Designing questionnaires: healthcare survey to compare two different response scales.
Designing questionnaires: healthcare survey to compare two different response scales.
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DOI：
10.1186/1471-2288-14-96
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发表时间：
2014-08-03
影响因子：
4
通讯作者：
Rosenthal R
中科院分区：
文献类型：
--
作者：
Dell-Kuster S;Sanjuan E;Todorov A;Weber H;Heberer M;Rosenthal R
患者满意度调查问卷中广泛讨论的一个设计问题是回答量表的最佳长度和标签。本研究的目的是比较个人内部对两个反应量表的回答，以评估患者对医院护理的看法的五个一般问题。 2011 年 11 月至 2012 年 1 月期间，瑞士大学医院的所有住院患者均收到了一份患者满意度调查问卷，该问卷采用形容词量表，其中包含 3 至 4 个标记类别 (LS)，并在 11 点末端锚定数字量表 (NS) 上显示 5 个冗余问题。比较了这些量表的上限效应、内部一致性（克朗巴赫α）、单个项目答案（斯皮尔曼等级相关）以及通过计算总体百分比分数（与最大可能总和相关的所有答案的总和）来比较总体满意度。回复率为 41% (2957/7158)，其中 2400 人 (81%) 完全填写了所有问题。有反应者和无反应者的基线特征相似。两种响应量表的下限和上限效应均较高，但 LS 上的效果比 NS 上的更明显。 NS 上的 Cronbach α 值高于 LS 上的 Cronbach α。在有关返回意愿、治疗质量以及患者是否受到尊重和尊严的判断的问题上，两个回答量表之间存在很强的个体项目相关性，但与医生或护士令人满意的信息传递相关性较低，其中LS中仅提供三个类别。总体百分比得分显示出可比较的分布，但 NS 中满意度较低的情况更广泛。由于较长的量表并没有大幅降低上限效应，因此可以通过关注有关具体情况的具体问题而不是一般问题来解决问题类型而不是回答量表类型。此外，有关信息提供的问题的相关性较低，表明只有三种可能的回答选择是不够的。需要进一步调查来找到区分高端评级的更敏感的尺度。否则，对患者护理进行医院内纵向比较或医院间横向比较是值得怀疑的。
A widely discussed design issue in patient satisfaction questionnaires is the optimal length and labelling of the answering scale. The aim of the present study was to compare intra-individually the answers on two response scales to five general questions evaluating patients’ perception of hospital care. Between November 2011 and January 2012, all in-hospital patients at a Swiss University Hospital received a patient satisfaction questionnaire on an adjectival scale with three to four labelled categories (LS) and five redundant questions displayed on an 11-point end-anchored numeric scale (NS). The scales were compared concerning ceiling effect, internal consistency (Cronbach’s alpha), individual item answers (Spearman’s rank correlation), and concerning overall satisfaction by calculating an overall percentage score (sum of all answers related to the maximum possible sum). The response rate was 41% (2957/7158), of which 2400 (81%) completely filled out all questions. Baseline characteristics of the responders and non-responders were similar. Floor and ceiling effect were high on both response scales, but more pronounced on the LS than on the NS. Cronbach’s alpha was higher on the NS than on the LS. There was a strong individual item correlation between both answering scales in questions regarding the intent to return, quality of treatment and the judgement whether the patient was treated with respect and dignity, but a lower correlation concerning satisfactory information transfer by physicians or nurses, where only three categories were available in the LS. The overall percentage score showed a comparable distribution, but with a wider spread of lower satisfaction in the NS. Since the longer scale did not substantially reduce the ceiling effect, the type of questions rather than the type of answering scale could be addressed with a focus on specific questions about concrete situations instead of general questions. Moreover, the low correlation in questions about information provision suggests that only three possible response choices are insufficient. Further investigations are needed to find a more sensitive scale discriminating high-end ratings. Otherwise, a longitudinal within-hospital or a cross-sectional between-hospital comparison of patient care is questionable.