Initial conceptual development of a pilot questionnaire for patient-perceived clinical inertia in chronic disease...

Clinical inertia has traditionally been conceptualized as a physician-centred phenomenon; however, in chronic disease management, it may also be influenced by patient-related factors and structural constraints within healthcare systems, particularly in resource-constrained settings.

To describe the initial conceptual development of a pilot questionnaire intended to explore patient-perceived clinical inertia in chronic disease management and to report its exploratory pilot-stage performance in terms of content validity, preliminary internal consistency, descriptive item behavior, and preliminary item-grouping patterns.

A quantitative, cross-sectional, exploratory pilot study was conducted using an online questionnaire disseminated through academic networks and social media in a predominantly Peruvian sample recruited online, with additional responses from other Latin American countries. The questionnaire assessed domains related to medical follow-up, patient knowledge, personal barriers, patient-doctor relationship, and healthcare system barriers. A total of 74 responses were collected, of which 51 complete responses were included. Content validity was examined using Aiken's V, preliminary internal consistency using Cronbach's alpha and McDonald's omega, and exploratory factor analysis was retained only as a preliminary descriptive item-grouping procedure.

The questionnaire showed high content validity based on expert judgment. In this pilot sample, retained dimensions showed preliminary internal consistency estimates within acceptable ranges, whereas the knowledge items showed low reliability and were excluded from the preliminary item-grouping analysis. The preliminary item-grouping analysis showed a tentative four-factor pattern that should be interpreted only as descriptive information for questionnaire refinement. Participants reported perceived delays in treatment adjustment, limited access to medications, prolonged waiting times for specialist care, and administrative barriers affecting continuity of care.

This exploratory pilot study provides initial evidence to inform further refinement of a questionnaire for patient-perceived clinical inertia. The findings should not be interpreted as population-level evidence or as confirmation of structural validity. Future versions should incorporate additional domains related to patient reluctance to treatment change, socioeconomic barriers, polypharmacy, treatment implementation, adverse-effect monitoring, and longitudinal follow-up. Because the sample was small, highly educated, recruited online, and predominantly composed of participants receiving care in Peru, the findings should not be generalized to Latin America or to chronic disease populations more broadly.