Developing and Testing a Satisfaction Survey for Nursing Home Residents

Abstract

Input from consumers has become an important part of quality improvement in long-term care and for consumer decision-making. This paper documents the development of the Ohio Nursing Home Resident Satisfaction Survey (ONHRSS) through a partnership of state government, research, and industry experts. The instrument was tested and refined through two waves of data—a pretest phase and later with statewide data. Exploratory and confirmatory analyses with statewide data identified eight primary factors along with an underlying, secondary Global Satisfaction factor. Reliability of the domains ranged from .69 to .95. Recommendations for further refinement and testing of the instrument are discussed along with policy and practice implications.     

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.     

Satisfaction With Family Life Scale

We wanted to present validity and reliability data for the Satisfaction With Family Life (SWFL) scale. This instrument has been successfully used in a variety of family samples and offers a brief, widely applicable tool to measure satisfaction with family life. The SWFL scale, modeled after the Satisfaction With Life scale, was designed to assess an individual's global judgment of family satisfaction, which is theoretically predicted to depend on a comparison of family life circumstances with one's own standards and expectations. The scale consists of five items on a Likert-type scale. Data were collected from parents and adolescents in 15 different family samples that vary across time, place, and culture. Across all samples a consistent unidimensional factor structure was maintained, with Cronbach's alpha ranging from .94 to .79. Evidence of usability, criterion, and construct validity were also established. The SWFL scale consistently distinguishes differences in family satisfaction among samples that would theoretically be predicted to have different levels of family satisfaction. The SWFL scale provides a brief, psychometrically sound, and widely applicable option for measuring satisfaction with family life.     

Implementation and results of the statewide ONHRSS

In response to increased consumer demand, state governments are publishing more detailed information about the quality of nursing homes. In 2002, Ohio legislation mandated the publication of a Long-Term Care Consumer Guide that included information on nursing home resident and family satisfaction surveys. Using the 2002 Ohio Nursing Home Resident Satisfaction Survey as an example, this article addresses two research questions: (1) how can statewide resident face-to-face satisfaction interviews be implemented to maximize participation of residents and facilities and produce reliable and valid results, and (2) how satisfied are residents with their nursing home experiences, overall and by level of cognitive function.     

Measuring Adherence to Alternative vs. Conventional Agricultural Paradigms: A Proposed Scale*

Abstract Current debates and conflicts in agriculture appear to reflect the competing perspectives of two increasingly distinct camps of agricultural stakeholders: proponents of “alternative agriculture” and proponents of “conventional agriculture.” Several analysts have argued that members of these two camps hold fundamentally divergent paradigms of agriculture, and thus, literally see the world quite differently. The purpose of this paper is to describe an instrument—the Alternative-Conventional Agriculture Paradigm Scale (or ACAP Scale)—developed to measure the basic beliefs and values assumed to constitute the two competing perspectives in agriculture. Items designed to tap all of the major dimensions identified in the alternative-conventional agriculture debate were included in surveys of known groups of alternative and conventional agriculturalists, as well as in a statewide survey of farmers. The items discriminate significantly between the three samples (with the statewide farmer sample taking the intermediate position), suggesting their validity as measures of the elements of the competing agricultural paradigms. The items also exhibit a high degree of internal consistency, indicating the appropriateness of combining them into a single instrument to measure adherence to alternative versus conventional agriculture. As expected, the known groups provide more consistent responses than do the statewide sample of farmers, presumably reflecting the greater ideological coherence of social movement and interest group members. However, the alternative agriculturalists are far more consistent than are the conventional agriculturalists, and potential explanations for this finding are drawn from recent work on social movements.     

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.     

