Can different patient satisfaction survey methods yield consistent results? Comparison of three surveys

Community perceptions matter: a mixed-methods study using local knowledge to define features of success for a community intervention to improve quality of care for children under-5 in Jigawa, Nigeria

OBJECTIVES

In this study, we used the information generated by community members during an intervention design process to understand the features needed for a successful community participatory intervention to improve child health.

DESIGN

We conducted a concurrent mixed-methods study (November 2019-March 2020) to inform the design and evaluation of a community-facility linkage participatory intervention.

SETTING

Kiyawa Local Government Area (Jigawa State, Nigeria)-population of 230 000 (n=425 villages).

PARTICIPANTS

Qualitative data included 12 community conversations with caregivers of children under-5 (men, older and younger women; n=9 per group), 3 focus group discussions (n=10) with ward development committee members and interviews with facility heads (n=3). Quantitative data comprised household surveys (n=3464) with compound heads (n=1803) and women (n=1661).

RESULTS

We analysed qualitative data with thematic network analysis and the surveys with linear regression-results were triangulated in the interpretation phase. Participants identified the following areas of focus: community health education; facility infrastructure, equipment and staff improvements; raising funds to make these changes. Community involvement, cooperation and empowerment were recognised as a strategy to improve child health, and the presence of intermediate bodies (development committees) was deemed important to improve communication and solve problems between community and facility members. The survey showed functional community relations' dynamics, with high levels of internal cohesion (78%), efficacy in solving problems together (79%) and fairness of the local leaders (82%).

CONCLUSIONS

Combining the results from this study and critical theories on successful participation identified community-informed features for a contextually tailored community-facility link intervention. The need to promote a more inclusive approach to future child health interventions was highlighted. In addition to health education campaigns, the relationship between community and healthcare providers needs strengthening, and development committees were identified as an essential feature for successfully linking communities and facilities for child health.

TRIAL REGISTRATION NUMBER

ISRCTN39213655.

Assessment of Level of Patient Satisfaction with Day-Care Surgery: An Observational Study

To assess the level of patient satisfaction with day-care surgery at a tertiary care centre and to find out the different determinants that influence the patient satisfaction. Observational study; Tertiary care hospital in Western India; Patients undergoing Day-care surgery at Dept of ENT from Feb 2018 to Aug 2018; All patients who underwent day-care surgery were given a questionnaire to determine level of satisfaction. On analysis of data according to questions the average score was in the range of 3.5 to 4.22 out of a maximum score of 5. On analysis of data according to domains of patient care the scores ranged from 3.61 to 4.19. Although patients were generally satisfied with the level of care being provided to them there is still scope of improvement.

Impact of a Dental Storybook on Parents' Knowledge of Children's Oral Health: A Randomized Controlled Trial

Purpose

To evaluate the effectiveness of a dental storybook on parents' knowledge about oral health of their children and to assess their perception of its effect in reducing dental anxiety levels among their children, as well as improving their oral health knowledge.

Patients and Methods

This was a two-arm parallel, single-blind, randomized controlled trial (RCT) which was performed at the pediatric dental clinics in the Dental University Hospital, King Saud University, Riyadh, Saudi Arabia. Parents of 88 children (6-8 years old) were included in the present study. Parents and their children were randomly divided into two groups as follows: the intervention group (received the storybook and verbal oral hygiene instructions) and the control group (only received verbal oral hygiene instructions; same information included in the book). Three dental visits, including screening, examination/cleaning and treatment, were provided for each child. In the screening visit, baseline parental oral health knowledge was evaluated for all parents. Afterward, parental oral health knowledge was re-evaluated in the examination visit. In the treatment visit, a parental perception questionnaire was administered to parents following treatment to evaluate their satisfaction regarding the use of the storybook in reducing anxiety levels among their children.

Results

There was a significant improvement in the total knowledge score at the follow-up visit in the intervention group compared to the control group (P<0.0001). Overall, the majority of parents perceived the storybook as a useful source of information, and they found it to be effective in reducing dental anxiety levels among their children.

Conclusion

The dental storybook is an effective educational tool that can help parents become more knowledgeable about their children's oral health. Moreover, parents perceived the storybook as an effective tool for enhancing their oral health knowledge and lowering their children's dental anxiety.

What sort of medical care is ideal? Differences in thoughts on medical care among residents of urban and rural/remote Japanese communities

Studies of aspirational ideals of medical care generally focus on patients rather than on ordinary people receiving or not receiving medications at the time of interview. The literature has not accurately conveyed the distinct ideals in individual communities or undertaken inter-regional comparisons. This current qualitative study focused on ideal medical care as perceived by residents of distinct Japanese communities in their everyday lives. Between December 2011 and November 2012, one-on-one and group-based semi-structured interviews were conducted with 105 individuals, each of whom had continuously lived for 20 years or more in one of the four types of communities classified as either 'metropolitan area', 'provincial city', 'mountain/fishing village' or 'remote island' in Japan. Interviews were transcribed from digital audio recordings and then analysed (in tandem with non-verbal data including participants' appearances, attitudes and interview atmospheres) using constructivist grounded theory, in which we could get the voice and mind of the participant concerning ideal medical care. The common themes observed among the four community types included 'peace of mind because of the availability of medical care' and 'trust in medical professionals'. Themes that were characteristic of urban communities were the tendency to focus on the content of medical care, including 'high-level medical care', 'elimination of unnecessary medical care' and 'faster, cheaper medical care', whereas those that were characteristic of rural communities were the tendency to focus on lifestyle-oriented medical care such as 'support for local lifestyles', 'locally appropriate standards of medical care' and 'being free from dependence on medical care'. The sense of ideal medical care in urban communities tended to centre around the satisfaction with the content of medical care, whereas that in rural communities tended to centre around the ability to lead a secure life. By considering medical care from the geographical point of view, we found out the significant relationship between communities and perceptions of medical care ideals.

Patient Perceptions of Care as Influenced by a Large Institutional Pharmacogenomic Implementation Program

Despite growing clinical use of genomic information, patient perceptions of genomic-based care are poorly understood. We prospectively studied patient-physician pairs who participated in an institutional pharmacogenomic implementation program. Trust/privacy/empathy/medical decision-making (MDM)/personalized care dimensions were assessed through patient surveys after clinic visits at which physicians had access to preemptive pharmacogenomic results (Likert scale, 1 = minimum/5 = maximum; mean [SD]). From 2012-2015, 1,261 surveys were issued to 507 patients, with 792 (62.8%) returned. Privacy, empathy, MDM, and personalized care scores were significantly higher after visits when physicians considered pharmacogenomic results. Importantly, personalized care scores were significantly higher after physicians used pharmacogenomic information to guide medication changes (4.0 [1.4] vs. 3.0 [1.6]; P < 0.001) compared with prescribing visits without genomic guidance. Multivariable modeling controlling for clinical factors confirmed personalized care scores were more favorable after visits with genomic-influenced prescribing (odds ratio [OR] = 3.26; 95% confidence interval [CI] = (1.31-8.14); P < 0.05). Physicians seem to individualize care when utilizing pharmacogenomic results and this decision-making augmentation is perceived positively by patients.

