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

Psychometric Validation of Patient Satisfaction Assessment Tool for Alternative Medicine Healthcare Facility in India

Purpose

Good health status has traditionally been linked to greater levels of patient satisfaction. With the emergence and integration of various medical modalities, including Homeopathy, Ayurveda, and other complementary and alternative medical treatments, patients are likely to have different satisfaction levels during their interaction with different practitioners. Amidst this diversity, the efficacy, accessibility, and cost-effectiveness of these treatment approaches have garnered significant attention. Hence, a tool was developed to assess the patient's interaction with Complementary and Alternative Medicine treatments specifically Homeopathy. The objective of this study is to evaluate the validity and reliability of the Patient Satisfaction Assessment Tool (PSAT) developed to assess patient interaction with homeopathic outreach services.

Methods

A new structured questionnaire was developed using a standardized procedure. After obtaining clearance from the scientific and ethics committee of the Central Council for Research in Homoeopathy, data was collected from consenting participants above 18 years of age attending the Dr. D.P. Rastogi Central Research Institute for Homoeopathy, Noida, Uttar Pradesh, India. Data was then computerized and analyzed by principal component analysis as the extraction method and orthogonal varimax as the rotation method.

Results

A total of 285 participants were enrolled for psychometric validation, and 254 participants were included in the final analyses after exclusion. The mean (±Standard Deviation) age of participants was 37.63 (±12.9) years (range 18-79). The final 34-item questionnaire was arranged into nine domains as per rotated component matrix analysis. The overall internal consistency of the final questionnaire, as calculated by Cronbach's alpha, was 0.79, and the measure of sampling adequacy was 0.85 (Kaiser-Meyer-Olkin test).

Conclusion

Initial results from the pilot tests suggest that Patient Satisfaction Assessment Tool (PSAT) is effective in capturing key aspects of patient satisfaction, from homeopathic clinical services which can guide future quality improvement initiatives in alternative medicine healthcare facilities.

Optimizing Early Detection: Validating Obstructive Sleep Apnea-18 (OSA-18) in Turkish-Speaking Pediatric Patients

Objective

Quality of life (QoL) assessments are increasingly important for evaluating the well-being of children with Obstructive Sleep Apnea Syndrome (OSAS). This study's objective is to culturally adapt and validate the Turkish version of the OSA-18 questionnaire, a commonly used tool for assessing QoL in children with OSAS.

Methods

The OSA-18 questionnaire was translated and culturally adapted for use in the Turkish-speaking population. The study was conducted with 180 participants, 100 boys and 80 girls, with a mean age of 6.16±2.14 years. The participants were divided into two groups. The patient group comprised individuals with symptoms of OSAS based on clinical evaluation, including anamnesis, physical examination, and video recording of apnea and snoring. The patient group underwent adenotonsillectomy and their caregivers completed the Turkish version of the OSA-18 scale postoperatively. The control group comprised 90 children who were similar to the patient group in terms of gender and age. These children had no major complaints such as snoring, apnea, fatigue during the day, irritability, or distraction. In the physical examination of this group, no major tonsillar or adenoid hypertrophy, which causes significant stenosis in the upper airway, was observed. Internal consistency, reliability, validity, responsiveness, and factor analysis were assessed.

Results

The Turkish version of the OSA-18 questionnaire demonstrated excellent reliability, with a Cronbach's alpha of 0.929. The test-retest results were not statistically different. Validity was confirmed through a positive correlation between the OSA-18 score and external parameters, such as the Mallampati score, and tonsil and adenoid size. We found a statistically significant reduction in OSA-18 scores postoperatively, signifying a robust responsiveness to the intervention.

Conclusion

Our study confirms the suitability of the Turkish OSA-18 questionnaire for assessing the QoL in children with OSAS. This quick and easy-to-use tool will be valuable for future research on Turkish-speaking children with OSAS, aiding in the evaluation of pediatric OSAS and QoL.