Developing a Community Attitude Assessment Scale

The Community Attitude Assessment Scale (CAAS) measures citizens'attitudes toward 15 community Life Areas (e.g., Education, Employment,and Health) on four dimensions—Importance, Influence,Equality of Opportunity, and Satisfaction. Residents generallyrate these Life Areas high on Importance and Equality of Opportunity,but feel only limited Satisfaction with them and perceive themselvesas having fairly low Influence on their operations. The scaleis discussed as an instrument, and in terms of community theory,attitude theory and research, and public policy applications     

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.     

The Social Basis of Agro‐Environmental Concern: Physical versus Social Proximity

Abstract In this study, we explore the social basis of environmental concern, specifically focusing on attitudes about the agricultural environment in relation to an individual's geographic and social distance from agriculture. We also consider the significance of rural recreational behaviors in relation to agro‐environmental concern. The analysis, based on data from a statewide survey of Ohioans, reveals a strong relationship between one's geographic location along the rural‐urban continuum and attitudes about agriculture and the environment. This relationship, though, does not exist once the effects of social proximity to agriculture are accounted for, suggesting that the relationship between residential location along the rural‐urban continuum and agro‐environmental attitudes may be spurious. The analysis also reveals a strong relationship between participation in rural recreation and attitudes about agriculture and the environment. We describe several conceptual and practical implications of this research for natural‐resource management.     

Income Satisfaction Inequality and its Causes

In this paper, the concept of Income Satisfaction Inequality is operationalized on the basis of individual responses to an Income Satisfaction question posed in the German Socio-Economic Panel (GSOEP). Income satisfaction is the subjective analogue of the objective income concept. The paper introduces a method to decompose Income Satisfaction Inequality according to the contributions from variables such as income, education, and the number of children. Given the panel structure of the data, inequality may be attributed partly to permanent individual circumstances and partly to transitory changes. The paper shows that by far the largest part of the satisfaction inequality has to be ascribed to unobserved heterogeneity. Distinguishing between a structural and an unexplained part of inequality we find that income explains the largest part of structural Income Satisfaction Inequality together with household membership; for non-working individuals, the age distribution is very relevant as well.     

Clients' views of live supervision and satisfaction with therapy

In this study we examined clients' perceptions of live supervision and their satisfaction with therapy in a university-based training clinic for marriage and family therapists. A total of 108 clients completed the Client Satisfaction Questionnaire-8 and a modified version of the Purdue Live Observation Satisfaction Scale. Clients' comments on the advantages and disadvantages of live supervision were also solicited through short-answer questions. Results indicated that clients were generally satisfied with therapy and found the live-supervision process satisfactory as long as the perceived helpfulness of live supervision outweighed its perceived intrusiveness. The challenge for training clinics is striking a balance between helpfulness and intrusiveness in an effort to both train competent therapists and provide quality treatment.     

Statewide substance abuse prevention planning

The State of Rhode Island contracted with the authors to prepare a statewide, comprehensive substance abuse prevention plan. The literature review revealed a lack of research on statewide planning for prevention services. To obtain data for Rhode Island's plan, the authors conducted a family of studies including synthetic estimation, key informant interviews, a telephone survey of agency directors, program budget analysis, construction of a statistical index for estimating the optimal geographic allocation of prevention dollars, and a review of General Laws regarding tobacco, alcohol, and other drugs. Their recommendations include the increased funding and coordination of prevention services, allocating services according to need rather than population size, greater use of social policy as a prevention tool, and a shift in primary prevention programming from senior high to lower grades and in program emphasis from information-education to psychosocial programs.     

The Seven Pillars of Quality Care in a Statewide Pediatric Sexual Assault Nurse Examiner Program

This article describes a systematic approach used by a statewide pediatric sexual assault nurse examiner program to ensure the quality of forensic medical examinations it provides in child sexual abuse investigations. Seven strategies for enhancing quality are described: (a) hiring experienced professionals, (b) effective training, (c) comprehensive protocols, (d) ample support for pediatric sexual assault nurses, (e) management oversight, (f) a clinical coordinator to provide ongoing training and technical assistance, and (g) a quality assurance process in which expert child abuse pediatricians review each statewide pediatric sexual assault nurse examination. To show the evolution of quality care over time, the program's experience from 2004 to 2010 is reviewed, and quality assurance data are analyzed.     

