Improving the assessment of (in)patients' satisfaction with hospital care

BACKGROUND. A self-report questionnaire is the most widely used method to a ssess (in)patients' satisfaction with (hospital) care. However, problems li ke nonresponse, missing values, and skewed score distributions may threaten the representativeness, validity, and reliability of results. We investiga ted which of alternative item-response formats maximizes desired outcomes. DESIGN. Five formats were compared on the basis of sample characteristics, psychometric properties at the scale and item levels, and patients' opinion s of the questionnaire. SUBJECTS. Consecutively discharged patients (n=784) were sampled, of which a representative (sex, age, length of hospital stay) subsample of 514 (65%) responded. MEASURES. A 54-item satisfaction questionnaire addressing 12 aspects of car e was used. Patients responded using either a 10-step evaluation scale rang ing from "very poor" to "excellent" (E10), a 5-step evaluation scale rangin g from "poor" to "excellent" (E5), or a 5-step satisfaction scale ranging f rom "dissatisfied" to "very satisfied" (S5), The 5-step scales were adminis tered with response options presented as either boxed scale steps to be mar ked or words to be circled. RESULTS, E5 scales yielded lower means than S5 scales. However, at the item level, the S5 scale showed better construct validity, more variability, an d less peaked score distributions. Circling words yielded fewer missing ite m scores than marking boxes. The E5 scale showed more desirable score distr ibutions than the E10 scale, but construct validity and reliability were lo wer. CONCLUSIONS. No large differences among formats were found. However, if ind ividual items are important carriers of information, a (5-step) satisfactio n response scale, with response options presented in words next to each ite m, appears to be the optimal format.