Health-Related Quality of Life and Life Satisfaction in a Greek Refugee Accommodation Center.

Introduction In recent years, a large number of refugees have crossed the Greek borders. The aim of this study was to estimate the health-related quality of life (HRQoL) and life satisfaction (LS) of refugees and asylum seekers residing in the Vagiochori Accommodation Center. Methods The Short Form-36 (SF-36) survey tool and the Satisfaction With Life Scale (SWLS) were employed for the analysis. The sample consists of 144 individuals with an average age of 39.4 years, most of which are Afghans, married, and have a secondary education level. Non-parametric tests examined the association of respondents' demographics and health-related and residence-related characteristics with the physical component scale (PCS) and mental component scale (MCS) of SF-36 and SWLS. Regression analysis was used to examine the effect of these variables on dependent scales. Results HRQoL and LS of the participants were poor (median scores: PCS = 44.91, MCS = 42.05, and SWLS = 12.00). Age, gender, education, marital status, and specific health-related and residence-related characteristics were associated with HRQoL (p < 0.05). Marital status and specific health-related and residence-related characteristics were associated with SWLS. Conclusion In summary, social support, legal counseling, and a better understanding of refugees' concerns are required to improve refugees' and asylum seekers' HRQoL and LS.

Health-Related Quality of Life Among Refugees and Asylum Seekers in Northern Greece.

We aimed at assessing the health-related quality-of-life (HRQoL) of refugees and asylum seekers in Northern Greece. The SF-36 Health Survey was used to assess participants' HRQoL. Participants were contacted in person. Correlation and dependence tests were employed to examine the association of participants' demographic, residence-related and medical-related characteristics with the two SF-36 component (physical-PCS/mental-MCS) scales. Regressions were conducted to investigate the effect of these characteristics on component scales. Refugees and asylum seekers (n = 161) living in urban apartments and camps in Northern Greece participated in the study reporting poor HRQoL (PCS = 43.9, MCS = 39.5). Age, gender, duration of stay, benefits offered by Non-Governmental Organisations (NGOs), type of accommodation, suffering from a serious health problem and receipt of medication were associated with HRQoL. This study constitutes the first research assessing HRQoL of refugees and asylum seekers in Northern Greece.

Examining Willingness-to-Pay and Zero Valuations for a Health Improvement with Logistic Regression.

Study aim was to elicit the Greek general population's willingness-to-pay (WTP) for a health improvement (recovery to perfect health), examine attitudinal differences between willing- and unwilling-to-pay individuals regarding healthcare services provision, and investigate -using a logistic regression model-demographic/socioeconomic factors impact on their intention to pay for a health improvement. A research tool was developed to conduct a cross-sectional stated-preference telephone-based survey (January-February 2019) and a representative sample (n = 1342) of the Greek general population was queried. The computer-assisted telephone-interview (CATI) method was used to ensure random sampling. WTP was elicited using the iterative bidding technique. Participants' attitudes toward healthcare services provision were assessed through pre-defined statements. Test-retest reliability of these statements was assessed using intraclass correlation coefficients (ICC). Logistic regression was employed to identify sociodemographic factors' effect on WTP intention. Differences among individuals' attitudes were assessed using the chi-square test. All analyses were conducted using the IBM SPSS Software v.25.0. Analysis showed acceptable reliability for WTP estimates (ICC = .67) and good reliability for healthcare services assessment statements (ICC = .83-.94). Mean WTP was estimated at €439.8. Respondents with higher educational level and higher household income were more likely to be willing to pay for a health improvement. On the contrary, older participants were less likely to be willing to pay. Most participants who considered public healthcare services to be of high quality were unwilling to pay. Logistic regression analysis led to the development of an effective predictive model regarding factors affecting individuals' WTP intention for a health improvement. Further classification of unwilling-to-pay individuals into protest responders and "true" zero valuators showed that protest responders are unlikely to be representative of the population. Hence, study results can be used for debiasing WTP responses, leading to a more accurate use of WTP estimates by policy makers, exploiting WTP values in medical interventions cost-benefit analysis within reimbursement decisions framework.

Performance obstacles of nurses in intensive care units of Greek National Health System hospitals.

