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Measuring nonspecific factors in treatment: item banks that assess the healthcare experience and attitudes from the patient’s perspective

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Abstract

Purpose

Nonspecific factors that accompany healthcare treatments, such as patients’ attitudes and expectations, are important parts of the experience of care and can influence outcomes. However, no precise, concise, and generalizable instruments to measure these factors exist. We report on the development and calibration of new item banks, titled the Healing Encounters and Attitudes Lists (HEAL), that assess nonspecific factors across a broad range of treatments and conditions.

Methods

The instrument development methodology of the Patient-Reported Outcomes Measurement Information System (PROMIS®) was used. Patient focus groups and clinician interviews informed our HEAL conceptual model. Literature searches of eight databases yielded over 500 instruments and resulted in an initial item pool of several thousand items. After qualitative item analysis, including cognitive interviewing, 296 items were included in field testing. The calibration sample included 1657 respondents, 1400 obtained through an Internet panel and 257 from conventional and integrative medicine clinics. Following exploratory and confirmatory factor analyses, the HEAL item banks were calibrated using item response theory.

Results

The final HEAL item banks were Patient–Provider Connection (57 items), Healthcare Environment (25 items), Treatment Expectancy (27 items), Positive Outlook (27 items), and Spirituality (26 items). Short forms were also developed from each item bank. A six-item short form, Attitudes toward Complementary and Alternative Medicine (CAM), was also created.

Conclusions

HEAL item banks provided substantial information across a broad range of each construct. HEAL item banks showed initial evidence of predictive and concurrent validity, suggesting that they are suitable for measuring nonspecific factors in treatment.

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Acknowledgments

The study was funded by the National Institutes of Health, National Center for Complementary and Integrative Health (NCCIH R01 AT006453). The NCCIH had no role in designing and conducting the study, data collection, management, and analysis, and interpretation of the data, or preparation, review, and approval of the manuscript.

Funding

This study was funded by the National Institutes of Health, National Center for Complementary and Integrative Health (R01 AT006453), USA.

Author information

Authors and Affiliations

  1. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Carol M. Greco, Kelly L. Johnston, Nathan E. Dodds, Ronald M. Glick, Christine E. McFarland, Suzanne Lawrence, Catherine C. Maihoefer, Neal D. Ryan & Paul A. Pilkonis

  2. Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Lan Yu, Natalia E. Morone & Jason Colditz

  3. Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA

    Michael J. Schneider

  4. Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA

    Mary Lou Klem

  5. Samueli Institute, Alexandria, VA, USA

    Wayne B. Jonas

  6. University of Pittsburgh Center for Integrative Medicine, 580 South Aiken Avenue, Suite 310, Pittsburgh, PA, 15232, USA

    Carol M. Greco, Ronald M. Glick, Christine E. McFarland & Neal D. Ryan

Authors
  1. Carol M. Greco
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  2. Lan Yu
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  3. Kelly L. Johnston
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  9. Christine E. McFarland
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  15. Paul A. Pilkonis
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Corresponding author

Correspondence to Carol M. Greco.

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Conflict of interest

All authors declare that they have no conflicts of interests regarding the study.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Institutional Review Board of the University of Pittsburgh.

Informed consent

Informed consent was obtained from all focus group participants, cognitive interview participants, and clinical calibration participants.

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Greco, C.M., Yu, L., Johnston, K.L. et al. Measuring nonspecific factors in treatment: item banks that assess the healthcare experience and attitudes from the patient’s perspective. Qual Life Res 25, 1625–1634 (2016). https://doi.org/10.1007/s11136-015-1178-1

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