Advertisement

Quality of Life Research

, Volume 16, Issue 7, pp 1107–1125 | Cite as

Measuring quality of health care from the user’s perspective in 41 countries: psychometric properties of WHO’s questions on health systems responsiveness

  • N. B. ValentineEmail author
  • G. J. Bonsel
  • C. J. L. Murray
Original Paper

Abstract

Objective

To evaluate, for different populations, psychometric properties of questions on “health systems responsiveness”, a concept developed by World Health Organization (WHO) to describe non-clinical and non-financial aspects of quality of health care.

Data sources/study setting/data collection

The 2000–2002 WHO Multi-Country Study comprised 70 general population surveys. Forty-one surveys were interviewer-administered, from which we extracted respondent records indicating ambulatory and inpatient health services use (excluding long-term institutions) in the previous 12 months (50,876 ambulatory and 7,964 hospital interviews).

Study design

We evaluated feasibility, reliability, and construct validity using 33 items with polytomous response options, comparing responses from populations identified by countries, sex, age, education, health and income.

Principal findings

Average item missing rates ranged from 0 to 16%. Domain-specific alpha coefficients exceeded 0.7 in 7 (of 9) cases. Average intertemporal reliability was acceptable in 6 (of 10) sites, where Kappas ranged from 0.54 to 0.79, but low in 4 sites (K < 0.5). Kappa statistics were higher for male, educated and healthier populations than for female, less educated and less healthy populations. Factor solutions confirmed the domain structure of 7 domains (only 7 were operationalized for ambulatory settings). As in other studies, higher incomes and age was associated with more positive responsiveness reports and ratings.

Conclusions

Quality issues addressed by WHO’s questions are understood and reported adequately across diverse populations. More research is needed to interpret user-assessed quality of care comparisons across population groups within and between countries.

Keywords

Quality of health care Health care surveys Quality indicators Patient-centred care Physician-patient relations Psychometrics 

List of Abbreviations

AHRQ

United States Agency for Healthcare Research and Quality

CAHPS

Consumer Assessment of Health Plans Survey

K

Kappa

MCS Study

Multi-Country Survey Study on Health and Health Systems Responsiveness

ML

Maximum Likelihood (factor analysis)

QUOTE

Quality of care through patients’ eyes

r

Correlation Coefficient (Pearson or Spearman, as specified)