Validation of the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) questionnaire and its correlation with visual analog pain scales in Greek population

INTRODUCTION

One of the diagnostic tools of neuropathetic pain (NP) relies on screening questionnaires including the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) questionnaire.

AIM

To apply and validate the LANSS questionnaire in Greek population. To assess any correlation between LANSS score and visual analog pain scales.

METHODS

A prospective instrument validation study of LANSS was conducted in University Hospital of Larissa, on 70 patients (35 NP and 35 nociceptive pain), from April 2015 to June 2015. Visual analog pain scales (VAS-ADL; impact of pain on daily living activities, VAS-INT; pain intensity) were also assessed and correlated with LANSS scale.

RESULTS

The mean age of NP and nociceptive pain group was 67.11±10.05 and 39.14±17.07years respectively. The mean LANSS score was 12.84 (±9.27) in initial test, and 12.54 (±9.41) in the retest evaluation. Cronbach's alpha was 0.895 and 0.901 at initial and retest examinations respectively, both values indicating good internal consistency. NP group had significant higher LANSS score than nocipeptive pain group (21.34 [±1.39] vs 4.34 [±4.86], p<0.01). The sensitivity of LANSS questionnaire to distinguish neuropathic and nociceptive pain was 94.29% (95% CI: 80.81-99.13%), while its specificity was 88.57% (95% CI: 73.24-96.73%). A significant correlation was noticed between total LANSS score and VAS-ADL (initial r=0.248; p<0.05 and retest evaluation r=0.288; p<0.05).

CONCLUSION

The LANSS score is a reliable and valuable instrument to assess neuropathic pain in diabetic patients and to differentiate it from nociceptive pain in Greek population. In diabetic patients LANSS score is associated with impact on daily activities and potentially with quality of life.

A comparison of the psychological burden of PET/MRI and PET/CT scans and association to initial state anxiety and previous imaging experiences

OBJECTIVE

To investigate the level of psychological burden experienced by patients undergoing positron emission tomography (PET)/MRI scanning compared with PET/CT.

METHODS

100 adult patients referred for PET/CT and underwent PET/MRI scanning were eligible. Initial state, psychological burden of PET/CT and PET/MRI, scan satisfaction and preference were assessed using a purpose-designed questionnaire, comprising 61 five-point Likert scale questions and a three-point tick box question indicating preference between PET/CT and PET/MRI. State anxiety was assessed using the state portion of the State Trait Anxiety Inventory. Wilcoxon signed-rank tests compared psychological burden experienced by participants following PET/CT and PET/MRI scan.

RESULTS

A greater level of psychological burden was experienced by patients during PET/MRI than PET/CT p ≤ 0.001, consistent with patients' preference for PET/CT over PET/MRI (p = 0.013). There was a significant relationship between PET/CT psychological burden and initial state (r = 0.386, p ≤ 0.001). No significant relationship was identified between Initial state and psychological burden of PET MRI (r = -0.089; p = 217). There was a significant relationship between psychological burden of PET/CT and PET/MRI (r = 0.354; p = 0.001).

CONCLUSION

Patients' experience increased psychological burden during PET/MRI compared with PET/CT. Previous scanning experiences and patients' interactions prior to and during PET/MRI improved patient satisfaction. Interventions could be implemented to improve imaging outcome.

ADVANCES IN KNOWLEDGE

This study provides evidence for the increased psychological burden of PET/MRI compared with PET/CT, and that people prefer the PET/CT procedure. We have shown that the patients who expressed a preference for PET/MRI demonstrated significantly lower psychological burden for that procedure than those that preferred PET/CT, which indicates that the benefit of reduced psychological burden could be facilitated by an appropriate intervention.