Validation and adaptation of the hospital consumer assessment of healthcare providers and systems in Arabic context: Evidence from Saudi Arabia

One of the main purposes of healthcare organizations is to serve patients by providing safe and high-quality patient-centered care. Patients are considered the most appropriate source to assess the quality level of healthcare services. The objectives of this paper were to describe the translation and adaptation process of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for Arabic speaking populations, examine the degree of equivalence between the original English version and the Arabic translated version, and estimate and report the validity and reliability of the translated Arabic HCAHPS version. The translation process had four main steps: (1) qualified bilingual translators translated the HCAHPS from English to Arabic; (2) the Arabic version was translated back to English and reviewed by experts to ensure content accuracy (content equivalence); (3) both Arabic and English versions were verified for accuracy and validity of the translation, checking for the similarities and differences (semantic equivalence); (4) finally, two independent bilinguals reviewed and made the final revision of both the Arabic and English versions separately and agreed on one final version that is similar and equivalent to the original English version in terms of content and meaning. The study findings showed that the overall Cronbach's α for the Arabic HCAHPS version was 0.90, showing good internal consistency across the 9 separate domains, which ranged from 0.70 to 0.97 Cronbach's α. The correlation coefficient between each statement for each separate domain revealed a highly positive significant correlation ranging from 0.72 to 0.89. The results of the study show empirical evidence of validity and reliability of HCAHPS in its Arabic version. Moreover, the Arabic version of HCAHPS in our study presented good internal consistency and it is highly recommended to be replicated and applied in the context of other Arab countries.

A pilot study of an emotional intelligence training intervention for a paediatric team

OBJECTIVE

Emotional intelligence (EI) is the individual's ability to perceive, understand and manage emotion and to understand and relate effectively to others. We examined the degree to which EI training may be associated with a change in EI among different medical personnel and patient satisfaction.

DESIGN, SETTING AND PARTICIPANTS

The EI of 17 physicians and 10 nurses in paediatric ward was prospectively evaluated with Bar-On's EI at baseline and after 18 months. 11 physicians who did not undergo the intervention served as controls.

INTERVENTIONS

The intervention consisted of a training programme comprising group discussions, simulations and case studies.

MAIN OUTCOMES AND MEASURES

Pre-emotional quotient inventory (EQ-i) and post-EQ-i scores and patient satisfaction surveys of nurse and physicians pre-intervention and post-intervention were analysed.

RESULTS

The mean overall EI score of the study sample rose from 99.0±9.6 (both plus and minus mathematical operations standing for SD) at baseline to 105.4±10 (p<0.000) after 18 months, with the most robust increase (nearly 6%; p<0.003) manifested among physicians. In contrast, the control group's EI scores did not change over this period. Within the intervention group, physicians displayed a statistically significant increase in three of the five EI dimensions, compared with only one of the five EI dimensions for nurses. Patient satisfaction scores relating to physician care rose from 4.4 pre-intervention to 4.7 post-intervention (p=0.03).

CONCLUSION

An EI intervention led to an overall increase in EI scores, with a significant improvement in patient satisfaction. These findings suggest important potential benefits for both staff and their patients.

Evaluating hospital at home and early discharge schemes for patients with an acute exacerbation of COPD

Hospital at home and early discharge schemes for patients experiencing an acute exacerbation of their chronic obstructive pulmonary disease, appear to be an effective and safe option for selected patients and these services have become increasingly common. Here we discuss the evaluation of such schemes including: the rationale for evaluation; aspects of quality which might be considered for evaluation; the role of evaluation frameworks, quantitative and qualitative evaluation and steps in planning an evaluation.

Western Cape Primary Care Assessment Tool (PCAT) study: Measuring primary care organisation and performance in the Western Cape Province, South Africa (2013)

BACKGROUND

Major health sector reform and the need for baseline measures of performance to determine impact.

AIM

Baseline audit of primary healthcare (PHC) performance.

SETTING

Cape Town and Cape Winelands (rural) PHC facilities (PCFs) in Western Cape Province, South Africa.

METHOD

The South African cross-culturally validated ZA PCAT to audit PHC performance on 11 subdomains associated with improved health and reduced costs. Adult PCF users systematically sampled. All full-time doctors and nurse practitioners in PCFs sampled and all PCF managers in sub-districts sampled invited into the study.

RESULTS

Data from 1432 users, 100 clinicians and 64 managers from 13 PCFs in 10 sub-districts analysed (figures show stakeholder percentages scoring subdomain performance 'acceptable to good'). 11.5% users scored access 'acceptable to good'; community orientation and comprehensive services provided 20.8% and 39.9%, respectively. Total PHC score for users 50.2%; for managers and practitioners 82.8% and 88.0%, respectively. Among practitioners access was lowest (33.3%); PHC team (98.0%) and comprehensive services available (100.0%) highest. Among managers, access (13.5%) and family centredness (45.6%) are lowest; PHC team (85.9%) and comprehensive services available (90.6%) highest. Managers scored access, family centredness and cultural competence significantly lower than practitioners. Users scored comprehensive services available, comprehensive services provided and community orientation significantly lower than practitioners and managers.

CONCLUSION

Gaps between users' experience and providers' assessments of PHC performance are identified. Features that need strengthening and alignment with best practice, provincial and national, and health policies are highlighted with implications for practitioner and manager training, health policy, and research.

How to ask about patient satisfaction? The visual analogue scale is less vulnerable to confounding factors and ceiling effect than a symmetric Likert scale

AIMS

To study the effects of scale type (visual analogue scale vs. Likert), item order (systematic vs. random), item non-response and patient-related characteristics (age, gender, subjective health, need for assistance with filling out the questionnaire and length of stay) on the results of patient satisfaction surveys.

BACKGROUND

Although patient satisfaction is one of the most intensely studied issues in the health sciences, research information about the effects of possible instrument-related confounding factors on patient satisfaction surveys is scant.

DESIGN

A quasi-experimental design was employed. A non-randomized sample of 150 surgical patients was gathered to minimize possible alterations in care quality.

METHODS

Data were collected in May-September 2014 from one tertiary hospital in Finland using the Revised Humane Caring Scale instrument. New versions of the instrument were created for the present purposes. In these versions, items were either in a visual analogue format or Likert-scaled, in systematic or random order. The data were analysed using an analysis of covariance and a paired samples t-test.