UNDP

United Nations Development Programme

UNESCO

United Nations Educational, Scientific and Cultural Organization

WHO

World Health Organization

Supplementary material

References

  1. 1.
    Kelley, E., & Hurst, J. (2006). Health care quality indicators project conceptual framework paper. OECD Health Working Papers No. 23. Retrieved 30 May at: http://www.oecd.or..Google Scholar
  2. 2.
    Donabedian, A. (1980). Explorations in quality assessment and monitoring: the definition of quality and approaches to assessment. Ann Arbor, Michigan: Health Administration PressGoogle Scholar
  3. 3.
    Murray, C. J. L., & Frenk, J. (2000). A framework for assessing the performance of health systems. Bulletin of the World Health Organisation, 78(6), 717–731Google Scholar
  4. 4.
    Thompson, A. G. H., & Sunol, R. (1995). Expectations as determinants of patient satisfaction. Health Expectation, 2, 93–104.Google Scholar
  5. 5.
    Sitzia, J., & Wood, N. (1997). Patient satisfaction: a review of issues and concepts. Social Science and Medicine, 45(12), 1829–1843PubMedGoogle Scholar
  6. 6.
    Wensing, M., Jung, H. P., Mainz J., Olesen, F., & Grol, R. (1998). A systematic review of the literature on patient priorities for general practice care. Part 1: Description of the research domain. Social Science and Medicine, 47(10), 1573–1588.Google Scholar
  7. 7.
    Ware, J. E., & Hays, R. D. (1988). Methods for measuring patient satisfaction with specific medical encounters. Medical Care, 26(4), 393–402.PubMedCrossRefGoogle Scholar
  8. 8.
    Penchansky, R., & Thomas, J. W. (1981). The concept of access. Medical Care, 19(2), 127–140PubMedCrossRefGoogle Scholar
  9. 9.
    De Silva A. A framework for measuring responsiveness. (Discussion Paper 32) 2000. Retrieved December 1, 2005, from http://www.who.int/responsiveness/papers/e.Google Scholar
  10. 10.
    Zastowny, T. R., Stratmann, W. C., Adams, E. J., & Fox, M. L. (1995). Patient satisfaction and experience with health services and quality of care. Quality Management in Health Care, 3, 50–61.PubMedGoogle Scholar
  11. 11.
    Murray, C. J. L., Kawabata, K., & Valentine, N. (2001). People’s experience versus people’s expectations. Health Affairs, 20(3), 41–43CrossRefGoogle Scholar
  12. 12.
    Hargraves, J. K., Hays, R. D., & Cleary, P. D. (2003) Psychometric properties of the consumer assessment of health plans study 2.0 adult core survey—CAHSP®. Health Services Research, 38(6p1), 1509–1528PubMedCrossRefGoogle Scholar
  13. 13.
    Ustun, B. S. et al. WHO multi-country survey study on health and responsiveness 2000–2001 (Discussion Paper 37) 2003. Retrieved December 1, 2005, from http://www.who.int/responsiveness/papers/e..Google Scholar
  14. 14.
    Schafer, J. L. (2001). NORM: multiple imputation of incomplete multivariate data under a normal model [statistical software]. University Park: Penn. State University. Department of StatisticsGoogle Scholar
  15. 15.
    Elliott, M. N., Edwards, C., Hambarsoomians, K., Angeles, J., & Hays, R. D. (2005). Patterns of unit and item nonresponse in the CAHPS® Hospital Survey. Health Services Research, 40(6p2), 2096–2119PubMedCrossRefGoogle Scholar
  16. 16.
    DeVellis, R. F. (1991). Scale Development. Theory and applications. (Applied Social Research Methods Series Volume 26.) London: Sage PublicationsGoogle Scholar
  17. 17.
    UNDP (2001). Human development report. New York: UNDP.Google Scholar
  18. 18.
    Gandek, B. et al. (1998). Tests of data quality, scaling assumptions, and reliability of the SF-36 in eleven countries: Results from the IQOLA project. Journal of Clinical Epidemiology, 51(11), 1149–1158 (spec iss)PubMedCrossRefGoogle Scholar
  19. 19.
    Cramer, D., & Howitt, D. (2004). The SAGE dictionary of statistics. London: Sage PublicationsGoogle Scholar
  20. 20.
    Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory. (3rd ed.). New York: McGraw-HillGoogle Scholar
  21. 21.
    Kim, J., & Mueller, C. W. (1978). Factor analysis statistical methods and practical issues. In E. M. Uslaner (Ed.), Quantitative Applications in the Social Sciences. London: SageGoogle Scholar
  22. 22.
    Hall, J. A., & Dornan, M. C. (1990). Patient sociodemographic characteristics as predictors of satisfaction with medical care: a meta-analysis. Social Science and Medicine, 30, 811–818PubMedCrossRefGoogle Scholar
  23. 23.
    UNESCO. Educational Statistic, 2002. Retrieved May 30, 2006, from http://www.uis.unesco.org..Google Scholar
  24. 24.
    Jenkinson, C. A., Coulter, A., & Bruster, S. (2002). The Picker patient experience questionnaire: development and validation using data from in-patient surveys in five countries. International Journal for Quality in Health Care, 14(5), 353–358PubMedCrossRefGoogle Scholar
  25. 25.
    Sitzia, J. (1999). How valid and reliable are patient satisfaction data? An analysis of 195 studies. International Journal for Quality in Health Care, 11(4), 319–328PubMedCrossRefGoogle Scholar
  26. 26.
    Sofaer, S., Crofton, E., Goldstein, C., Hoy, E., & Crabb, J. (2005) What do consumers want to know about the quality of care in hospitals? Health Services Research, 40(6p2), 2018–2037PubMedCrossRefGoogle Scholar
  27. 27.
    Ware, J. (1976). Scales for measuring general health perceptions. Health Services Research, (Winter), 396–415.Google Scholar
  28. 28.
    Hudson, S., Weisman, C., Anderson, R., & Camacho, F. (2004). The development and validation of the primary care satisfaction survey for women. Women Health Issues, 14, 35–50Google Scholar
  29. 29.
    Coulter, A., & Jenkinson, C. (2005). European patients’ views on the responsiveness of health systems and healthcare providers. European Journal for Public Health, 15(4), 355–360CrossRefGoogle Scholar
  30. 30.
    Grogan, S., Conner, M., Norman, P., & Willits, D. (2000) Porter Validation of a questionnaire measuring patient satisfaction with general practitioner services. Quality and Safety in Health, Care 9, 210–215Google Scholar
  31. 31.
    Stewart, M. (2005). Reflections on the doctor–patient relationship from evidence and experience. British Journal of General Practice, 55(519), 793–801.PubMedGoogle Scholar
  32. 32.
    Campbell, A., Converse, P. E., & Rodgers, W. L. (1976). The quality of American life; perceptions evaluations and satisfactions. New York: Russell Sage FoundationGoogle Scholar
  33. 33.
    Edwards, C., Staniszwesda, S., & Crichton, N. (2004). Investigation of the ways in which patients’ reports of their satisfaction with healthcare are constructed. Sociology of Health and Illness, 26(2), 159–183PubMedCrossRefGoogle Scholar
  34. 34.
    Sitzia, J., & Wood, N. (1998). Response rate in patient satisfaction research: an analysis of 210 published studies. International Journal for Quality in Health Care, 10(4), 311–317PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • N. B. Valentine
    • 1
    • 2
    Email author
  • G. J. Bonsel
    • 2
  • C. J. L. Murray
    • 3
  1. 1.WHOGeneva 27Switzerland
  2. 2.Erasmus Medical CenterInstitute of Health Policy and Management (iBMG)RotterdamThe Netherlands
  3. 3.Harvard UniversityCambridgeUSA

Personalised recommendations