Background The family doctor team dynamics mainly refer to inter-member interaction state of the family doctor team in the process of providing services. Improving the team dynamics among family doctors can help promote the enhancement of team effectiveness. The Primary Care Team Dynamics Scale (PCTDS) developed by Sara J. Singer's team at Harvard University, which can be used to comprehensively assess the primary care team dynamics.
Objective To translate the PCTDS into a Chinese version, and test the reliability and validity of the Chinese version.
Methods The Brislin's model for translation, back translation and cross-cultural adaptation was utilized to translate the PCTDS into a Chinese version (PCTDS-C) strictly following the principle of scale introduction, and the PCTDS-C was revised in accordance with an email-based expert consultation and a pre-test. Then a total of 569 family doctor team members were selected from 17 cities (including Guangdong's Shenzhen, Hubei's Wuhan, Zhejiang's Hangzhou, and so on) by the convenience sampling method from November 2021 to February 2022 to attend a survey using a self-developed Demographic Questionnaire and the PCTDS-C. The critical ratio (CR) method and item-total correlation were used for item analysis. The content validity of the scale was assessed by the expert consultation. The structural validity of the scale was tested by the KMO test, Bartlett's test of sphericity, exploratory factor analysis, and confirmatory factor analysis. And the reliability of the scale was evaluated by the Cronbach's α.
Results Three hundred and nine of the 569 cases (54.3%) who returned responsive questionnaires were included for analysis. The absolute CR value for each of the entries was greater than 3.000 (P<0.001), and the average r-value of the correlation between each item score and the total scale score was greater than 0.300 (P<0.001). The I-CVI was 0.692-1.000, and S-CVI was 0.896. A significant KMO value of 0.946 and a significant value of Bartlett's test of sphericity〔χ2=4 488.198 (df= 406, P<0.001) 〕indicated that the scale was suitable for factor analysis. Four common factors with an eigenvalue greater than 1.000 were extracted, including the conditions of team effectiveness (4 items), team shared understanding (6 items), team collaboration process (9 items), and team effectiveness (9 items), explaining 74.2% of the total variance. The load value of each item on the common factor was 0.561-0.802. Confirmatory factor analysis indicated that the performance of fit indices of the initial model was not satisfactory. After the correlations between the error variables e20 and e31, e6 and e7, e19 and e31, e24 and e25, e18 and e23, e4 and e10, e3 and e9 were added according to the indicator prompts, except for χ2/df, IFI and CFI, the performance of the other fit indices of the modified model was still unsatisfactory (χ2/df =2.313, RMSEA=0.091, GFI=0.748, AGFI=0.699, NFI=0.866, IFI=0.919, CFI=0.919). The Cronbach's α for the total scale was 0.978. And the Cronbach's α was 0.826 for the conditions of team effectiveness, 0.945 for team shared understanding, 0.957 for team collaboration process, and 0.956 for team effectiveness.
Conclusion The PCTDS-C has proven to have a good reliability and a fair validity, which can be used as a tool to evaluate the family doctor team dynamics in China. However, there is still much room for the scale improvement. Future research can focus on in-depth exploration of the dimensions and item classification of the scale, and the adding of dimensions in line with the actual situation of family doctor teams in China.
