Der Zürcher Fragebogen zur Patientenzufriedenheit in der Psychiatrie: Entwicklung und Charakteristika

Abstract

Since the beginning of the 1990s, an increasing attention has been paid to patients' satisfaction with the care they receive. Personal satisfaction is a part of the measurement of the outcome quality in general. We reporton the development and characteristics of a new self-rating questionnaire designed for psychiatric patients to assess the satisfaction with their care. Mentally ill patients have been shown to be well able to give valid estimates in this regard. Relevant areas were defined in four focus groups with psychiatric inpatients, four focus groups with psychiatric staff of different professional background and one focus group with patients' relatives. The participants' views were collected, systematically categorised, and questionnaire items were formulated considering the most important categories and participants' verbatim statements. To assess the dimension of general satisfaction the short uni-dimensional satisfaction questionnaire ZUF-8 has been incorporated; besides, a broad spectrum of different areas of interest were considered. The first version of the questionnaire was tested in two pretests with regard to the acceptance of the questionnaire and its formal criteria. In the 1st pretest, 157 completed questionnaires were obtained from hospitalised patients, in the 2nd pretest, 51 completed questionnaires from patients just leaving the hospital. The questionnaire was both times well accepted, the patients needed about 10 minutes (median) to fill it out and in the 2nd pretest with the slightly adjusted questionnaire no equivocal or not understandable questions were reported. Afterwards, the questionnaire was tested in five psychiatric hospitals of the Canton of Zurich in two investigations. In the 1st investigation, patients were asked immediately before their discharge to complete the Zurich Questionnaire and the Munsterlinger Questionnaire, another approved Swiss self-rating instrument to assess satisfaction with the psychiatric care. In the 2nd investigation, the same patients were asked 10 days after their discharge to fill out the Zurich Questionnaire once again. Results, based on 288 and 110 completed questionnaires respectively, demonstrate that only exceptionally questions were not answered. The answers were generally well distributed, the highest degree of satisfaction having been indicated in less than 50% on average. Practically all items differentiated well or at least in an acceptable way between satisfied and not satisfied patients. In a factor analysis 6 factors were extracted explaining 59% of the variance. Repeating the procedure with the data from the 2nd investigation, the 6-factor solution could be replicated; sufficiently high inner consistence was confirmed for the first factor on which all ZUF-8 items loaded. The Zurich Questionnaire was found to be reliable: Cronbach's alpha was 0.89 in the first and 0.91 in the 2nd investigation, and comparing the individual scores of both investigations, the 10-14 days test-retest correlation coefficient was 0.74. ZUF-8 items correlated with the remaining items of the questionnaire with r = 0.75 and 0.76 respectively, the scores of Zurich Questionnaire correlated with scores of Munsterlinger Questionnaire with r = 0.71 pointing to an acceptable convergent validity of the questionnaire. Generally, there was a tendency for older, better-insured and voluntary admitted patients to indicate higher ratings and thus higher satisfaction. Comparing the average satisfaction ratings of the 1st and 2nd investigation by the same patients, practically the same results were obtained. Summing up, the Zurich Questionnaire, largely constructed on the basis of the patients' statements in the focus groups, proved to be well accepted by the patients. The questionnaire also proved to be reliable and valid and can easily be used. Accordingly, it has been approved by the responsible Swiss authorities as a standard instrument to assess satisfaction of the patients with the ps