Development and validation of inventory tool to evaluate social accountability principles in case scenarios used in problem-based curriculum (Social accountability inventory for PBL)

Figures & data

Figure 1. Diagram describing the research methodology and process

Table

I-CVI = No. of agreements/total participants

SCVI/Ave = Average of all I-CVIs

SCVI/UA = Total agreements (from I-CVI)/total items

Table 1. Number and percentage of total agreements (4–5 rating), Draft 1

Question No.	No. of responders	Relevance		Importance		Clarity		Simplicity
		No.	%	No.	%	No.	%	No.	%
1	7	6	86	6	86	3	50	4	67
2	6	6	100	5	100	6	100	5	83
3	6	5	83	5	83	4	100	4	67
4	6	6	100	6	100	6	100	6	100
5	6	6	100	6	100	5	83	5	83
6	6	5	83	5	83	6	100	5	83
7	6	6	100	6	100	4	67	4	67
8	6	5	83	3	50	4	67	3	50
9	6	4	67	3	50	4	67	4	67
10	6	2	33	2	33	2	33	2	33
11	6	6	100	6	100	6	100	4	67
12	6	5	83	6	100	5	83	5	83
13	3	2	67	1	33	2	67	2	67
14	3	2	67	3	100	3	100	2	67
15	3	3	100	3	100	2	67	2	67
16	3	2	67	2	67	2	67	2	67
17	3	2	67	2	67	3	100	2	67
18	3	2	67	2	67	1	33	1	33
19	3	2	67	3	100	1	33	1	33
20	3	2	67	2	67	2	67	2	67
21	3	1	33	2	67	2	67	2	67
22	3	2	67	3	100	2	67	1	33

Table 2. I-CVI indices and the agreement number for each question for the first, second, and final rounds of evaluation

SA Value	Question No.	No. of Agreements			I-CVI
		Draft 1	Draft 2	Final Draft	1^st Time	2^nd Time	3^rd Time
Relevance	1	6	5	5	0.86	1	1
	2	6	5	5	1	1	1
	3	5	3	4	0.83	0.8	0.8
	4	6	5	5	1	1	1
	5	6	5	5	1.00	1	1
	6	5	4	4	0.83	0.8	0.8
	7	6	4	4	1.	0.8	0.8
	8	5	1	R2	0.83	0.2	R2
	9	4	4	5	0.67	1	1
	10	2	R1		0.33	R1
	11	6	5	5	1	1	1
	12	5	5	5	0.83	1	1
Equity	13	2	4	4	0.67	0.8	0.8
	14	2	4	4	0.67	0.8	0.8
	15	3	2	4	1	1	0.8
	16	2	4	4	0.67	0.8	0.8
	17	2	4	4	0.67	0.8	0.8
Cost-Effectiveness	18	2	2	4	0.67	0.4	0.8
	19	2	R1		0.67	R1
	20	2	R1		0.67	R1
Quality	21	1	2	R2	0.33	0.66	R2
	22	2	4	4	0.67	0.8	0.8

R1 = Removed after the first rating. R2 = Removed after the second rating.

Table 3. First, second, and third SCVI/Ave and SCVI/UA indices for the entire inventory

SCVI/Ave			SCVI/UA
1^st Time	2^nd Time	3^rd Time	1^st Time	2^nd Time	3^rd Time
0.79	0.88	0.9	0.37	0.47	0.47

Table

SA Values and values related to the GCSA	Analysis Points	Comment (Answers should contain explanations)
Relevance	To what extent does the problem relevant to the society health concerns?
	What is the evidence of this relevance in the problem scenario?
	What social determinate of health in the country are pointed in the problem scenario?
	What principles of health promotion and Preventive measures are pointed in the scenario?
	What elements of involvement of the society in care and or partnership with stakeholders are pointed in the scenario?
	What Psycho-social issues are pointed in the scenario?
	What Health System issues are pointed in the scenario?
	What element of medical/health professionalism is/are introduced in the scenario?
	Does the problem include discussion of health care in first line of care as a priority intervention in the health system (e.g PHC) Only?
	Does the problem include discussion of healthcare in first line of care as a priority intervention in the health system (e.g PHC) and then Referral?
	Does the problem include discussion of healthcare in Tertiary Level only?
	Does the problem include discussion of Involvement of Family Medicine (Could be NA)?
	Does the problem introduce students to the future role of doctors as a change agent in the health system? Please explain through quotes from the scenario
Equity	The Problem is Addressing which nationality?
	The Problem is Addressing which social Class?
	The Problem is Addressing which age group?
	The Problem is Addressing which gender?
	The Problem is Addressing underserved, disadvantaged or vulnerable population? Please explain through quotes from the scenario
Cost-effectiveness	Does the problem include discussion of cost of care? Please explain through quotes from the scenario
	Does the problem include discussion of cost-effective care? Please explain through quotes from the scenario
	Are alternatives to high cost interventions be considered? Please explain through quotes from the scenario
Quality	Does the problem include discussion of quality of Health Care? Please explain through quotes from the scenario
	Is health care described in the scenario represent a “person-centered healthcare” (Person-centred care is a way of thinking and doing things that sees the people using health and social services as equal partners in planning, developing and monitoring care to make sure it meets their needs.)
	Are services provided by an integrated health care unit ?, compared to different services disseminated throughout several units.

