# Development and Validation of a Culturally Adapted Patient‐Reported Experience Measure for Diabetes Care in Thailand: Mixed‐Methods Study

## TL;DR

A new patient-reported experience measure for diabetes care was developed and validated in Thailand to improve patient-centered care.

## Contribution

The first culturally adapted patient-reported experience measure for diabetes care in Thailand was developed and validated.

## Key findings

- The final PREM consists of 16 items across four domains with good internal consistency (Cronbach's alpha of 0.84).
- The tool explains 60.1% of overall variance and is culturally appropriate for Thai diabetes patients.
- Patients were actively involved in refining the questionnaire's clarity and relevance.

## Abstract

Patient‐centred care is essential for managing Type 2 diabetes, as it relies on understanding patients’ experiences and perspectives. However, in Thailand, no culturally adapted patient‐reported experience measure (PREM) exists to capture these insights and support quality improvement in diabetes care.

To develop and validate a culturally adapted PREM for Thai people with Type 2 diabetes receiving primary care.

This mixed‐methods study was conducted at Saraphi Hospital, Chiang Mai, from July to December 2024. Stage 1 involved drafting the initial PREM based on a prior scoping review. In Stage 2, content validity was assessed by experts, and face validity was evaluated through patient interviews. Stage 3 involved a quantitative survey of patients to assess construct validity and reliability using exploratory and confirmatory factor analyses.

The initial PREM included 37 items across four domains, developed based on findings from the scoping review. After expert and patient feedback, the tool was refined. Exploratory and confirmatory factor analyses confirmed the tool's structure, resulting in a final version with 16 items across four domains: care planning, patient education, professionalism and quality of service. This final PREM structure explained 60.1% of overall variance, and demonstrated good internal consistency (Cronbach's alpha of 0.84), supporting its utility for capturing patient experiences in the Thai healthcare setting.

This study developed the first culturally adapted PREM for Thai people living with diabetes. Although further implementation is needed, this current validated tool can support patient‐centred care in Thailand and other low‐ and middle‐income settings in Southeast Asia.

The development of this instrument actively involved patients throughout key stages. During content validation, individuals living with diabetes participated in an expert panel and provided feedback on item clarity, relevance and comprehensiveness. Their suggestions directly influenced revisions to the questionnaire. For face validity, a pilot test was conducted with patients in a primary care setting, gathering their insights on wording, usability and cultural appropriateness. Their contributions ensured the tool was clear, acceptable and contextually relevant to Thai people living with diabetes.