RESULTS

The visual analogue scale items were less vulnerable to bias from confounding factors than were the Likert-scaled items. The visual analogue scale also avoided the ceiling effect better than Likert and the time needed to complete the visual analogue scale questionnaire was 28% shorter than that needed to complete the Likert-scaled questionnaire.

CONCLUSION

The present results supported the use of visual analogue scale rather than Likert scaling in patient satisfaction surveys and stressed the need to account for as many potential confounding factors as possible.

Meta-analysis: methodological confounders in measuring patient satisfaction

The study aimed to identify methodological confounding factors affecting patient satisfaction survey results. The data gathered from CINAHL and PubMed databases consisted of 355 surveys published from 2006 to 2012. Linear regression and Bayesian models, with seven potential survey-related confounders together with patient age and gender as explanatory variables, were constructed. According to the linear model, up to 12% of the original variation in patient satisfaction was explained by confounding variables, not by the actual variation in satisfaction. The presence of an interviewer resulted in lower satisfaction levels, and the satisfaction results correlated negatively with the number of items in the questionnaire. According to the Bayesian model, if patients were over 60 years old and the questionnaire consisted mainly of positively phrased items, the probability of rating their experiences as very satisfied was 75%. The Bayesian and linear models endorsed each other and revealed specifically that the surveys reporting high patient satisfaction could be predicted on the basis of confounding variables. The following recommendations are given for constructing a patient satisfaction survey: use neutral rather than negatively or positively phrased items, and use enough items to increase the likelihood that the least satisfactory care components are also included in order to better enable comparisons across sporadic surveys.

Perceived patient satisfaction with in-patient services at Jimma University Specialized Hospital, Southwest Ethiopia

Background

Patient satisfaction is an attitude resulting from a person’s general orientation towards a total experience of health care. It is a key determinant and a legitimate measure for quality of care. In developing countries, satisfaction studies were conducted mainly on nursing care and outpatient services.

Objective

This study aims to measure and describe the level of patient satisfaction within inpatient health care services.

Methods

Across sectional study design was conducted from 8 May 2011 to 2 June 2011 at Jimma University Specialized Hospital. Systematic random sampling technique was employed to recruit participants. A standardized structured questionnaire developed by reviewing similar literatures was used to assess the level of patient satisfaction towards the inpatient services. SPSS version 19 statistical packages were used for data management and analysis.

Result

A total of 189 patients participated. The proportion of overall net patient satisfaction was 117 (61.9%). Majority of the respondents 148 (78.3%) reported that they got the kind of service they anticipated. Cleanliness of the ward 145 (76.7%) and time to get back to home 27 (14.3%) were found to have the highest and the lowest proportion of satisfied respondents, respectively. Patients with no formal education 60 (76.9%) and patients from the rural areas 75 (68.8%) were satisfied higher than those from their counterparts. Patients at medical 22 (61.1%) and ophthalmology 10 (62.5%) wards were less satisfied than patients in other departments.

Conclusion

Nearly two third of the patients were found to be satisfied by the service they received from the hospital. Most of the patients found to be dissatisfied with the nursing, pharmacy and laboratory services, while some others were still dissatisfied with the level of health education, communication and information they received about their illness. Therefore, the hospital administration system should best work on new innovative approach to keep and improve the administrative system, waiting time, hospital stay, hospital accommodation, access for medications and laboratory services to bring patient satisfaction. Nurses and physicians should have to work best to improve health education, communication and understanding between doctors/nurses and patients. Hospital reformation and modern hospital administration system could work best to keep and improve the level of patient satisfaction.

Patient-reported outcome measures after endoscopic retrograde cholangiopancreatography: a prospective, multicentre study

OBJECTIVE

While patient-reported outcome measures (PROMs) in ERCP are scarce, these reports are important for making improvements in quality of care. This study sought to document patient satisfaction and specifically pain related to endoscopic retrograde cholangiopancreatography (ERCP) procedures and to identify predictors for these experiences.

METHODS

From 2007 through 2009, prospective data from consecutive ERCP procedures at 11 hospitals during normal daily practice were recorded. Information regarding undesirable events that occurred during a 30-day follow-up period was also reported. The patient-reported pain, discomfort and general satisfaction with the ERCP were recorded.

RESULTS

Data from 2808 ERCP procedures were included in this study. Patient questionnaires were returned for 52.6% of the procedures. Moderate or severe pain was experienced in 15.5% and 14.0% of the procedures during the ERCP and in 10.8% and 7.7% of the procedures after the ERCP, respectively. In addition, female gender, endoscopic sphincterotomy (EST), and longer procedure times served as independent predictors of increased pain during the ERCP. The performing hospitals and sedation regimens were independent predictors of the procedural pain experience. In 90.9% of the procedures, the patients were satisfied with the information overall, and in 98.3% of the procedures, the patients were satisfied with the treatment provided. Independent predictors of dissatisfaction with the treatment included the occurrence of specific complications after ERCP and pain during or after the procedure.

CONCLUSIONS

Female gender, the performance of EST and longer procedure times were independent predictors for increased procedure-related pain. The individual hospital and sedation regimen predicts the patient's pain experience.

An exploratory study of complaints handling and nature

Different countries have different complaints handling systems. This study reveals general pathways to handling complaints that provide an overview at the case hospital as well as a general complaints handling picture in Taiwan. It explores hospital complaints and how hospital staff handle them. A large teaching hospital in Taiwan was purposefully chosen as a case study. Data were collected through in-depth interviews, document analysis and interrogating a 3-year complaints archive. The study found that dissatisfaction with 'humaneness' and 'care/treatment' commonly causes the case hospital patients to complain. Understanding complaint patterns, therefore, can help hospital managers improve organizational performance, which shows that certain service provision needs to be prioritized if hospital staff intend to improve service quality.

Developing a theoretical framework to illustrate associations among patient satisfaction, body image and quality of life for women undergoing breast reconstruction

Within the field of breast reconstruction there is increasing focus on patient-reported outcomes related to satisfaction, body image, and quality of life. These outcomes are deemed highly relevant because the primary goal of breast reconstruction is to recreate the appearance of a breast (or breasts) that is satisfying to the patient. Prominent researchers have suggested the need to develop improved standards for outcome evaluation which can ultimately benefit patients as well as physicians. The purpose of this article is to summarize key findings in the area of patient-reported outcomes for breast reconstruction and introduce a theoretical framework for advancing research in this field. We conducted an extensive literature review of outcome studies for breast reconstruction focusing on patient-reported results. We developed a theoretical framework illustrating core patient-reported outcomes related to breast reconstruction and factors associated with these outcomes. Our theoretical model highlights domains and distinguishing features of patient satisfaction, body image, and quality of life outcomes for women undergoing breast reconstruction. This model further identifies a broad range of variables (e.g., historical/premorbid influences, disease and treatment-related factors) that have been found to influence patient-reported outcomes and need to be taken into consideration when designing future research in this area. Additional attention is given to examining the relationship between patient reported outcomes and outside evaluation of breast reconstruction. Our proposed theoretical framework suggests key opportunities to expand research in this area with the goal of optimizing body image adjustment, satisfaction, and psychosocial outcomes for the individual patient.