Table

SA Values	Analysis questions
Relevance	1. The problem is relevant to the social health concerns Social health concerns are the identifies major health problems in the community (country) Please check http://www.healthdata.org/united-arab-emirates Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
	2. The problem scenario addresses one or more of the social determinates of health Social Determinants of health are the economic and social conditions and their distribution among the population that influence individual and group differences in health status, such as (income, education, employment, etc. Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
	3. The problems scenario points out the relevant principles of health promotion and preventive measures Health promotion integrates the three dimensions of the WHO health definition: physical, social, and mental dimensions (and often, spiritual health Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
	4. The problem scenario reflects involvement of the society in health care and or partnership with other stakeholders Stakeholders in health include the community, other governmental sectors, NGOs, Insurance sector, etc. Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
	5. The problem scenario integrates the relevant psycho-social issues and not only a disease oriented issues Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
	6. The problem scenario reflects the relevant health system management issues Health System Management: Policies and plans adopted by government and other stakeholders to govern and maintain the health of the communities and individuals e.g.: immunisation policy, referral system, infectious disease notifications, etc. Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
	7. The problem scenario includes the relevant elements of medical/health professionalism Medical professionalism is a belief system about how best to sorganise and deliver health care, which calls on group members to jointly declare (“profess”) what the public and individual patients can expect regarding shared competency standards and ethical values, and to implement trustworthy means to ensure that all medical professionals live up to these promises. Professional responsibilities defined by the charter on professionalism* • Commitment to professional competence • Commitment to honesty with patients • Commitment to patient confidentiality • Commitment to maintaining appropriate relations with patients • Commitment to improving quality of care • Commitment to improving access to care • Commitment to a just distribution of finite resources • Commitment to scientific knowledge • Commitment to maintaining trust by managing conflicts of interest • Commitment to professional responsibilities Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
	8. The problem scenario includes triggers related to health care in the first line of care (primary health) only Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
	9. The problem scenario includes triggers related to referral system in health care Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
	10. The problem scenario confines itself to secondary/tertiary level of care only Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
	11. The problem scenario includes triggers related to the evolving roles of doctors in the health system Health care system is defined broadly, to include health care services, organisations and professionals Evolving role of doctors in the 21^st century Work in teams, work more collaboratively sUtilise resources effectively Patient-centred care, or provide care dedicated to patients Education of patients on limits of resources etc. Advocacy for health care system and primary care Advocacy for physicians and health care staff Work longer hours and increase accessibility for patients Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
	12. The problem scenario includes triggers to highlight the importance of multidisciplinary approach to patient management Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
Equity	13. The problem addresses the nationality of the patient? UAE nationals Non-UAE nationals Not mentioned
	14. The problem addresses the socioeconomic aspect of the patient [NEED DEFINITION OF THESE CLASSES - ROUGH] High-income class Middle-income class Low-income class Not mentioned
	15. The problem addresses the age group Children Youth Middle Age Geriatrics
	16. The problem addresses the gender of the patient Male Female
	17. The problem scenario includes underserved, disadvantaged or vulnerable population Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
Cost-effectiveness	18. The problem scenario includes triggers to discuss health care cost Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
	19. The problem scenario includes triggers related to the discussion of the cost-effectiveness of healthcare Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
	20. The problem scenario discusses alternatives to high-cost intervention Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
Quality	21. The problem scenario includes triggers related to the discussion of the quality in health care WHO definition of quality of care is “the extent to which health care services provided to individuals and patient populations improve desired health outcomes. In order to achieve this, health care must be safe, effective, timely, efficient, equitable and people-centred.” Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree
	22. The problem scenario includes the concept of “person-centered healthcare.” (Person-centred care is a way of thinking and doing things that sees the people using health and social services as equal partners in planning, developing and monitoring care to make sure it meets their needs.) Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree