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.
Similar content being viewed by others
Notes
High human development - Argentina, Bahrain, Belgium, Canada (telephone), Costa Rica, Croatia, Czech Republic, Estonia, Finland, France, Germany, Iceland, Ireland, Italy, Latvia, Luxembourg, Malta, Mexico (long survey - 9 modules), Portugal, Slovakia (long), Spain, Sweden, The Netherlands, United Arab Emirates. Low human development—Bulgaria, China (long), Colombia (long), Egypt (long), Georgia (long), India (long), Indonesia (long), Iran (long), Jordan, Morocco, Nigeria (long), Oman, Romania, Russian Federation, Syria (long), Turkey (long), Venezuela.
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
References
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..
Donabedian, A. (1980). Explorations in quality assessment and monitoring: the definition of quality and approaches to assessment. Ann Arbor, Michigan: Health Administration Press
Murray, C. J. L., & Frenk, J. (2000). A framework for assessing the performance of health systems. Bulletin of the World Health Organisation, 78(6), 717–731
Thompson, A. G. H., & Sunol, R. (1995). Expectations as determinants of patient satisfaction. Health Expectation, 2, 93–104.
Sitzia, J., & Wood, N. (1997). Patient satisfaction: a review of issues and concepts. Social Science and Medicine, 45(12), 1829–1843
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.
Ware, J. E., & Hays, R. D. (1988). Methods for measuring patient satisfaction with specific medical encounters. Medical Care, 26(4), 393–402.
Penchansky, R., & Thomas, J. W. (1981). The concept of access. Medical Care, 19(2), 127–140
De Silva A. A framework for measuring responsiveness. (Discussion Paper 32) 2000. Retrieved December 1, 2005, from http://www.who.int/responsiveness/papers/e.
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.
Murray, C. J. L., Kawabata, K., & Valentine, N. (2001). People’s experience versus people’s expectations. Health Affairs, 20(3), 41–43
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), 1509–1528
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..
Schafer, J. L. (2001). NORM: multiple imputation of incomplete multivariate data under a normal model [statistical software]. University Park: Penn. State University. Department of Statistics
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), 2096–2119
DeVellis, R. F. (1991). Scale Development. Theory and applications. (Applied Social Research Methods Series Volume 26.) London: Sage Publications
UNDP (2001). Human development report. New York: UNDP.
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)
Cramer, D., & Howitt, D. (2004). The SAGE dictionary of statistics. London: Sage Publications
Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory. (3rd ed.). New York: McGraw-Hill
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: Sage
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, 811–818
UNESCO. Educational Statistic, 2002. Retrieved May 30, 2006, from http://www.uis.unesco.org..
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), 353–358
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), 319–328
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), 2018–2037
Ware, J. (1976). Scales for measuring general health perceptions. Health Services Research, (Winter), 396–415.
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, 35–50
Coulter, A., & Jenkinson, C. (2005). European patients’ views on the responsiveness of health systems and healthcare providers. European Journal for Public Health, 15(4), 355–360
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, 210–215
Stewart, M. (2005). Reflections on the doctor–patient relationship from evidence and experience. British Journal of General Practice, 55(519), 793–801.
Campbell, A., Converse, P. E., & Rodgers, W. L. (1976). The quality of American life; perceptions evaluations and satisfactions. New York: Russell Sage Foundation
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), 159–183
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), 311–317
Author information
Authors and Affiliations
Corresponding author
Additional information
The views expressed by the authors do not necessarily represent the stated policy of the World Health Organization.
Appendices
Appendices
Rights and permissions
About this article
Cite this article
Valentine, N.B., Bonsel, G.J. & Murray, C.J.L. Measuring quality of health care from the user’s perspective in 41 countries: psychometric properties of WHO’s questions on health systems responsiveness. Qual Life Res 16, 1107–1125 (2007). https://doi.org/10.1007/s11136-007-9189-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11136-007-9189-1