Outpatient satisfaction and quality of health care in North Indian medical institute

PURPOSE

Outpatient departments (OPDs) need to monitor the quality of care and patient satisfaction for continuous quality improvement. Additionally, there is a need for an increase in focused literature on patient satisfaction and quality of health care at a tertiary care level. The purpose of this paper is to attempt to fulfil this need.

DESIGN/METHODOLOGY/APPROACH

A cross-sectional hospital-based study among OPD patients was undertaken, where investigators conducted interviews with 120 patients at entry (registration), 120 patients at the OPD clinic (60 doctor-patient interactions and 60 exit interviews), and a further 120 patients at investigation facilities. Patient satisfaction, client convenience facilities, prescription quality, doctor-patient interaction and other quality elements as described in the study were given score of 0 or 1.

FINDINGS

At exit, 52 (86.6 percent) patients were satisfied with the OPD care. The mean total quality score was 80.9 percent of the total scores. It was above 90 percent of the total score for patient convenience facilities and for doctor-patient interaction, 76 percent for the prescription quality of the doctors and 43.3 percent for signage display. The mean score for patient-doctor interaction was found to be significantly lower (3.6/5) among dissatisfied patients compared to the satisfied patients (4.7/5). Satisfied patients reported a significantly higher consultation time (12.4 minutes) with a doctor compared to dissatisfied patients (8.5 minutes) (p = 0.04).

RESEARCH LIMITATIONS/IMPLICATIONS

Not using a Likert scale to measure patient satisfaction could be considered a limitation However, the authors also arrived at similar conclusions with their tools as with the use of Likert scales in other studies. Furthermore, findings are limited to medicine and surgery general OPDs in a tertiary care setting. Any interpretation beyond this frame may be done with caution.

PRACTICAL IMPLICATIONS

Hospitals should encourage good patient-doctor interaction as it has emerged as the key factor associated with patient satisfaction.

SOCIAL IMPLICATIONS

Quality improvements in public sector health institutes can lead to better utilization of health care by the poor and compromised sections of society and can lead to a reduction in the inequity associated with health care.

ORIGINALITY/VALUE

This paper fulfils the need to evaluate quality of hospital care in public sector hospitals at the tertiary care level. The methods and tools used are simple and extensive enough to capture information at multiple service points.

Cross-cultural evaluation of the relevance of the HCAHPS survey in five European countries

OBJECTIVE

To describe the systematic language translation and cross-cultural evaluation process that assessed the relevance of the Hospital Consumer Assessment of Healthcare Providers and Systems survey in five European countries prior to national data collection efforts.

DESIGN

An approach involving a systematic translation process, expert review by experienced researchers and a review by 'patient' experts involving the use of content validity indexing techniques with chance correction.

SETTING

Five European countries where Dutch, Finnish, French, German, Greek, Italian and Polish are spoken.

PARTICIPANTS

'Patient' experts who had recently experienced a hospitalization in the participating country. Main OutcomeMeasure(s) Content validity indexing with chance correction adjustment providing a quantifiable measure that evaluates the conceptual, contextual, content, semantic and technical equivalence of the instrument in relationship to the patient care experience.

RESULTS

All translations except two received 'excellent' ratings and no significant differences existed between scores for languages spoken in more than one country. Patient raters across all countries expressed different concerns about some of the demographic questions and their relevance for evaluating patient satisfaction. Removing demographic questions from the evaluation produced a significant improvement in the scale-level scores (P= .018). The cross-cultural evaluation process suggested that translations and content of the patient satisfaction survey were relevant across countries and languages.

CONCLUSIONS

The Hospital Consumer Assessment of Healthcare Providers and Systems survey is relevant to some European hospital systems and has the potential to produce internationally comparable patient satisfaction scores.

Patient-doctor depth-of-relationship scale: development and validation

PURPOSE Because patient-doctor continuity has been measured in its longitudinal rather than its personal dimension, evidence to show that seeing the same doctor leads to better patient care is weak. Existing relational measures of patient-doctor continuity are limited, so we developed a new patient self-completion instrument designed to specifically measure patient-doctor depth of relationship. METHODS Draft versions of the questionnaire were tested with patients in face-to-face interviews and 2 rounds of pilot testing. The final instrument was completed by patients attending routine appointments with their general practitioner, and some were sent a follow-up questionnaire. Scale structure, validity, and reliability were assessed. RESULTS Face validity of candidate items was confirmed in interviews with 11 patients. Data from the pilot rounds 1 (n = 375) and 2 (n = 154) were used to refine and shorten the questionnaire. The final instrument comprised a single scale of 8 items and had good internal reliability (Cronbach's α = .93). In the main study (N = 490), seeing the same doctor was associated with deep patient-doctor relationships, but the relationship appeared to be nonlinear (overall adjusted odds ratio = 1.5; 95% CI, 1.2-1.8). Test-retest reliability in a sample of participants (n = 154) was good (intracluster correlation coefficient 0.87; 95% CI, 0.53-0.97). CONCLUSIONS The Patient-Doctor Depth-of-Relationship Scale is a novel, conceptually grounded questionnaire that is easy for patients to complete and is psychometrically robust. Future research will further establish its validity and answer whether patient-doctor depth of relationship is associated with improved patient care.

Patient satisfaction with breast cancer follow-up care provided by family physicians

PURPOSE

There is little evidence to document patient satisfaction with follow-up care provided by family physicians (FPs)/general practitioners (GPs) to breast cancer patients. We aimed to identify determinants of satisfaction with such care in low-income, medically underserved women with breast cancer.

METHODS

This was a cross-sectional study of 145 women who reported receiving follow-up care from an FP/GP. Women were enrolled in California's Breast and Cervical Cancer Treatment Program and were interviewed by phone 3 years after their breast cancer diagnosis. Cleary and McNeil's model, which states that patient satisfaction is a function of patient characteristics, structure of care, and processes of care, was used to understand the determinants of satisfaction. Stepwise logistic regression was used to identify significant predictors.

RESULTS

Of the patients interviewed, 73.4% reported that they were extremely satisfied with their treatment by the FP/GP. Women who were able to ask their family physicians questions about their breast cancer had six times greater odds of being extremely satisfied compared with women who were not able to ask any questions. Women who scored the FP higher on the ability to explain things in a way she could understand had higher odds of being extremely satisfied compared with women who scored their family physicians lower.

