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.     

An analysis of simple counting methods for ordering incomplete ordinal data

Measurement in the social sciences often involves an attempt to completely order a set of entities on the basis of an underlying attribute. However, limitations of the measurement process often prevent complete empirical determination of the desired ordering. Nevertheless, the ordinal data obtained from the measurement process can be used in attempting to recover or construct more of the underlying order than is provided by the data. Previous research (Fishburn and Gehrlein, 1974a) has shown that a simple one-stage construction method, referred to as the cardinal rule, is fairly effective in correctly identifying ordered pairs in the underlying linear order that are not identified by the measurement process. The present paper re-examines the cardinal rule from the perspective of construction methods based on simple counting measures derived from the data, and argues that it is the best one-stage method in this class when a natural monotonicity assumption holds for the measurement process. The paper then examines two-stage construction rules that are based on the cardinal rule and the simple counting measures. It is shown that one of the two-stage rules gives better overall results than does the cardinal rule by itself.     

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.     

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.     

The validity of indices for rural health manpower needs assessment

Population-to-practitioner ratios have long been the primary index in the designation of health manpower shortage areas. This paper documents that application of the widely used population-to-dentist index results in understatement of the need for dental health manpower in rural areas. Through the analysis of utilization data collected from a statewide health screening program in Colorado, the practice of sole reliance on the population-to-dentist indices as an indicator of need was tested. Another measure, the area-(square miles) to-dentist ratio was formulated, examined, and found to be a more useful referent of the need for additional health manpower in rural areas. Utilization of dental services in sparsely settled rural counties of Colorado was unrelated to population-to-dentist ratios. A strong, statistically significant association of utilization with land area-to-dentist ratios was found. The findings of this analysis suggest a need for reevaluation of needs assessment methodologies used in the designation of health manpower shortage areas. Indices more sensitive to consumer circumstance than to the number of health care providers available must be considered.     

Deterrence in the workplace: perceived certainty, perceived severity, and employee theft

The phenomenon of employee theft is examined empirically, utilizing a deterrence paradigm. Employees selected randomly from three different industry sectors and metropolitan areas were asked to self-report their involvement in a number of property theft activities within the employment setting. Using a weighted least-squares logit regression analysis, the study found that the perception of both the certainty and severity of organizational sanctions were related to employee theft. Males reported more theft than did females, but contrary to previous research, no gender/certainty or gender/severity interactions were observed. The best-fit model did, however, contain two significant first-order interactions: age/certainty and age/severity. These interactions strongly suggest that younger employees are not as deterrable as their older peers, especially under conditions of both high certainty and high severity of punishment. While a number of possible explanations might account for differential deterrability according to age, a commitment to or stakes in conformity explanation is proposed.