Abstract
BackgroundPerson-centredness is promoted as a central feature of the long-term care of older adults. Measures are needed to assist researchers, service planners and regulators in assessing this feature of quality. However, no systematic review exists to identify potential instruments and to provide a critical appraisal of their measurement properties.MethodA systematic review of measures of person-centredness was undertaken. Inclusion criteria restricted references to multi-item instruments designed for older adult services, or otherwise with measurement properties tested in an older adult population. A two-stage critical appraisal was conducted. First, the methodological quality of included references was assessed using the COSMIN toolkit. Second, seven measurement properties were rated using widely-recognised thresholds of acceptability. These results were then synthesised to provide an overall appraisal of the strength of evidence for each measurement property for each instrument.ResultsEleven measures tested in 22 references were included. Six instruments were designed principally for use in long-stay residential facilities, and four were for ambulatory hospital or clinic-based services. Only one measure was designed mainly for completion by users of home care services. No measure could be assessed across all seven measurement properties. Despite some instruments having promising measurement properties, this was consistently undermined by the poor methodological quality underpinning them. Testing of hypotheses to support construct validity was of particularly low quality, whilst measurement error was rarely assessed. Two measures were identified as having been the subject of the most rigorous testing.ConclusionThe review is unable to unequivocally recommend any measures of person-centredness for use in older adult care. Researchers are advised to improve methodological rigour when testing instruments. Efforts may be best focused on testing a narrower range of measurement properties but to a higher standard, and ensuring that translations to new languages are resisted until strong measurement properties are demonstrated in the original tongue. Limitations of the review include inevitable semantic and conceptual challenges involved in defining ‘person-centredness’.The review protocol was registered with PROSPERO (ref: CRD42014005935).Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0229-y) contains supplementary material, which is available to authorized users.
Highlights
Person-centredness is promoted as a central feature of the long-term care of older adults
No measure could be assessed across all seven measurement properties
Of the 11 instruments included in the review, four stood out as having been the subject of tests of measurement properties in three or more studies, and together accounted for over half of the 22 references: the Individualised Care Instrument (ICI) [29,30,31]; Person-Centred Care Assessment Tool (P-CAT) [32,33,34,35]; the Person-centred
Summary
As in any research field, the acceptance of empirically-derived estimates without critical appraisal undermines the evidence-base [26]. The purpose of this review is to address this gap. Those seeking to evaluate change and improve standards have limited evidence to support their choice of measurement instruments. This review aimed to identify, describe and critically appraise relevant measures
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