CONCLUSIONS

FPs/GPs providing follow-up care for breast cancer patients should encourage patients to ask questions and must communicate in a way that patients understand. These recommendations are congruent with the characteristics of patient-centered communication for cancer patients enunciated in a recent National Cancer Institute monograph.

Perceived quality of healthcare delivery in a rural district of ghana

OBJECTIVE

The study aimed at finding out clients' perceptions of the quality of healthcare delivery at the district level in rural Ghana, using the Komenda-Edina-Eguafo-Abrem District as a case study.

DESIGN

803 patients were purposively selected and interviewed after visits to health facilities using a pretested questionnaire, while focus group discussions were held in 13 communities. The study was done between October 2003 and August 2004.

RESULTS

The majority of respondents (70%) were females. The mean expected maximum waiting time for seeking medical help was 1 hr. About 98% said they were asked to explain their problem. However, lower proportions, 74%, 43% and 46% were physically examined, told what was wrong, or given advice about their illness, respectively. About 90% of the respondents were satisfied or very satisfied with the care given during their visit to the health facility. The participants perceived poor attitude of some health workers, long waiting times, high cost of services, inadequate staff, policy of payment for health services, frequent referrals to hospitals, and lack of ambulances at facilities as being detrimental to effective delivery of quality healthcare.

CONCLUSIONS

The study found that generally the quality of healthcare delivery was perceived to be high for most of the indicators used. There were, however, some concerns that patients were not told the diagnosis or informed about the management of their illness. These need to be addressed. The level of satisfaction with quality of healthcare was high.

Patient satisfaction with birthing center nursing care and factors associated with likelihood to recommend institution

This study analyzed data from an existing hospital birthing center patient satisfaction survey to determine which care factors were most important to patients and correlated with the likelihood to recommend the facility to others. Three dimensions of care emerged--wait time, communication, and service. Patients gave lower scores for satisfaction if they waited longer than expected for a call light response: 40% of patients expected to wait 4 minutes or less for a response. Discussing with patients realistic wait times for call light responses may be a way to improve patient satisfaction.

HEALTH SERVICES RESEARCH METHODS IN PHARMACY: Triangulation

There are many examples of studies in which pharmacy practice researchers have combined different types of data, methods and approaches within a single research project. Although a common practice in research across many disciplines, concerns have been expressed over combining methods underpinned by different philosophical assumptions and conceptual frameworks. The choice of methods made by pharmacy researchers is generally governed by practical considerations of the research and data requirements for fulfilling research objectives rather than these theoretical concerns. This review of the pharmacy practice research literature demonstrates how a wide variety of methods have been combined for different purposes and in a variety of study designs.

Are consumer surveys valuable as a service improvement tool in health services? A critical appraisal

PURPOSE

In the recent climate of consumerism and consumer focused care, health and social care needs to be more responsive than ever before. Consumer needs and preferences can be elicited with accepted validity and reliability only by strict methodological control, customerisation of the questionnaire and skilled interpretation. To construct, conduct, interpret and implement improved service provision, requires a trained work force and infrastructure. This article aims to appraise various aspects of consumer surveys and to assess their value as effective service improvement tools.

DESIGN/METHODOLOGY/APPROACH

The customer is the sole reason organisations exist. Consumer surveys are used worldwide as service and quality of care improvement tools by all types of service providers including health service providers. The article critically appraises the value of consumer surveys as service improvement tools in health services tool and its future applications.

FINDINGS

No one type of survey is the best or ideal. The key is the selection of the correct survey methodology, unique and customised for the particular type/aspect of care being evaluated. The method used should reflect the importance of the information required.

RESEARCH LIMITATIONS/IMPLICATIONS

Methodological rigor is essential for the effectiveness of consumer surveys as service improvement tools. Unfortunately so far there is no universal consensus on superiority of one particular methodology over another or any benefit of one specific methodology in a given situation. More training and some dedicated resource allocation is required to develop consumer surveys. More research is needed to develop specific survey methodology and evaluation techniques for improved validity and reliability of the surveys as service improvement tools. Measurement of consumer preferences/priorities, evaluation of services and key performance scores, is not easy.

PRACTICAL IMPLICATIONS

Consumer surveys seem impressive tools as they provide the customer a voice for change or modification. However, from a scientific point-of-view their credibility in service improvement in terms of reproducibility, reliability and validity, has remained debatable.

ORIGINALITY/VALUE

This artcile is a critical appraisal of the value of consumer surveys as a service improvement tool in health services--a lesson which needs to be learnt.

Developing and implementing a survey to determine employer satisfaction with care provided to injured workers

satisfaction surveys have become the primary means of evaluating perceptions of quality in the health care industry, including occupational health services. In occupational health, nurses need to know not only it injured workers are satisfied with their case, but also if injured workers' employers believe heath care provided to their workers was satisfactory. One problem is the lack of published surveys addressing issues relevant to occupational health services. the authors describe how a satisfaction was developed to understand employers' satisfaction with the case provided to injured workers. The theory of Self-Administered Questionnaire Design, a previously used survey, and in put from-multiple sources were used to develop the survey tool.

Reducing the rate of unregistered studies

The aim of this audit cycle is to measure the extent to which unregistered or wrongly classified studies (research, clinical audit, satisfaction surveys/service evaluations) are conducted within a National Health Service (NHS) Trust, and to ascertain whether promotion of the correct processes can improve the results. An anonymous questionnaire was sent to staff in a single NHS Trust via internal post and email concerning unregistered or wrongly classified studies being conducted. An information sheet was attached to the questionnaire, which gave a brief description and information relating to conducting different types of study. The audit was conducted before and after the introduction of a variety of promotional activities within the Research and Development (R&D) department. The percentage of unregistered research was shown to be 45.8% in audit 1, with audit 2 showing a reduction in unregistered studies to 5.2% ( P = 0.005). For clinical audits the results were similar between audits (with no additional promotion) (2.3–2.4%). Satisfaction surveys which were included in the promotion of the research department reduced its level of unregistered studies from 46% to 5% ( P = 0.0084). With the targeted and persistent promotion of the relevant departments a dramatic reduction in unregistered studies can be achieved ( P = 0.01).

Patient satisfaction after endoscopic retrograde cholangiopancreatography for biliary stones: a prospective multicenter study in Lombardy

AIMS

To measure patients' satisfaction after endoscopic retrograde cholangiopancreatography (ERCP) for biliary stones in a large number of unselected endoscopy units.

METHODS

A prospective study using a questionnaire (Group Health Association of America-9 [GHAA-9], modified) was administered 24 h and 30 days after the procedure. Patients undergoing endoscopy for biliary stones for the first time were enrolled in a large number of endoscopy units, regardless of their size and workload.