Community satisfaction with the urban health extension service in South Ethiopia and associated factors

BACKGROUND

The urban health extension program (UHEP) is an innovative government plan to ensure health equity by creating demand for essential health services through the provision of appropriate health information at a household level. It aims to improve the overall health of a community through active participation and utilization of services, which depends on satisfaction and acceptance of the program. However, there is no study on community satisfaction with the services provided by the UHEP in Ethiopia. This study was aimed to assess the level of community satisfaction with the UHEP in Hadiya Zone, South Ethiopia, and the associated factors with it.

METHODS

A community based cross-sectional study, using quantitative and qualitative methods of data collection, was employed. Quantitative data were collected from 407 respondents using a structured questionnaire. Descriptive statistics, bivariate and multiple regression analyses were performed. P-value less than 0.05 and 95% confidence intervals were used to determine an association between independent and dependent variables. Qualitative data were collected through focus group discussions with village health committee members and model families in Hadiya Zone.

RESULTS

The majority (67.4%) of respondents were satisfied with the services provided by the UHEP. The communities' perceptions of technical competency (ß = 0.425; 95% CIs 0.084, 0.34), interpersonal relationships (ß = 0.506; 95% CIs 0.216, 0.797), and perceived accessibility of services (ß = 0.752; 95% CIs 0.064, 0.86) were independent predictors of satisfaction (P < 0.05). In addition, the marital status, knowledge, and attitudes of the respondents were associated with community satisfaction.

CONCLUSION

A community's satisfaction with UHEP has supposed to have a significant influence on the community's utilization of the services and implementation of the program. The present study have clearly shown that majority of the respondents were satisfied with the services provided by urban health extension program.

Cross-cultural adaptation and validation of the Greek OSA-18 questionnaire in children undergoing polysomnography

OBJECTIVE

Translations of validated questionnaires help to compare different countries/cultures populations and establish protocols for global health. OSA-18 is a validated disease-specific questionnaire for pediatric Obstructive Sleep Apnea (OSA). Our aim was to validate OSA-18 in Greek and correlate it with polysomnography results and OSA severity.

STUDY DESIGN

Prospective instrument validation study.

SUBJECTS AND METHODS

OSA-18 was translated in Greek and back into English. Children undergoing polysomnography due to snoring were recruited prospectively. OSA-18 was completed by parents during the initial clinic visit (test), in the evening prior to the sleep study (retest), and 3 months postoperatively for subjects who underwent adenotonsillectomy. Internal consistency and test-retest reliability were evaluated. Validity was assessed by exploring correlations between OSA-18 and AHI, by comparing OSA-18 of OSA and non-OSA groups, and by calculating questionnaire's sensitivity and specificity for detecting OSA. Total scores of non-OSA, mild, moderate and severe OSA subgroups were compared. In OSA children who underwent adenotonsillectomy, preoperative and postoperative total scores were compared to assess responsiveness.

RESULTS

Test-retest questionnaires were fully completed for 141 children. OSA-18 in Greek had good internal consistency (Cronbach's alpha 0.951 for test and 0.947 for retest) and test-retest reliability (Pearson's correlation coefficients between test and retest scores: 0.850-0.946; P<0.05). Total and subscale OSA-18 scores and AHI were significantly correlated (Spearman's correlation coefficients: 0.376-0.633; P<0.01), while children with OSA had higher total OSA-18 score than those without OSA [median (interquartile range): 61 (35) vs. 38 (22), respectively; P<0.001)]. Sensitivity was 53.4%, suggesting poor validity compared to polysomnography. All OSA severity subgroups had significant higher score than non-OSA. OSA-18 scores postoperatively were significantly lower compared to preoperatively (22.91±5.49 vs. 67.13±15.27, respectively; P<0.001), indicating good responsiveness.

CONCLUSION

Greek OSA-18 is an instrument with satisfactory internal consistency, reliability, and responsiveness, but it is a poor predictor of OSA severity.

