Comparison of indirect and direct approaches to measuring patient satisfaction

One indirect (PSQ) and two direct (CSQ-18B and ERS) measures of patient satisfaction were compared across a series of psychometric, acceptability, and concurrent validity criteria. None of the three measures was significantly related to health status or demographic characteristics. Each measure performed as expected from prior research on their psychometric properties. The scales contrasted, however, in regard to acceptability, with the PSQ being much less acceptable to patients than the other two. The PSQ also produced more missing data. The results on the PSQ reflected patient inconsistency on cross-check items and patients tended to be uncertain in their responses to many items. In multivariate analyses the three measures were used as predictors of patient-rated indices of global service satisfaction. The CSQ-18B and the ERS were significant predictors of patient-rated indices of global service satisfaction, whereas the PSQ was unrelated to these indices. It was concluded that the direct and indirect approaches measure different satisfaction domains. The PSQ likely assesses more generalized attitudes about health services while the CSQ-18B and the ERS efficiently reflect opinions about the specific setting in which they are administered.     

Defining and measuring patient satisfaction with medical care

This paper describes the development of Form II of the Patient Satisfaction Questionnaire (PSQ), a self-administered survey instrument designed for use in general population studies. The PSQ contains 55 Likert-type items that measure attitudes toward the more salient characteristics of doctors and medical care services (technical and interpersonal skills of providers, waiting time for appointments, office waits, emergency care, costs of care, insurance coverage, availability of hospitals, and other resources) and satisfaction with care in general. Scales are balanced to control for acquiescent response set. Scoring rules for 18 multi-item subscales and eight global scales were standardized following replication of item analyses in four field tests. Internal-consistency and test-retest estimates indicate satisfactory reliability for studies involving group comparisons. The PSQ well represents the content of characteristics of providers and services described most often in the literature and in response to open-ended questions. Empirical tests of validity have also produced generally favorable results.     

The client satisfaction questionnaire. Psychometric properties and correlations with service utilization and psychotherapy outcome

An 18-item version of the Client Satisfaction Questionnaire (CSQ-18) was included in an experimental study of the effects of pretherapy orientation on psychotherapy outcome. The psychometric properties of the CSQ-18 in this study were compared with earlier findings. In addition, the correlations of the CSQ-18 with service utilization and psychotherapy outcome measures were examined. Results indicated that the CSQ-18 had high internal consistency (coefficient alpha = .91) and was substantially correlated with remainer-terminator status (rs = .61) and with number of therapy sessions attended in one month (r = .54). The CSQ-18 was also correlated with change in client-reported symptoms (r = -.35), indicating that greater satisfaction was associated with greater symptom reduction. Results also demonstrated that a subset of items from the scale (the CSQ-8) performed as well as the CSQ-18 and often better. The excellent performance of the CSQ-8, coupled with its brevity, suggests that it may be especially useful as a brief global measure of client satisfaction.     

Assessing client satisfaction among Hispanics

Data from two studies using community health center clients are analyzed to assess how a measure of client satisfaction operates when used with different ethnic populations. The eight-item version of the Client Satisfaction Questionnaire (CSQ-8) is a measure of general satisfaction with services that was developed to provide a brief, standard assessment procedure suitable for use in a wide variety of service settings. Based on the results of this survey, the CSQ-8 seems to operate about the same, whether administered to Anglos, blacks, persons of Mexican descent, or persons of other Hispanic origin, or whether in English or Spanish. There were essentially no differences among the various ethnic groups across statistical criteria of internal consistency reliability, central tendency, dispersion, item intercorrelation, or missing values. These results suggest that the CSQ-8 is a measure of general satisfaction with services suitable for use with a variety of client populations, including Hispanics.     

Client satisfaction in a community crisis center

Variables determining client satisfaction with crisis intervention services were evaluated. The short version of the Client Satisfaction Questionnaire (CSQ-8), and open ended questions were used in telephone interviews of clients and significant others. Results showed that 40% of the total variance of client satisfaction was explained by clients' evaluation of workers. Low correlations were found between reports of clients and significant others, implying that different factors determine satisfaction for each group.     