RESULTS

In all, 700 patients were enrolled in 15 units. A high proportion of patients expressed satisfaction (80%). Satisfaction was less extensive for pain control and the quality of information provided before the procedure. There were no differences in the replies to questionnaires at 24 h and 30 days.

CONCLUSION

It is feasible to record patients' satisfaction and in this series most patients were very satisfied. Criticisms concerned pain control and explanations provided before the procedure.

Can clinicians benefit from patient satisfaction surveys? Evaluating the NSF for Older People, 2005-2006

BACKGROUND

A transformation of healthcare is underway, from a sellers' market to a consumers' market, where the satisfaction of the patient's needs is part of the definition of quality. Patient satisfaction surveys are widely used to judge service quality, but clinicians are sceptical about them because they are too often poorly designed measures that do not lead to improvements in the quality of care.

AIM

To explore the use of patient satisfaction survey data in identifying problems with the provision of inpatient care for older people.

METHODS

A case study using secondary analysis of postal survey data about older people's experiences of health and social care services, obtained during the evaluation of the National Service Framework for Older People in 2005-2006. The survey asked about experiences of inpatient care and of discharge from hospital, and sought perceptions of the avoidability of the admission.

SETTINGS AND PARTICIPANTS

A total of 4170 people aged 50 years and over returned a postal questionnaire in six local authority areas of England. Responses from 584 who had experienced a recent overnight stay in hospital are reported and discussed.

FINDINGS

The response rate was 35%, ranging from 26% to 44% in the six areas surveyed. The great majority of those who had recent direct experience of inpatient care reported that they had been engaged in decision-making, that staff promoted their independence and maintained their dignity. There were widespread examples, however, of the opposite experiences. Discharge from hospital was problematic for about one-third of survey respondents with this experience, and there were different accounts of poorly managed discharges from all areas.

CONCLUSIONS

Case studies using local survey data can be used as formative assessments of services. The response rate to the survey and the likelihood of responder bias mean that patient satisfaction survey data of this sort cannot be used to judge or compare services in a summative way, but can highlight areas where remedial action is needed. Small-scale local surveys may seem to lack the robustness of larger studies, but do identify similar areas of concern. Commissioners and clinicians could use the findings of such surveys to inform dialogues about the quality of hospital care for older people.

Parental experiences of the newborn hearing screening programme in Wales: a postal questionnaire survey

OBJECTIVES

To evaluate parental experiences and satisfaction with Newborn Hearing Screening Wales, which was set up over 18 months in 2003-04 to provide an all-Wales neonatal hearing screening programme.

METHODS

A postal questionnaire was developed and piloted, then distributed to mothers of babies who had recently been screened.

RESULTS

General satisfaction levels were high. Women were less satisfied with the information provided than with staff or the test itself. Women whose babies had had no clear responses on initial screening were significantly more likely to feel that the test upset their baby (P<0.05) and that there were things they were unhappy with about the screening programme (P<0.01). These women also reported significantly more anxiety after screening than women whose babies had clear initial responses (P<0.01).

CONCLUSIONS

The survey results provide a baseline against which future user satisfaction surveys of neonatal hearing screening programmes can be evaluated. They highlight significant differences in user satisfaction between those whose babies had clear responses on initial screening and those who did not, and point to areas where improvement may be possible.

Balancing patient preferences and clinical needs: community versus hospital based care for patients with suspected DVT

OBJECTIVE

To establish patients' preferences and willingness to pay (WTP) for different service models for suspected deep vein thrombosis (DVT).

METHODS

We analysed patient responses to a discrete choice experiment (DCE) questionnaire which had been targeted at patients in Leicester, UK. The questionnaire elicited preferences/WTP for attributes of DVT provision including speed of diagnosis; access; continuity of care; and minimizing hospital visits. Additionally we evaluated trade-offs between clinical and service attributes. We analysed responses from 256 patients with suspected DVT (65% response rate).

RESULTS

Respondents are WTP pound 4.82 per extra hour of dedicated DVT service provision; pound 17.12 per hospital visit avoided; pound 115.73 per day's reduction in diagnostic wait; and pound 179.32 for 'much' not 'some' continuity, or pound 56.88 for 'some' not 'lack' of continuity in nursing.

CONCLUSIONS

Research evaluating different DVT service models usually reports on clinical efficacy in centres of excellence. Results show prompt diagnosis is valued by patients and may improve efficacy by reducing unnecessary anticoagulation. However, patients value 'process' measures such as continuity of care also. To ensure optimal provision, clinical benefit measurement ought to be augmented with information on patients' preferences.

Dental care utilization and satisfaction of residential university students

AIM

The objective of this study was to provide information on the level of utilization and satisfaction of residential university students with the dental services provided by the dental clinic of a teaching hospital. VOLUNTEERS AND MATERIAL: A stratified sampling technique was used to recruit volunteers from the outpatient clinic of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Information was collected by a self-administered questionnaire composed of questions that measure the level of utilization and satisfaction with the dental services provided. Questionnaires were provided to 650 randomly chosen students residing in the University hostels. There were 39 refusals, and 6 incomplete questionnaires were discarded. This left a sample size of 605 volunteers.

RESULTS

Forty seven students (7.8%) indicated that they visited the dental hospital within the last 12 months. Males and females utilized the dental services equally, and utilization increased with age and the number of years spent on campus. Anticipation of painful dental treatment, high dental charges, long waiting times and being too busy for a dental visit were cited as the most important impediments to seeking dental treatment. Females expressed greater satisfaction with the services.

CONCLUSION

Dental service utilization among the students was found to be low. Oral health awareness campaigns, improving the quality of the services, and shortening the waiting time are expected to increase service utilization and satisfaction.

Does it matter whether the recipient of patient questionnaires in general practice is the general practitioner or an independent researcher? The REPLY randomised trial

Background

Self-administered questionnaires are becoming increasingly common in general practice. Much research has explored methods to increase response rates but comparatively few studies have explored the effect of questionnaire administration on reported answers.

Methods

The aim of this study was to determine the effect on responses of returning patient questionnaires to the respondents' medical practice or an independent researcher to questions relating to adherence and satisfaction with a GP consultation. One medical practice in Waveney primary care trust, Suffolk, England participated in this randomised trial. Patients over 18 years initiated on a new long-term medication during a consultation with a GP were randomly allocated to return a survey from their medical practice to either their medical practice or an independent researcher. The main outcome measures were self reported adherence, satisfaction with information about the newly prescribed medicine, the consultation and involvement in discussions.