Validation of the nasal obstruction symptom evaluation (NOSE) scale for Greek patients

OBJECTIVE

Nasal Obstruction Symptom Evaluation (NOSE) scale is a validated disease-specific questionnaire for the assessment of Nasal Obstruction (NO). The aim of this study was to validate the Greek-NOSE questionnaire.

STUDY DESIGN

Prospective instrument validation study.

SETTING

Tertiary referral center.

SUBJECTS AND METHODS

NOSE questionnaire was translated into Greek and then translated back into English. A prospective study was conducted on adult patients with NO due to septal deviation (SD). Test-retest evaluation of SD patients was carried out. Internal consistency was assessed with Cronbach's alpha test and test-retest reliability with Pearson's test (correlation), kappa (reproducibility), and Bland-Altman plot (extent of agreement). Validity was assessed by comparing scores of a control group of volunteers without NO to preoperative scores of SD patients undergoing septoplasty with Mann-Whitney test. Responsiveness was assessed by comparing preoperative to 3 months postoperative scores of SD patients with paired t test and evaluating the magnitude of surgery effect.

RESULTS

Test-retest evaluation was accepted on 109 patients. The Greek-NOSE had good internal consistency (Cronbach's alpha 0.74 for test and 0.76 for retest). All its items were significantly correlated between test and retest evaluation. NOSE showed high reproducibility (mean kappa: 0.75), and almost all differences in Bland-Altman plot were between agreement thresholds. Controls (123 volunteers) had significant lower score. Postoperative scores were significantly lower than preoperative, and magnitude of surgery effect was high, both indicating good responsiveness.

CONCLUSION

The Greek-NOSE questionnaire is a valid instrument with satisfactory internal consistency, reliability, reproducibility, validity, and responsiveness.

Validation of the Greek OSD-6 quality of life questionnaire in children undergoing polysomnography

OBJECTIVE

OSD-6 is a disease specific questionnaire for pediatric obstructive sleep apnea (OSA). The aims of this study were to validate OSD-6 in Greek language and correlate OSD-6 with polysomnography results.

STUDY DESIGN

Prospective study.

SETTING

Tertiary referral center.

SUBJECTS AND METHODS

OSD-6 questionnaire was translated to Greek and back to English. A prospective study was conducted on children undergoing overnight polysomnography due to snoring and disrupted sleep. Test-retest evaluation was carried out. Internal consistency and test-retest reliability were evaluated. Validity was assessed by exploring correlations between OSD-6 scores and apnea-hypopnea index (AHI), and by comparing total scores of OSA and non-OSA groups. Responsiveness was assessed by comparing preoperative to postoperative total scores in OSA children who underwent adenotonsillectomy.

RESULTS

Test-retest evaluation of 91 subjects showed good internal consistency (Cronbach's alpha 0.860 for test and 0.873 for retest) and reliability (Pearson's correlation coefficients between test and retest scores: 0.751-0.546; p<0.01). Total and domains' OSD-6 scores and AHI were significantly correlated (Spearman's correlation coefficients: 0.277-0.630; p<0.01), while children with OSA had higher total OSD-6 score than those without OSA (median (interquartile range): 16 (11) vs. 10 (7), respectively; p<0.01), indicating good validity. Postoperative OSD-6 scores were significantly lower than preoperative (2.84 ± 3.21 vs. 15.42 ± 6.48, respectively; p<0.001), suggesting good responsiveness.

CONCLUSION

The Greek version of the OSD-6 questionnaire proved to be a valid instrument with satisfactory internal consistency, reliability, validity and responsiveness. Furthermore, in our study OSD-6 was significantly correlated to polysomnography results.

Migration background and patient satisfaction in a pediatric nephrology outpatient clinic

BACKGROUND

We examined the association of a migration background and patient satisfaction in a pediatric nephrology outpatient clinic in Germany.