A cross-national validation of the client satisfaction questionnaire: the Dutch experience

A Dutch translation of the eight-term version of the Client Satisfaction Questionnaire (CSQ-8) was administered to community mental health outpatients in the Netherlands (n = 110). Data analyses indicate that the Dutch CSQ-8 has highly similar operating characteristics and psychometric properties compared with the English language version. Results also indicate that one general satisfaction factor was found in the Dutch CSQ-8 data. All eight of the scale items loaded heavily on this general factor, strong inter-item correlations were found, and the scale demonstrated high internal consistency. On these grounds, we can conclude that the Dutch CSQ-8 has the same properties as the original questionnaire and can be used as such in Holland. It was also found that those clients who decided to stop therapy on their own were less satisfied than other clients. Clients who made a common decision with their therapist or let him/her make that decision were more satisfied than clients who stopped by themselves. Additional research is planned to investigate whether clients who complete treatment goals are indeed more satisfied and whether this line of research could be a means of studying the external validity of the scale.     

The contribution of a cultural perspective in understanding and evaluating client satisfaction

Increasing attention is being given to including measures of client satisfaction as a component in the evaluation of health care services. An understanding of cultural factors that may influence attitudes and behaviors in the health care situation can contribute to the theory and measurement of client satisfaction. Through an examination of some of the cross-cultural literature, this paper delineates dimensions of the health care situation in which clients have been shown to have distinctive preferences, behavioral patterns, attitudes, and treatment expectations. A knowledge of the beliefs and attitudes concerning health and illness that are espoused by a particular cultural group can be a valuable asset in understanding how members of that group will evaluate the delivery of health care services. The examination of how cultural and ethnic differences may affect client satisfaction outcomes points to the necessity of avoiding a global measure of client satisfaction without first examining those particular aspects of health care delivery and of the measurement context that may have a predictable influence on client satisfaction ratings.     

Antecedents and Consequences of Marital Satisfaction in an Emirati Sample: A Structural Equation Model Analysis

This study surveyed 1,000 married Emirati men and women to explore a model of marital satisfaction in relation to self-esteem, satisfaction with life, gender-role attitudes, and general health (physical and psychological). The Emirati Marital Satisfaction Scale (EMSS), State Self-Esteem Scale (SSES), Satisfaction With Life Scale (SWLS), the Arabic General Health Questionnaire, and the Sex-Role Egalitarianism Scale were used. Confirmatory factor analysis (CFA) on the EMSS indicated a moderate fit of the data to one factor structure. CFA on SSES and SWLS indicated an adequate fit of the data to the four-factor solution and one factor, respectively. The structural equation model for the EMSS showed that both general health and gender-role attitudes predict marital satisfaction and that marital satisfaction seems to predict the individual’s well-being as measured by life satisfaction and self-esteem. These results are discussed within the context of the United Arab Emirates culture and directions for future research are provided.     

The pinney sexual satisfaction inventory

The purpose of the present investigation was to (a) develop a reliable self‐report questionnaire that assesses women's sexual satisfaction and (b) investigate the correlates of sexual satisfaction in women. A total of 275 college‐aged women completed the Pinney Sexual Satisfaction Inventory (PSSI) and were also assessed on a variety of sexual behaviors, experiences, and attitudes. The results supported the internal reliability of the PSSI, and evidence of covergent validity was provided by strong positive correlations between the PSSI and other measures of sexual satisfaction. A factor analysis revealed two underlying dimensions of the PSSI: General Sexual Satisfaction and Satisfaction with Partner. The variables that were most highly correlated with the PSSI were relationship commitment, orgasm consistency, frequency of intercourse, and effectiveness of contraceptive device. These findings have implications for further use of the PSSI in research and clinical practice.     

Artifact in client satisfaction assessment: experience in community mental health settings

Artifact in client satisfaction assessment is discussed and the results of a study of three factors thought to mediate client satisfaction ratings; (a) general life satisfaction, (b) mode of administration, and (c) psychological symptomatology, are reported. A standard client satisfaction questionnaire (CSQ) was modified to yield parallel forms and was administered orally and in writing to 92 clients in two mental health day treatment programs. Satisfaction ratings obtained from these clients were quite similar to out-patient ratings obtained in previous studies conducted in this setting and using the same measures. Oral administration of the CSQ produced 10% higher satisfaction ratings than written administration (p less than .05) and less missing data (p less than .01). Satisfaction ratings were also obtained using a simple graphic instrument. Graphic ratings were comparable to CSQ ratings. Satisfaction with life in general and level of psychiatric symptoms together accounted for 25% of CSQ variance. The implication of these findings for future client satisfaction research is discussed.     