Results

274 (47%) patients responded to the questionnaire (45% medical practice, 48% independent researcher (95% CI -5 to 11%, p = 0.46)) and the groups appeared demographically comparable, although the high level of non-response limits the ability to assess this. There were no significant differences between the groups with respect to total adherence or any of the satisfaction scales. Five (4%) patients reported altering doses of medication in the medical practice group compared with 18 (13%) in the researcher group (P = 0.009, Fisher's exact test). More patients in the medical practice group reported difficulties using their medication compared to the researcher group (46 (35%) v 30 (21%); p = 0.015, Fisher's exact test).

Conclusion

Postal satisfaction questionnaires do not appear to be affected by whether they are returned to the patient's own medical practice or an independent researcher. However, returning postal questionnaires relating to detailed patient behaviours may be subject to response biases and further work is needed to explore this phenomena.

Do patients' comfort levels and attitudes regarding medical student involvement vary across specialties?

BACKGROUND

Studies on patient comfort with medical student involvement have been conducted within several specialties and have consistently reported positive results. However, it is unknown whether the intrinsic differences between specialties may influence the degree to which patients are comfortable with student involvement in their care.

AIM

This is the first study to investigate whether patient comfort varies across specialties.

METHODS

A total of 625 patients were surveyed in teaching clinics in Family Medicine, Obstetrics/Gynaecology, Urology, General Surgery, and Paediatrics. Seven patient attitudes and patients' comfort levels based on student gender, level of training, and type of clinical involvement were assessed.

RESULTS

Patients in all specialties shared similar comfort levels and attitudes regarding medical student involvement for the majority of parameters assessed, suggesting that findings in this area may be generalised between specialties. Most of the inter-specialty variation found pertained to patient preference for student gender and the genitourinary specialties.

CONCLUSION

As there are numerous specialties that have never undergone a similar investigation of their patients, this study has important implications for medical educators in those specialties by supporting their ability to apply the results and recommendations of studies conducted in other specialties to their own.

Direction of wording and responses to items in oral health-related quality of life questionnaires for children and their parents

OBJECTIVES

In order to minimize acquiescence response set bias, it is often recommended that questionnaires measuring attitudes, behaviours or health states contain items worded positively and negatively. It has also been suggested that when measuring health status this approach means that both the negative and positive dimensions of health can be assessed. This study aimed at assessing the performance of negatively and positively worded items in questionnaires to measure child and parent perceptions of child oral health-related quality of life.

METHODS

Both the child and parent questionnaire included four pairs of items, one negatively worded and one positively worded, that assessed eating, appearance, oral self-care and self-confidence. The response format was a five-point Likert frequency scale with a 'Don't know' option. Prior to analysis, the positive items were reverse coded. The relative performance of the two sets of items was assessed by means of comparisons of the proportions with 'Don't know' responses or missing values, mean item scores and proportions with the two highest frequency codes. Kappa statistics and intraclass correlation coefficients were used to assess the agreement between the negative and reverse-coded positive items and scores and the agreement between child and parent pairs. Factor analysis was used to determine if the two sets of items were measuring the same underlying construct.

RESULTS

The study was completed by 91 Canadian children and 100 parents (91 child-parent pairs) recruited from clinics treating paediatric, orthodontic and oro-facial conditions. The positively worded items elicited substantially more 'Don't know' responses or missing values than the negatively worded items and failed to discriminate between groups. In addition, mean item scores and proportions with the highest frequency codes were substantially larger for reverse-coded positive than negative items. Agreement between pairs of items was slight. Child-parent agreement was substantial for a scale constructed from the negative items but only moderate for the positive items. Factor analysis revealed that the two sets of items loaded onto different factors.

CONCLUSIONS

The performance of the positively worded items was unsatisfactory and their use in oral health-related quality of life indexes, either to reduce response set or assess positive oral health, is at best questionable.

Evaluating multi-dimensional aspects of postnatal hospital care

OBJECTIVES

to investigate women's experiences of postnatal hospital care in relation to four different aspects: (1) interpersonal care; (2) time spent on physical check-ups; (3) time spent on information and support; and (4) time spent on assistance with breast feeding. More specifically, we aimed to establish whether typical clusters of women could be identified, and if so, whether these clusters could be related to specific outcomes of care, to the way in which care is organised, and to the individual's psychological health and socio-demographic background.

DESIGN

longitudinal population-based survey, including three questionnaires completed in early pregnancy, at 2 months and 1 year after birth.

SETTING

all postnatal wards in Sweden.

PARTICIPANTS

women (n=2338) recruited at their first booking visit at 593 antenatal clinics, who responded to questions relating to postnatal hospital care 2 months after birth.

FINDINGS

eight cluster profiles defined by the four aspects of postnatal care were identified. About half of the women were found in clusters that were satisfied with most aspects of care, and half in clusters that were dissatisfied with one aspect or more. Only 32% were very satisfied with all four dimensions. Specific groups of women, such as first-time mothers, migrants, young mothers and those with a short length of stay, were dissatisfied with different assessments of postnatal care. Psychological health in early pregnancy was associated with high ratings of all aspects of care, whereas emergency caesarean section and instrumental vaginal delivery was associated with dissatisfaction with breast feeding support and time spent on health check-ups.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

women's individual appraisal of specific aspects of hospital postnatal care could be grouped into response patterns that were shared by smaller or larger groups. These patterns were related to maternal characteristics, labour outcomes and the way in which care was organised. The multi-faceted approach used in this study provided details about who was dissatisfied with what, and showed that women are not necessarily either satisfied or dissatisfied with care in a general sense. In order to provide individualised care, the carer needs to be aware of these differences.

Older people's satisfaction with intermediate care: a systematic review

Although intermediate care takes a variety of different forms and has developed somewhat differently in different countries, we believe that intermediate-care schemes have enough in common to make it meaningful to examine the relationship between this method of care and the views of older patients receiving either it or its alternatives. This is particularly important as one of the underlying principles of intermediate care is to extend patient choice; furthermore, most intermediate-care services target older people. In this review we examine evidence about whether older people prefer intermediate or hospital care, and what they like and dislike about intermediate care.

Women's satisfaction with intrapartum care - a pattern approach

AIM

This paper is a report of a study to investigate women's satisfaction with intrapartum care along three distinct dimensions simultaneously (interpersonal care, information and involvement in decision-making and physical birth environment) and to describe the characteristics of women with different patterns of satisfaction.

BACKGROUND

Patient satisfaction is an important outcome in the evaluation and development of healthcare services. Studies of satisfaction have often used single global ratings but such ratings may not capture the multidimensionality of care during childbirth.

METHOD

A cluster analytic technique was used to establish a finite set of response patterns. Data were obtained from a longitudinal population-based Swedish survey including 2605 women who completed questionnaires in early pregnancy, and 2 months and 1 year after the birth. Data collection commenced in March 1999 and was completed in April 2002.