The emerging role of adoption reunion registries: adoptee and birthparent views

Since the 1980s, government-sponsored adoption reunion registries have emerged as key access points for individuals separated by adoption to secure information and initiate efforts to be reunited with their birth-families. Despite the prevalence of such registries, little information is available about their operational effectiveness. This article presents data from a survey of adult adoptees and birthparents who used the services of a statewide reunion registry.     

Training consumers to collect data in mental health service system evaluation research

Consumer satisfaction with services is an outcome measure. This report describes The Consumer Satisfaction Research Associate Training Program, which was designed for the education and supervision of recovered consumers who collected data during four studies at three psychiatric hospitals. The educational program had didactic and laboratory components. Consumer research associates collected quantitative and qualitative data using a survey tool for face-to-face interviews. Participant recruitment and management of confidential records were included in the role. Data collected by research associates from consumers who are in treatment can enhance the validity and trustworthiness of satisfaction surveys. Nurses can play an important role in the research process by serving as staff resources for consumers who collect data in various service system settings.     

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.     

EXPLAINING PUBLIC SUPPORT FOR LEGISLATIVE TERM LIMITS

A number of theories have been offered to explain popular supportfor term limits and their passage in states across the country.Using survey data from the 1992 American National Election Studyand several other statewide surveys, this article examines thefollowing explanations for term limits support: dissatisfactionwith Congress and state legislatures, cynicism, self-interest,and ideology. An analysis of these data suggest that term limitssupport is not influenced by a dissatisfaction with legislaturesor particular incumbents or by a specific ideology. Instead,support for term limits is related to cynicism and, to someextent, self-interest.     

The National Family Caregiver Support Program: A Multivariate Examination of State-Level Implementation

Research on caregiver support policy implementation has offered valuable insights but has not incorporated theoretical frameworks or multivariate analysis. This article describes how the communications model for intergovernmental policy implementation was used as a framework to examine predictors of successful statewide implementation of the National Family Caregiver Support Program (NFCSP). Using data from the National Center on Caregiving State of the States survey, U.S. Census, Administration on Aging, and historical records, implementation (extent of service delivery) was examined in 50 states and the District of Columbia. State-level characteristics (demographic, historical, political, and organizational) were tested for their ability to explain more or less successful implementation. Bivariate and multivariate findings suggest that historical characteristics predict the likelihood of delivering more counseling, support group, and training. States that recognize caregivers as both service recipients (through counseling and support groups) and service providers (through training) may demonstrate more effective implementation.     

Financial Strain and Depression Among Farm Operators: The Role of Perceived Economic Hardship and Personal Control1

Abstract The causal processes accounting for the relationship between farm financial strain and depression are not well understood. Using data from a statewide survey of North Carolina farm operators, we develop a covariance structure model that specifies relationships among farm financial strain, perceived economic hardship in the household, personal control, and depression. Analyses reveal that the relationship between farm financial strain and depression is mediated by perceptions of economic hardship and personal control. Results point to the importance of differential resilience to objective economic problems instead of differential exposure to these problems.     

Transition from Home Care to Nursing Home: Unmet Needs in a Home- and Community-Based Program for Older Adults

A major effort is under way nationally to shift long-term care services from institutional to home- and community-based settings. This article employs quantitative and qualitative methods to identify unmet needs of consumers who transition from a statewide home- and community-based service program for older adults to long-term nursing home residence. Administrative data, care manager notes, and focus group discussions identified program service gaps that inadequately accommodated acute health problems, mental health issues, and stressed family caregivers; additional unmet needs highlighted an inadequate workforce, transportation barriers, and limited supportive housing options. National and state-level policy implications are considered.