Localise, test, and prove singapore fit

Most available PREMs were developed in North America or Europe and may not fit Singapore without more than simple translation. PREM-SG was built to create a brief, generic measure for Singaporean chronic-disease patients while retaining internationally meaningful experience domains.

PREM-SG has 13 items, adapted from GS-PEQ and PEQ-GP or newly drafted to cover PaRIS domains. It was tested in a nationwide household survey of 1,462 Singapore citizens and permanent residents aged 45 years and over with at least one of 16 common chronic conditions. Participants rated their regular or most-visited provider, or one provider visited in the past 12 months, in English, Chinese, or Malay.

PREM-SG is chiefly a local-adaptation case, not a fair-comparison instrument. Its value is showing how international PREM concepts can be reworked for Singapore's languages, care patterns, and chronic-care context; the authors describe the evidence as preliminary and call for further research on validity and usefulness before wider use.

PREM-SG is an instrument-development study, not a deployed national reporting programme. Its architecture lesson is narrower but valuable: a generic chronic-care PREM can sit on an international conceptual framework while being adapted to local provider relationships and care arrangements.

PREM-SG moves beyond a single visit: it measures an ongoing relationship with one provider for people managing chronic conditions. It therefore sits between journey and pathway measurement, but its organisational boundary remains one selected provider rather than every provider involved in the person's care.

The 13 items were mapped to the PaRIS experience framework: 10 came from GS-PEQ or PEQ-GP, while three were written for appointment access, repeating information, and self-management support.

Question-format caution: this agreement scale is a design choice, not necessarily the best PREM response format. Agreement wording asks people to endorse a statement, whereas observable-care questions can ask what happened. Future refinement should test whether more experience-based response options would be clearer and less prone to agreement bias.

PREM-SG asks people to rate their experience of a regular, most-visited, or recent provider over the past 12 months. That recall period captures an accumulated impression of an ongoing care relationship, but can blur the detail of individual encounters and give greater weight to recent or especially memorable experiences. It is therefore not designed to capture a problem while the person is still receiving care.

Participants could complete the questionnaire on a tablet, with interviewer administration available for people unable to self-complete it. The study does not establish a distinctive digital feedback model; its more useful lesson is that a technology-enabled collection method needs a supported alternative to avoid excluding respondents.

The development process mapped existing Norwegian instruments to PaRIS, adapted and modified items for Singapore, translated the questionnaire into Chinese and Malay, pre-tested the three language versions with 12 eligible participants, and then piloted the revised questionnaire with 30 participants from different language and age groups.

The main study assessed dimensionality, item properties, reliability, construct validity, and measurement invariance. A significant limitation is that patients and providers were not involved in the measure's initial development, so the authors identify comprehensiveness and patient priority as future work.

PREM-SG is at an early refinement stage rather than a mature, continuously revised programme. The study recommends further validation in other patient groups and survey modes, and further assessment of the safety and continuity items.

• The PREM-SG development and preliminary-testing study - original 2025 development and preliminary psychometric-evaluation study used throughout this profile.