RESULTS

Nine different clusters, or patterns of satisfaction/dissatisfaction, were found. Nearly half of the women (47%) were in clusters that were satisfied or very satisfied with at least one dimension of care, 20% in clusters that were fairly satisfied (average), and 33% in less than satisfied clusters. Fifteen per cent were mainly dissatisfied with the physical environment, 8% mainly with interpersonal care, 7% only with information and decision-making and 3% with all dimensions. Women in the different clusters differed statistically significantly in psychological health in early pregnancy, emotional reactions during labour and in labour outcomes, but not in background characteristics.

CONCLUSION

Looking at different dimensions of care instead of a single global measure gave a richer, more diverse, and also a more negative picture of women's experiences of intrapartum care.

Development and testing of a questionnaire to measure patient satisfaction with intermediate care

BACKGROUND

Individual trials have suggested high levels of general patient satisfaction with intermediate care, but this topic has not been examined in detail.

AIMS

To identify the key elements of patient satisfaction with intermediate care, and to see whether these can be validly measured using a questionnaire.

METHOD

A questionnaire was developed on the basis of a literature review and piloting with patients and staff on participating schemes (phase I). In phase II, the questionnaire was tested for validity and reliability in a group of patients recently discharged from two "hospital-at-home" intermediate-care schemes. In phase III, a shortened version of the questionnaire was psychometrically tested in five sites taking part in a national evaluation of intermediate care.

RESULTS

96 patients with an average age of 76.5 years took part in phase II. Test-retest reliability was evaluated by repeating the questionnaire 2 weeks later in a subsample of 42 patients. This was "moderate" (kappa 0.4-0.6) for 12 questions, "fair" (kappa 0.2-0.4) for 6 questions and "poor" (kappa 0.1-0.2) for 5 questions. Scores correlated well with the Client Satisfaction Questionnaire (Spearman's r = 0.75, p<0.001). 843 patients (57% of those eligible) from five intermediate-care schemes took part in phase III. Principal components analysis suggested six factors or subscales: general satisfaction, affective response, cognitive response, timing of discharge, coordination after discharge, and access to pain relief, although the last three factors comprised only one question each. The intraclass correlation coefficients in the first three subscales varied from 0.82 to 0.89. Scores for all subscales differed by scheme, suggesting construct validity. Only one question (on general satisfaction) was found to be redundant.

CONCLUSION

The questionnaire, with some minor amendments to improve performance, could be used as a validated tool for audit and research in intermediate care. An amended version and scoring programme is available from us on request.

Cellulitis and treatment: a qualitative study of experiences

Although cellulitis is usually a relatively mild condition, it is potentially life threatening, often necessitating emergency treatment in either the acute or community care settings. The treatment of cellulitis with antibiotics is well established, with effectiveness generally measured against purely biochemical and clinical outcomes (Cox, 2002). Although important, these outcomes are centred purely on the disease process from the medical perspective and little is known about patients' experiences of cellulitis. This qualitative study explores patients' view on the management of community-acquired cellulitis in the secondary healthcare setting. Data were collected through semi-structured groups and individual telephone interviews. Participants were selected through purposive sampling and the Framework Analysis Technique was used to analyse the data. Three superordinate themes emerged: initial presentation/motivation for seeking help; confidence and satisfaction; anxiety and dissatisfaction. Severe pain was almost universally a cause of distress and flu-like symptoms delayed recognition. Health information and communication was generally poor. Participants largely welcomed a move from inpatient to day-patient or outpatient care provided there was adequate information and support. To meet the diverse needs of cellulitis patients, services must be more flexible and tailored to the needs of the individual. Patients are often not told what they can do to prevent recurrence.

The concept of positive health: a review and commentary on its application in oral health research

Although the concept of positive health has been around for more than 60 years, acceptable measures of this construct have yet to emerge. Potential explanations are that there is no consensus on how it is to be defined and its ambiguous status with respect to medical and socioenvironmental models of health. In this paper we review definitions of positive health, the origins of these definitions, the way the concept of positive outcomes has been used in research on the outcomes of oral and orofacial conditions and assess whether the concept of positive health has any merit in terms of applied oral health research. This literature reveals many competing and imprecise definitions, many of which are similar to other constructs, such as well-being. Most are lacking empirical referents or indicators. In examining the literature on oral health we found five distinct, although overlapping, ways in which the concept of positive health has been framed: (i) positive health as the absence of negative health states; (ii) positive health as positively worded items; (iii) the positive outcomes of oral health; (iv) positive oral health as a set of psychological and social attributes, and (v) the positive outcomes of chronic conditions such as oro- and craniofacial differences. Each of these ways can be challenged on conceptual or methodological grounds. For example, the states that comprise the upper end of the negative-positive health continuum have not been defined and health states and determinants of health are often confused. Moreover, the meaning of responses to health status questionnaires and the interpretation of accounts of the illness experience is often unclear. Nevertheless, the notion of positive health, irrespective of its merits and public policy implications, provides a context for methodological and theoretical debate that can only serve to enrich theory and practice with respect to measures of health and quality of life and therapeutic interventions at the individual and population.

Patients' satisfaction with the preoperative informed consent procedure: a multicenter questionnaire survey in Switzerland

OBJECTIVE

To assess patients' satisfaction with the preoperative informed consent procedure in obstetrics and gynecology.

PATIENTS AND METHODS

Between March 2001 and April 2002, patients from 11 Swiss hospitals, representing 3 linguistic areas of Switzerland, were given a questionnaire and a standardized operation-specific leaflet and engaged in a structured conversation. The questionnaire and operation-specific leaflet were designed in collaboration with the Swiss Patient Organization, the judiciary service of the Swiss Medical Association, and the Swiss Society of Obstetrics and Gynecology.

RESULTS

A total of 3888 (56%) of 6970 women received the questionnaire and were enrolled in the study. Most of the patients considered the written and oral information to be good or excellent, and more than 80% did not desire further written information. Forty-five percent would have preferred to receive this structured Information the same day the decision to undergo an invasive procedure was made, and mere than half of the patients were reassured by the information provided. However, in 7% anxiety increased. In the multivariate analysis, Turkish (odds ratio [OR], 6.7; 95% confidence Interval [CI], 2.0-22.4; P=-.002) and Serbo-Croat (OR, 8.0; 95% CI, 2.4-27.4; P=.001) language and a poor rating of the written description of the planned operation (OR, 3.1; 95% CI, 1.1-9.0; P=-.03) were the only variables significantly associated with discontent.

CONCLUSIONS

The combined written and oral preoperative information presented is well adapted to patients' Informative wishes and needs; it allows for a structured conversation, facilitates documentation, and offers valid legal proof that adequate information has been provided. Therefore, close collaboration between the national patient organization and the expert Judiciary and medical societies of the corresponding country is strongly recommended to Improve the Informed consent procedure.