Abstract
BackgroundA widely discussed design issue in patient satisfaction questionnaires is the optimal length and labelling of the answering scale. The aim of the present study was to compare intra-individually the answers on two response scales to five general questions evaluating patients’ perception of hospital care.MethodsBetween November 2011 and January 2012, all in-hospital patients at a Swiss University Hospital received a patient satisfaction questionnaire on an adjectival scale with three to four labelled categories (LS) and five redundant questions displayed on an 11-point end-anchored numeric scale (NS). The scales were compared concerning ceiling effect, internal consistency (Cronbach’s alpha), individual item answers (Spearman’s rank correlation), and concerning overall satisfaction by calculating an overall percentage score (sum of all answers related to the maximum possible sum).ResultsThe response rate was 41% (2957/7158), of which 2400 (81%) completely filled out all questions. Baseline characteristics of the responders and non-responders were similar. Floor and ceiling effect were high on both response scales, but more pronounced on the LS than on the NS. Cronbach’s alpha was higher on the NS than on the LS. There was a strong individual item correlation between both answering scales in questions regarding the intent to return, quality of treatment and the judgement whether the patient was treated with respect and dignity, but a lower correlation concerning satisfactory information transfer by physicians or nurses, where only three categories were available in the LS. The overall percentage score showed a comparable distribution, but with a wider spread of lower satisfaction in the NS.ConclusionsSince the longer scale did not substantially reduce the ceiling effect, the type of questions rather than the type of answering scale could be addressed with a focus on specific questions about concrete situations instead of general questions. Moreover, the low correlation in questions about information provision suggests that only three possible response choices are insufficient. Further investigations are needed to find a more sensitive scale discriminating high-end ratings. Otherwise, a longitudinal within-hospital or a cross-sectional between-hospital comparison of patient care is questionable.
Highlights
A widely discussed design issue in patient satisfaction questionnaires is the optimal length and labelling of the answering scale
Patients who completely filled out all questions (Webappendix: Additional file 3) showed similar baseline characteristics as those who sent back the questionnaire (Table 1)
The results of the comparison of Cronbach’s alpha, the individual items and of the overall percentage score did not greatly differ from overall results (Webappendix: Additional file 7). This intra-individual answering scale comparison shows that patients’ perception of hospital care in this public teaching hospital is high without a substantial reduction in floor and ceiling effects on the numeric compared to the labelled adjectival response scale
Summary
A widely discussed design issue in patient satisfaction questionnaires is the optimal length and labelling of the answering scale. The aim of the present study was to compare intra-individually the answers on two response scales to five general questions evaluating patients’ perception of hospital care. Measuring patients’ perception of hospital care after inpatient treatment is an important tool to identify strengths, weaknesses and unmet needs in healthcare services, as well as to identify changes in patient satisfaction over time. The ultimate goal is to improve the quality of healthcare It allows the comparison of different hospitals’ performance. Patient satisfaction is frequently assessed using questionnaires When designing such questionnaires, several aspects need to be carefully evaluated in order to achieve a reliable and valid instrument. Preston and Colman [6] could show that reliability, validity and discrimination were significantly higher in scales with up to about seven response categories. Respondents considered scales with up to seven response categories a good compromise between ease of use and discriminative capacity
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
