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.     

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.     

Blacks, whites, and attitudes towards abortion

This article examines patterns of black and white support forabortion from 1972 to 1980. The findings reveal that black-whitedifferences are present on the abortion issue. Many of the differencesare due to the different demographic characteristics of blacksand whites and the greater degree of religiosity of blacks.     

The determinants of modern Maltese emigration

The author evaluates studies by Huw R. Jones and Russell King concerning the determinants of emigration from Malta and tests a new set of migration functions using cross-sectional and time-series data for the inter-censal years 1957 to 1967. Jones and King concluded that emigration was influenced more by socio-demographic factors than by economic forces. In the present article, the author concludes that economic factors did influence the decision to migrate from Malta. The policy implications of these findings are also considered. (summary in FRE, SPA)     

The impact of revolution on social welfare in Latin America

Conclusion The foregoing analysis assessed ways that revolutions affected the social welfare of Latin Americans. It compared differences between societies of roughly similar levels of economic development that did and did not have revolutions, revolutions ushered in by different class alliances, revolutions instituting different modes of production, and revolutions occurring in countries differently situated within the world economy. The class transformations in Mexico, Bolivia, Cuba, and Peru gave rise to more egalitarian societies than they displaced, but low income groups in each country gained most during the new regimes' consolidation of power. Subsequently, the interests of the popular sectors were sacrificed to those of middle and upper income groups. The rural masses benefited from revolution mainly in conjunction with agrarian reforms.Agrarian reforms have been promulgated in all the countries under study, but a much larger proportion of the agrarian population and a much larger proportion of the farmland has been redistributed in the four countries that had political upheavals than in the paired countries that did not. Whereas all the land reforms perpetuate minifundismo, recipients of land titles enjoy a modicum of security and the opportunity to appropriate the full product of their labor, which rural wage workers and peasants dependent on usufruct arrangements do not.Examining the countries that have had revolutions shows that peasants and workers do not necessarily benefit most when they participate in the destruction of the old order. Peasants and rural farm laborers gained land where they were disruptive, but in Mexico only after a global Depression weakened the ability of large landowners to resist expropriation. The Peruvian experience demonstrates that rural laborers may benefit even if they are politically quiescent at the time of the extralegal takeover of power, and that they may, under certain conditions, gain benefits sooner after revolutions from above than after revolutions from below. The level of development of the economy and the way the societies have been integrated into the world economy historically limit what Third World revolutions can accomplish, quite independently of how the upheavals originated. The four revolutionary governments adapted land policies to property relations under the anciens régimes, and they reorganized agriculture to profit from trade. Global constraints have also been one factor restricting labor's ability to improve its earning power and influence over the organization of production. Labor did benefit from the upheavals, but as the postrevolutionary governments became concerned with attracting foreign investment and foreign financial assistance, and with improving profits from trade, labor was marginalized. The Mexican-Brazilian comparison, however, suggests that the middle class and the small proportion of workers employed in the oligopolistic sector benefit more and the richest 5% less in societies where civilian groups have been incorporated into the political apparatus as a result of revolution than in equally industrialized societies where they have been excluded, in the absence of revolution.Revolutionary-linked forces may modify the income generating effect of capitalist industrial dynamics, though not to the advantage of the lowest income earners.The dominant mode of production instituted under the new order is the aspect of revolution most affecting patterns of land and income distribution and health care. To the extent that ownership of the economy is socialized the state has direct access to the surplus generated. Although the Cuban state has not consistently allocated the resources it controls to low income groups, because the Castro regime need not provide a favorable investment climate, it can more readily redistribute wealth downward than can the capitalist regimes. It accordingly has also been freer to redesign the health care delivery system in accordance with societal needs rather than business interests and market power. But the Cuban experience suggests that the distributive effects even of socialist revolutions can be limited. Although socialism allows certain allocative options that capitalism does not, the capacity to improve the welfare of Third World people by any revolutionary means is constricted by the weak position of less developed nations within the global economy, by investment-consumption tradeoffs, and by internal political and economic pressures.     

Medical care, living conditions, and children's well-being

We examine the effect of medical care and living conditions on children's physical and psychological well-being. We develop a causal model in which living conditions (including the socioeconomic status of the family and the social-psychological aspects of family functioning) may affect well-being both directly, and indirectly through medical care. We find that families in the higher social classes and families that function well tend to go to large prepaid groups where they receive good medical care. High quality technical care of illness, in turn, improves physical health. The quality of psychotherapeutic care, on the other hand, has no effect on psychological well-being. For this aspect of health, the effect of living conditions is largely direct, rather than indirect by way of medical care. Families characterized by high levels of functioning have children who are psychologically healthy. In addition, physical health affects psychological well-being, but not vice versa.     

Are sex differences in nonverbal and verbal behavior generalizable to mentally retarded persons?

Sex differences in three communication behaviors consistently found to be more common among females than males — smiling, gazing at one's partner, and sentence complexity — were examined through analysis of interviews with 78 institutionalized mentally retarded adults. While females were significantly more likely than males to smile or laugh, and tended to use longer, more complex sentences, the commonly observed sex difference in gazing failed to generalize to a retarded sample. These findings clarify limits on the generalizability of sex differences beyond college students and other normal populations.This research was partially supported by a grant to the Texas Tech University Research and Training Center in Mental Retardation from the Rehabilitation Services Administration, Department of Health Education, and Welfare.