Development and Validation of the Primary Care Needs Assessment (PCNA) Questionnaire: A Participatory...

Background/Objectives: Assessing population healthcare needs is essential for effective primary health care (PHC) planning; however, existing approaches often rely on biomedical or service-centered frameworks (i.e., approaches focusing on utilization patterns, clinical indicators, and provider performance metrics) that may not adequately capture the multidimensional and context-dependent nature of health needs. This study aimed to develop and validate the Primary Care Needs Assessment (PCNA) questionnaire, a participatory, multidimensional, and context-sensitive instrument for assessing perceived unmet healthcare needs and contextual determinants of health in community-based PHC settings. Methods: A sequential mixed-methods design was employed. In the qualitative phase, focus groups with PHC professionals and semi-structured interviews with community members informed item generation. The resulting questionnaire was administered to a sample of 817 participants recruited from community and primary care settings. Exploratory factor analysis (EFA) was conducted on a subsample (n = 520), followed by confirmatory factor analysis (CFA) on an independent subsample (n = 297). Internal consistency was assessed using Cronbach's alpha. Results: EFA identified a 10-factor structure explaining 55.05% of the variance. CFA supported a refined 9-factor model with good fit indices (χ²/df = 1.675, RMSEA = 0.048, CFI = 0.92, TLI = 0.90, SRMR = 0.06). The instrument demonstrated satisfactory internal consistency (α = 0.76). Findings also highlighted unmet needs related to mental health, access to specialized services, and structural barriers (e.g., geographic distance, financial cost, limited service availability, and organizational constraints in accessing care), underscoring the multidimensional nature of health needs. Conclusions: The PCNA is a valid and reliable instrument that captures the complex interplay of individual, social, and contextual factors shaping health needs in PHC. By integrating community perspectives with psychometric validation, it provides a practical tool for supporting evidence-informed planning and more responsive, person-centered PHC systems (i.e., systems that adapt service provision to community-identified priorities and evolving population needs).