Equity-Oriented Health Care Scale

Information and Permissions

Primary health care is a critical context for addressing issues of equity as they are experienced within the everyday lives of patients when they seek health care. Yet, limited attention has been given to defining what constitutes equity-oriented health care from the perspective of patients, or to developing appropriate and valid ways of measuring such care.

Drawing on a conceptualization of equity-oriented primary health care (Browne, Varcoe, Ford-Gilboe, & Wathen, 2015; Browne et al., 2018; Ford-Gilboe et al., 2018), we used conventional scale development approaches combined with item response theory (IRT) to develop and evaluate the psychometric properties of a brief patient self-report measure of equity-oriented health care (EOHC), called the Equity-oriented Health Care Scale (EHoCS). We adopted a balanced approach that emphasized a combination of precision, theoretical integrity and practical relevance.

Format and Scoring of the 12-item EHoCS:

The EHoCS is comprised of 12 items that reflect 5 domains of EOHC (see document attached). Respondents are asked to rate, in the previous 12 months, the extent to which their interactions with health care staff were equity-oriented on a 5-point scale ranging from never (0) to always (4).

The EHoCS total score is a count of the number of items rated by patients as “always” occurring (for 10 positively worded items) and “never” occurring (for 2 negatively worded items), with a range of 0 to 12. Scores on the EHoCS provide an index of the degree or level of equity‐oriented health care, from lower to higher. Total scores correlated with measures of overall quality of care (r= .602) and fit of care with needs (r = .599), providing evidence of concurrent validity.

Although developed in a primary health care context, the EHoCS may be appropriate in other health care contexts (such as in community health). With further adaptation and testing, it may also be useful in settings with more episodic approaches to care, or in other sectors (e.g. social services).

Permissions Process:

The EHoCS is freely available and downloadable here. We ask that you send us a brief email (equip.healthcare@ubc.ca) informing us of the purpose and setting in which you are considering using the EHoCS. We are using this information to track how the EHoCS is being used, whether the scale is reliable and valid in these contexts, and any lessons related to the content or format (e.g., difficulties in administration).

If you are willing to share basic information with us about how the scale performed in your study (i.e., descriptive statistics for the items, subscale and total scores, reliabilities), we will add this to our records so that others can benefit from your work. We would appreciate it if you could send this information to us when your study has been completed.

References

1. Browne, A. J., Varcoe, C., Ford-Gilboe, M., & Wathen, C. N., on behalf of the EQUIP Research Team (2015). EQUIP Healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings. Int J Equity Health, 14(152). doi:10.1186/s12939-015-0271-y
2. Browne, A. J., Varcoe, C., Ford-Gilboe, M., Wathen, C. N., Smye, V., Jackson, B. E., . . . Blanchet Garneau, A. (2018). Disruption as opportunity: Impacts of an organizational health equity intervention in primary care clinics. International Journal for Equity in Health, 17(1), 154. doi:10.1186/s12939-018-0820-2
3. Ford-Gilboe, M., Wathen, C. N., Varcoe, C., Herbert, C., Jackson, B. E., Lavoie, J. G., . . . Browne, A. J. (2018). How equity-oriented health care affects health: Key mechanisms and implications for primary health care practice and policy. Milbank Quarterly, 96(4), 635-671. doi:10.1111/1468-0009.12349