Are the voices of parents heard? A scoping review of satisfaction in parenting programs

Parenting programs are an effective approach to promote positive parenting. In evidence-based practice, client’s values and preferences contribute to promoting quality, and are a crucial component of service evaluation. The current scoping review summarizes quantitative research that examines parental satisfaction with parent training for families with child conduct problems. We aimed to know how much research had been undertaken; what measures have been used; and what were the findings related to parental satisfaction. A scoping review was conducted to retrieve peer-reviewed original articles.Out of 420 papers 5.5 % obtained data on parental satisfaction. Seven different measures were used, mainly Therapy Attitude Inventory and Client Satisfaction Questionnaire. Out of 23 papers, ten studies reported Cronbach's alpha coefficients on the assessment that was used to evaluate parental satisfaction. All of the 23 included studies found that parents are very satisfied with the parenting program they have received.The findings indicate that only a few studies included parents’ values and preferences in quantitative evaluation studies on parental programs. In addition, there is a limited arsenal of assessment tools to measure what matters to parents. There is a need to develop measures with high psychometric quality, which will promote more quality in service evaluation.     

The role of client satisfaction in evaluating university counseling services

Though ubiquitously used for evaluating university counseling services, client satisfaction assessment has been hampered by inadequate instrumentation. Systematic use of a short form of the Client Satisfaction Questionnaire (CSQ) in one such center over the past 5 years is described, together with strategies to ensure maximal accuracy and utilization of results. Several method factors were investigated. Optional respondent identification was not found to reduce response rate or increase reported satisfaction compared to anonymity, while a substudy obtaining very high response suggested bias from nonresponse to the routine survey (response rate = 40%) was not great. The CSQ was found to have excellent psychometric properties and many advantages for use in student service settings. Relationships between satisfaction and a number of other variables such as demographics, precounseling expectancies, problem type and severity, counselor differences, and duration of counseling are reported. Ways such findings were incorporated in service planning are briefly discussed.     

Assessment of patient satisfaction: development and refinement of a service evaluation questionnaire

A series of seven studies was conducted by the authors and their colleagues to produce an efficient measure of service satisfaction that can easily be related to symptom level, demographic characteristics, and type and extent of service utilization. The resulting measure, the Service Evaluation Questionnaire (SEQ) is a brief, global index that has excellent internal consistency and solid psychometric properties. Data from an extensive SEQ field study can be used as a comparison base for future applications of the two SEQ component scales, the CSQ-8 and the SCL-10. A new hypothesis has emerged from this series of studies that will guide future research: Service recipients may find if difficult to formally express dissatisfaction in the face of significant caring--however ineffectual--when the technical capacity to offer definitive treatment is not yet fully developed and when criteria for evaluating the efficacy of treatment are not yet crystal clear.     

Evaluating consumer satisfaction in residential continuing care settings

The outcome of the project reported on here is a client-centered consumer satisfaction questionnaire designed to evaluate new models of residential continuing care in Alberta, Canada. Satisfaction is defined as a multi-dimensional construct that is grounded in the consumer's experience. Consultation with the clients of the services during development of the instrument ensured that characteristics important to the clients were assessed. The result is an instrument with which to measure satisfaction that is fully client-centered and that, with appropriate modifications, can be used to monitor any client-centered program for cognitively-able continuing care clients.     

Variables Affecting Patient Satisfaction with Health Care Services in the College Health Setting

Abstract

Patient satisfaction with health care services is an important factor in health care delivery. It will significantly influence whether or not a patient seeks medical care, complies with prescribed treatment, and/or maintains a continuing relationship with a medical practitioner.

A survey questionnaire, relating patient satisfaction with a number of variables identified through a literature review, was mailed to a random sample of 500 students utilizing Student Health Service (SHS) at Kent State University (KSU) during the five week study period. The data obtained would be utilized to help with planning future health care services and staff inservice education programs.

