity index of 0.90, scale-level content validation ratio of 0.90, and item-level face validity index of 0.76, respectively. The internal reliability was calculated as a Cronbach α value of 0.90, with an intraclass correlation coefficient of 0.91. Scales were determined by the scree plot with eigenvalues >1, and 13 subscales were identified based on principal component analysis. The Kaiser-Meyer-Olkin value was 0.90 (P<.049). The total variance explained was 76.07%, and factor loading scores for all variables were >0.7. The Bartlett test of sphericity, determining construct validity, was found to be significant (P<.049).

The TPC-OHCIS questionnaire is valid to be used at the primary health care level to evaluate the TPC-OHCIS implementation. It can assess health care workers’ work performance and job acceptance and improve the quality of care.