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Qual Life Res. 2014 Sep;23(7):2063-72. doi: 10.1007/s11136-014-0650-7. Epub 2014 Feb 28.

Measurement properties of the Client-centered Care Questionnaire (CCCQ): factor structure, reliability and validity of a questionnaire to assess self-reported client-centeredness of home care services in a population of frail, older people.

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Department of General Practice and Elderly Care Medicine/EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands,



The increasing and specific use of home care services by frail, older people asks for the evaluation of the client-centeredness of these services. To our knowledge, no instrument that measures client-centeredness of home care from this group's unique perspective exists. We therefore tested the factor structure, reliability, content validity and acceptability of the Client-centered Care Questionnaire (CCCQ), an existing instrument developed for general home care users, in a population of frail, older people in the Netherlands.


We used data from a 2-year clinical trial.


frail, older people who received home care. Data were collected at baseline (n = 600) and 24-month measurements (n = 389); retest data (n = 67) were collected 7-14 days after the 24-month measurements.


We performed confirmatory factor analysis, investigated reliability and validity parameters and assessed acceptability.


The factor analysis yielded a bifactor model with essential unidimensionality. Internal consistency was high (omega total .88). We found a test-retest reliability of total test scores of .81; the standard error of measurement was 2.61 (total score range 15-75) and the limits of agreement were -7.03 and 7.86. We rejected three out of four hypotheses for construct validity.


The CCCQ is sufficiently unidimensional to permit the use of total test scores. We found acceptable reliability values, but considered our results on construct validity inconclusive. Respondents found the CCCQ questions challenging to answer, which is indicative of a high degree of respondent burden. Future instruments that measure client-centeredness of home care from the frail, older client's perspective should therefore be tailored to the specific circumstances of this population.

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