Table 5

Subjects’ interpretations on individual item, suggested rewording and investigators’ follow-up actions

Item (synopsis)	Subjects’ interpretation of items, suggested rewording and follow-up actions
1 (accessibility)	Subjects understood the item and most of them correlated it with geographical accessibility, the phone booking system and the professional services provided.
2 (comprehensiveness)	All subjects understood the item and correlated it with the context in ‘general practice’.
3 (integration)	All subjects understood the item. They correlated the ‘factors affecting their health’ to a broad range of contexts including their symptoms, medical records, the investigations needed, complications of diseases, well-being on the whole, psychological factors, habits, drug usage and diet pattern and so on.
4 (coordination)	Most subjects showed understanding to it. They commonly linked the item to making referrals to other specialties or allied health services. Some correlated it with services suggested elsewhere (for example, wound dressing initiated by the emergency department).
5 (knows my needs in all aspects; relationship)	In the first round of interviews (n=9), subjects interpreted the meaning of ‘understands me well’ quite diversely. Their interpretations included understanding his or her medical background, habits, diet pattern, drug allergies and so on. After reworded to ‘knows me as a person holistically’ in the second round (n=5), the subjects thought that ‘holistic’ was too general to be real in their experience. Further deliberation of the item was made among the local and US investigators. The item was subsequently rephrased as ‘knows my needs in all aspects’. No more question was raised in the clarity and understanding of the item in the third (n=3) and fourth (n=3) rounds of interviews. However, some subjects suggested changing the words ‘This doctor or practice’ to ‘The doctors of this practice’ as they might not be seeing the same doctor every time. The investigators decided there was no need to further change the translation.
6 (continuity)	Most of the subjects thought it was not their experience with the doctors in this clinic. The main reason was that they might not be seeing the same doctor every time. One subject appreciated this question as focusing on chronic diseases management by the same doctor. The investigators concluded that we should keep the translation unchanged.
7 (advocacy)	Most subjects suggested that it should be made more specific in ‘stands up for me’ in which aspect. They suggested fields like ‘confidentiality’, ‘the right to receive medical care’, ‘putting patients’ benefits first’ and so on. However, the investigators concluded we should keep the original translation to avoid narrowing down too much and running the risk of losing those important functions of primary care services in the subjects’ notions.
8 (family context)	All subjects showed understanding to this item. However, many of them found it was not applicable to their situations. A subject suggested adding a response option of ‘Not Applicable’ to the answers. The investigators concluded that we should keep the translation and response options unchanged.
9 (community context)	Two subjects commented that the item was slightly unclear. Some of the subjects interpreted it as ‘knowledge of the community resources available’ while some others interpreted it as ‘the general health or socio-economic condition of the community’. A few of them thought that the knowledge of the community was irrelevant to them. A subject suggested adding a response option of ‘Not Applicable’ to the answers. The investigators decided to keep the translation and response options unchanged because the problem actually stemmed from lack of experience by the subjects to the item.
10 (goal-oriented care)	Majority of the subjects commented that the word ‘goals’ was not specific. They usually interpreted that as ‘health-related’ goals and suggested adding these words to make the meaning more explicit. In the original English PCPCM, the ‘goals’ actually refer to goals in a larger context. After thorough discussion among the investigators, we agreed that it was justifiable to add ‘health-related’ to make the ‘goals’ more comprehensible in the Chinese patients’ context.
11 (health promotion)	All subjects commented this item was clear.
How many years have you known this doctor?	All subjects commented this item was clear.
Response options	18 out of 20 subjects commented the response options were clear and selectable. Two subjects found the response options being unclear in the distinction between ‘mostly’ and ‘somewhat’. Both of them suggested that the response could be changed to a percentage scale to indicate the degree of agreement with the item instead of using categorical options. A few subjects made further suggestions to the response options despite agreeing that the current choices were acceptable: One subject suggested that the response options should be reworded as ‘very satisfied’, ‘satisfied’, ‘dissatisfied’ and ‘very dissatisfied’. One subject commented there should be an additional ‘neutral’ option to make the negative and positive options more balanced. Two subjects commented that for item eight and item nine, an option of ‘not applicable’ could be added. The investigators concluded that the response options need not be changed.