The findings of this survey indicate that patient satisfaction has a statistically significant correlation with perceived technical competence of the practitioner and perceived adequacy of the interpersonal aspects of the practitioner-patient relationship. A significant relationship did not exist between satisfaction and expectations the patient holds of the practitioner's role performance. A statistically significant relationship was found to exist between receiving health information/education related to diagnosis, prognosis, and treatment plan and satisfaction with health care services. This relationship did not hold for health information/education related to activity restrictions or preventive measures. The study also revealed that time waited during the medical care encounter was inversely related to satisfaction. Last, stepwise regression found that perceived technical competence of the practitioner was the most important variable influencing patient satisfaction with health care services.

This study provides data about factors important to personal satisfaction with health care services for a selected group of college students.     

Comparing customer satisfaction across industries and countries

Although aggregate satisfaction measures continue to proliferate, their value in making broad-based comparisons remains unclear. This study uses arguments from the economics, psychology, sociology and marketing domains to predict systematic differences in aggregate customer satisfaction across both industries and countries. These predictions are tested using a database created from three broad-based national satisfaction surveys in Sweden, Germany and the United States. The results reveal that, across countries, satisfaction is highest for competitive products, lower for competitive services and retailers, and lower still for government and public agencies. However, the differences vary by country. Satisfaction is also predictably lower in Sweden and Germany compared to the US, and shown to change systematically in Sweden over time. Methodological differences do not appear to limit the comparability of the aggregate satisfaction measures. Overall the study supports the use of national indices for making meaningful comparisons of satisfaction on a broad scale.     

Effects of anonymity and experimenter demand on client satisfaction with mental health services

Among the methodological issues associated with the measurement of client satisfaction are those concerning anonymity of response, experimenter demand effects, and reliability of instruments. In this study, 100 inpatients were randomly assigned in a 2 X 2 factorial design; subjects were asked or not asked to sign their names to the CSQ-8 questionnaire and were asked or not asked to "tell it like it is." The reported satisfaction of those given anonymity was significantly lower but there was no effect due to demand. Furthermore, subjects in the anonymity group had lower scores on all 8 items of the questionnaire. A factor analysis of the CSQ-8 revealed one major factor; the internal consistency of the scale was .93. The CSQ-8 was found to be a useful measure of overall client satisfaction but, because ceiling effects are a pervasive problem in client satisfaction research, anonymity should be assured whenever possible.     

Relationship of interpersonal behaviors and health-related control appraisals to patient satisfaction and compliance in a university health center

OBJECTIVE: The authors' aim was to evaluate patient-provider relationships in a college health center. PARTICIPANTS: Eighty student patients and their health-care providers. METHODS: Patients completed a measure of perceived health competence before a consultation and measures of provider participatory behavior and interpersonal behavior before and after the consultation. They evaluated their satisfaction with care and compliance after the consultation and again 2 weeks later. Providers completed measures of their participatory behavior and patients' interpersonal behavior after the consultation. RESULTS: Patients preferred to be well informed and to have their preferences taken into account, and generally felt competent at managing their own health affairs. They indicated they obtained the high level of participation they desired. Patients desired and actually experienced friendly and submissive providers. Degree of match between patients' desired and actual level of involvement in their care was associated with greater satisfaction. A greater match between the extent to which they desired the provider to be affiliative and the provider's actual affiliative behavior was associated with more satisfaction. No variables were predictive of patient compliance. CONCLUSION: The authors discuss results in terms of the influence of situational factors characteristic of a college health center.     

Patient satisfaction in primary health care: a literature review and analysis.

This paper reviews the literature on patient satisfaction in primary health care settings. Definitions and models of satisfaction are considered first. Attention is given to the conceptualization of satisfaction by investigators concerned about consumers in general as well as by researchers focusing on consumers of medical services. Research findings are discussed and used to develop a model of patient satisfaction. The measurement of patient satisfaction and the findings of empirical studies are then reviewed, including summaries of effect sizes. It is concluded that patient satisfaction information can provide a dependent measure of service quality and serves as a predictor of health-related behavior. Issues deserving further investigation and recommendations regarding research strategies are presented.     

The Parent Satisfaction with Foster Care Services Scale.

Client satisfaction measures are an essential component of program evaluation. This article describes the development of a scale for measuring the satisfaction levels of parents whose children have received foster care services. Subjected to various statistical measures, the Parent Satisfaction with Foster Care Services Scale appears to be a reliable instrument with the promise of utility for social work researchers, practitioners, and administrators.