METHODS

This was a cross-sectional study of 348 families presenting at the Pediatric Nephrology Outpatient Department of Charité University Children's Hospital in Berlin during 2008. Parents were asked to complete a questionnaire containing basic sociodemographic information, a subjective categorical rating of disease severity and communication with the medical team, and a validated patient satisfaction score (ZUF-8) derived from a customer satisfaction score used by industry and modified for healthcare providers.

RESULTS

Of the 348 families included in the study, 131 patients (38 %) had a migration background (20 different nationalities, 22 different native languages). Patient satisfaction (rated on a scale from 8 to 40) was significantly higher in families without (32.9  ±  4.6) than in those with a migration background (30.8  ±  4.7; p < 0.0001). A multivariate linear regression analysis revealed that trust in doctors, friendliness of the doctor, severity of the child's disease, number of medications prescribed, and a migration background were significantly and independently correlated with patient satisfaction.

CONCLUSIONS

Migrant families were less satisfied with the provision of the outpatient care provided by our department than non-migrants.

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.

Challenges, benefits and weaknesses of intermediate care: results from five UK case study sites

The authors explore the views of practitioners and managers on the implementation of intermediate care for elderly people across England, including their perceptions of the challenges involved in its implementation, and their assessment of the main benefits and weaknesses of provision. Qualitative data were collected in five case study sites (English primary care trusts) via semistructured interviews (n = 61) and focus group discussions (n = 21) during 2003 to 2004. Interviewees included senior managers, intermediate care service managers, clinicians and health and social care staff involved in the delivery of intermediate care. The data were analysed thematically using an approach based on the 'framework' method. Workforce and funding shortages, poor joint working between health and social care agencies and lack of support/involvement on the part of the medical profession were identified as the main challenges to developing intermediate care. The perceived benefits of intermediate care for service-users included flexibility, patient centredness and the promotion of independence. The 'home-like' environment in which services were delivered was contrasted favourably with hospitals. Multidisciplinary teamworking and opportunities for role flexibility were identified as key benefits by staff. Insufficient capacity, problems of access and awareness at the interface between intermediate care and 'mainstream' services combined with poor co-ordination between intermediate care services emerged as the main weaknesses in current provision. Despite reported benefits for service-users and staff, the study indicates that intermediate care does not appear to be achieving its full potential for alleviating pressure within health and social care systems. The strengthening of capacity and workforce, improvements to whole systems working and the promotion of intermediate care among doctors and other referrers were identified as key future priorities.

Prevalence of depression and anxiety symptoms in elderly patients admitted in post-acute intermediate care

OBJECTIVES

Depression and anxiety symptoms are common in medically ill older patients. We investigated the prevalence and predictors of depression and anxiety symptoms in older patients admitted for further rehabilitation in post acute intermediate care.

DESIGN

Observational cohort study.

SETTING

An intermediate care unit, North West of England.

PARTICIPANTS

One hundred and seventy-three older patients (60 male), aged mean (SD) 80 (8.1) years, referred for further rehabilitation to intermediate care.

MEASUREMENTS

Depression and anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale, and severity of depression examined by the Montgomery Asberg Depression Rating Scale. Physical disability was assessed by the Nottingham Extended ADL Scale and quality of life by the SF-36.

RESULTS

Sixty-five patients (38%) were identified with depressive symptoms, 29 (17%) with clinical depression, 73 (43%) with anxiety symptoms, and 43 (25%) with clinical anxiety. 15 (35%) of the latter did not have elevated depression scores (9% of the sample). Of those with clinical depression, 14 (48%) were mildly depressed and 15 (52%) moderately depressed. Longer stay in the unit was predicted by severity of depression, physical disability, low cognition and living alone (total adjusted R2 = 0.24).

CONCLUSIONS

Clinical depression and anxiety are common in older patients admitted in intermediate care. Anxiety is often but not invariably secondary to depression and both should be screened for. Depression is an important modifiable factor affecting length of stay. The benefits of structured management programmes for anxiety and depression in patients admitted in intermediate care are worthy of evaluation.