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.     

Disability, social exclusion and the consequential experience of justiciable problems

In this article, we examine the situation of disabled people in England and Wales with regard to one specific aspect of social exclusion—experience of justiciable problems, and the potential effects such problems can have on their lives. Having defined 'disability', we examine how this fits within the wider dialogue on social exclusion issues. By analysing the results of the Legal Services Research Centre's (LSRC) periodic survey of justiciable problems, we find that disabled respondents were not only more likely to experience a problem, they also experienced more problems. Increased likelihood of a problem was observed in the majority of problem categories and particularly those relating to issues of social exclusion, such as housing and welfare benefits. This propensity to experience multiple problems can lead to a negative impact on the lives of long-term ill and disabled people.     

Lone Parents and Civil Law: Their Experience of Problems and Their Advice-seeking Behaviour

The percentage of dependent children living in lone‐parent families has more than tripled in Britain over the last 30 years. Though there is much diversity within this lone‐parent population, there are common experiences and characteristics. Lone‐parent families tend to be headed by women, to be poor, on benefits and experience problems with ill health and disability. This paper examines lone parenthood in the context of the experience of justiciable problems (problems for which there is a potential legal remedy), drawing upon a large‐scale survey of 5,611 people representative of the population of England and Wales. The survey included 223 lone parents, who were likely to be female, to be living in rented accommodation, to be on a low income, to be economically inactive and to be in receipt of benefits. Lone parents were significantly more likely than others to have experienced a justiciable problem. Lone parents sought advice for their problems more often than others, particularly from solicitors, even after controlling for problems experienced. Lone parents were more likely than others to receive legal‐aid funding. Lastly, lone parents found trying to resolve problems particularly stressful, though they tended to believe that their life had improved as a consequence of doing so.     

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.     

A sociology of bullying: Placing youth aggression in social context

In this paper we review the sociological literature on peer aggression among adolescents and demonstrate how it can form the basis of a new subfield in sociology on the subject of bullying. Although sociologists have mostly avoided the term bullying in classic works on adolescent aggression, these studies suggest that institutional social control, status hierarchies and social inequalities provide important social context for youth aggression. While historically they have not been in dialog with each other, when taken together sociological research on youth status relations and social networks, systemic bias, school culture and social ecology can lay the foundation of a sociology of bullying. We suggest that if sociologists see this work as shedding light on issues of bullying, they can begin to play a larger role in the shaping of the national conversation on bullying and influence anti-bullying programs in schools to take better account of the social dimensions of bullying.     

The evaluation ranking scale: clarification of methodological and procedural issues

Compared with CSQ-8, a typical questionnaire approach to assessing global patient satisfaction, the Evaluation Ranking Scale (ERS) had equally good patient acceptability, yielded more normally distributed satisfaction scores, and results allowed comparative information about patients' evaluation of specific service dimensions. The study also addressed key questions that have emerged about the ERS procedure. Patients apparently do not distinguish conceptually between "importance" of dimensions and "satisfaction" with dimensions in the first phase (ranking) of the ERS. Results did confirm that the ERS sequence of ranking and then rating the dimensions is essential to achieving optimal utility of results. The ranking task seems to have an organizing effect on patients' approach to the rating task. This effect does not work to dictate results in the rating phase but rather seems to familiarize patients with the dimensions to be rated thereby yielding greater potential discriminative capacity for the ERS. Finally, results indicate that the ERS can be administered in a flexible fashion that yields additional information about the absolute importance of the six dimensions without loss of desired operating characteristics for the measure.     

The evaluation ranking scale: a new methodology for assessing satisfaction

Most patient satisfaction scales produce high, undifferentiated levels of reported satisfaction that fail to detect program areas that consumers do not like. Methodological problems apparently contribute to these results. An alternative procedure, the Evaluation Ranking Scale (ERS), was formulated and tested. A 2 X 3 design was employed with 246 public health center patients randomly assigned to one of two measurement techniques (ERS vs. a global measure) and one of three informational sets. A secondary group of subjects was a convenience sample of 26 staff members, which allowed comparisons of staff evaluations of the health center to patients' evaluations of the health center. Compared to the global measure, the ERS provided more specific information about particular program components, was more discriminating, and resulted in mean satisfaction scores that were significantly lower. This new approach may be a more effective technique for assessing the psychosocial effectiveness of human service programs.     

Social Exclusion and Civil Law: Experience of Civil Justice Problems among Vulnerable Groups

Combating social exclusion has become a priority target for many governments and was a key factor in the establishment of the Legal Services Commission (LSC) and the Community Legal Service (CLS) in England and Wales in April 2000. This study aims to assess whether socially excluded groups within the general population are more likely to suffer justiciable problems (problems for which there is a potential legal remedy) and whether such groups differ in their problem resolution strategies and advice‐seeking behaviour. We draw upon a large‐scale survey of 5,611 people representative of the population of England and Wales, and a further survey of 197 people in temporary accommodation. Five vulnerable groups are extracted: survey respondents with a long‐term illness or disability, young and elderly respondents, low‐income respondents and those living in temporary accommodation. We identify how some of these vulnerable groups have a high likelihood of experiencing justiciable problems. We also examine advice‐seeking strategies among our vulnerable groups and, where contact was made, which advisers were typically contacted. The findings demonstrate the potentially crucial role of access to justice and advice and legal services in tackling social exclusion.     

Disabled people and disaster management in New Zealand: examining online media messages

This article explores how disability and disabled people were portrayed in New Zealand online media between 2006 and 2016, with specific reference to disasters. Following a process of content analysis, the findings indicated that post disaster, persistent advocacy was required and ensuring accessibility, immediately following a disaster as well as in the recovery phase, was a significant issue. Disabled people were also primarily presented as a vulnerable cohort and the wide-ranging issues highlighted in the media suggest they currently have minimal voice in the four disaster management stages of risk reduction, readiness, response and recovery. This article emphasises the utilisation of relationships, skills and knowledge between individuals and Disabled People’s Organisations to strengthen the disability and disaster management discourse and activity. Increased inclusion of disabled people across all phases of disaster management will assist with the New Zealand government meeting its aspiration of a non-disabling society, especially during future disaster events.