BACKGROUND: Nurses in intensive care units confront various challenges and problems during their everyday work that adversely affect performance and patient safety. Despite their importance, performance obstacles have been studied extensively only in the USA, with no validated instrument being available in the Greek setting for their measurement. AIMS AND OBJECTIVES: To develop a questionnaire that quantifies the obstacles nurses of intensive care units (ICUs) of Greek hospitals might be facing and examine its properties; to assess if such obstacles existed in selected Greek National Health System hospitals. METHODS: A questionnaire was developed and administered to nurses who were working in intensive care units in Thessaloniki. Exploratory factor analysis was applied, and the reliability, validity and ceiling and floor effects of the constructed scales were evaluated. The potential influence of socio-demographic characteristics on scale scores was assessed by independent sample t-tests and analysis of variance (ANOVA). Summated mean and median scores were computed. RESULTS: Two hundred and five nurses participated with a response rate of 65·3%. Resulting scales were 'Space Adequacy', 'Staff Collaboration', 'Materials' Suitability', 'Time Inefficiencies' and 'Psychological Aggravation'. Cronbach's alpha values ranged between 0·67 and 0·86. Multi-trait analysis confirmed construct validity. Ceiling effects were reasonable, whereas floor effects took acceptable values with the exception of the 'Materials' Suitability' scale. The medians of the scales ranged from 1·50 to 3·33. In terms of the measurement of performance obstacles per se, we found that considerable problems exist in the ICUs in all dimensions. Specifically, the suitability of hospital materials, the lack of appropriate spaces and facilities design and psychological distress were recorded as the most serious. CONCLUSIONS: The questionnaire is a promising tool that can be exploited in the health care system to assess the obstacles faced by intensive care nursing staff. In fact, there is considerable room for performance improvement in hospitals in Northern Greece. RECOMMENDATIONS: Nursing administrators and health care policy makers should administer the questionnaire in all Greek hospitals in order to quantify performance obstacles and identify potential managerial remedies.

Comparative validation of the WOMAC osteoarthritis and Lequesne algofunctional indices in Greek patients with hip or knee osteoarthritis.

PURPOSE: To comparatively evaluate the reliability and validity of the Western Ontario and McMaster (WOMAC) and the Lequesne algofunctional indices in Greek patients with hip or knee osteoarthritis (OA). METHODS: The Greek versions of WOMAC LK 3.1 and Lequesne indices were administered to 97 outpatients with OA. Internal consistency reliability was assessed by Cronbach's alpha and item-scale correlations. Test-retest reliability was examined with intraclass correlations. Patients were also asked to complete the Short Form 36 (SF-36) and a Visual Analog Scale capturing strength of pain, in order to assess construct validity. Additional demographic and clinical data were also recorded to evaluate further associations. RESULTS: Cronbach's alpha values of the WOMAC ranged between 0.92 and 0.98 for hip and 0.89-0.97 for knee OA. The respective values for Lequesne were 0.63-0.74 and 0.74-0.80. Item-scale correlations confirmed the superiority of WOMAC with respect to internal consistency reliability. Intraclass correlations were 0.79-0.97 and 0.57-0.98 for hip and 0.86-0.97 and 0.82-0.97 for knee OA, for WOMAC and Lequesne, respectively. The two indices showed high correlations with comparable subscales of SF-36 and the Visual Analog Scale. Significant relationships were identified for age, body mass index, duration of disease, duration of stiffness and radiographic classification. CONCLUSIONS: Our findings, in samples of knee and hip OA patients, indicate that the WOMAC index demonstrates better internal consistency reliability than the Lequesne counterpart, as well as equivalent test-retest reliability and construct validity.

Psychometric properties of the Greek Diabetes Treatment Satisfaction Questionnaire.

OBJECTIVES: Measurement of treatment satisfaction in diabetes is important as it has been shown to be associated with positive outcomes, reduced disease cost and better health. The aim of this study was to assess the construct validity and internal consistency reliability of the Greek version of the Diabetes Treatment Satisfaction Questionnaire (DTSQ). METHODS: A sample of type II diabetes patients (N = 172) completed the DTSQ status version, the SF-36 health survey and also provided data regarding treatment method, clinical and socio-demographic status. Instrument structure, reliability (Cronbach's a) and construct validity (convergent, discriminative, concurrent and known-groups) were assessed. RESULTS: The DTSQ measurement properties were confirmed in the Greek version with confirmatory factor analysis (CFA). Scale reliability was high (Cronbach's a = 0.92). Item-scale internal consistency and discriminant validity were also good, exceeding the designated success criteria. Significant correlations were observed between DTSQ items/overall score and SF-36 scales/component scores, which were hypothesized to measure similar dimensions. Known groups' comparisons yielded consistent support of the construct validity of the instrument. CONCLUSIONS: The instrument was well-accepted by the patients and its psychometric properties were similar to those reported in validation studies of other language versions. Further research, incorporating a longitudinal study design, is required for examining test-retest reliability and responsiveness of the instrument, which were not addressed in this study. Overall, the present results confirm that the DTSQ status version is a reasonable choice for measuring diabetes treatment satisfaction in Greece.

Development and preliminary validation of a questionnaire to measure satisfaction with home care in Greece: an exploratory factor analysis of polychoric correlations.

BACKGROUND: The primary aim of this study was to develop and psychometrically test a Greek-language instrument for measuring satisfaction with home care. The first empirical evidence about the level of satisfaction with these services in Greece is also provided. METHODS: The questionnaire resulted from literature search, on-site observation and cognitive interviews. It was applied in 2006 to a sample of 201 enrollees of five home care programs in the city of Thessaloniki and contains 31 items that measure satisfaction with individual service attributes and are expressed on a 5-point Likert scale. The latter has been usually considered in practice as an interval scale, although it is in principle ordinal. We thus treated the variable as an ordinal one, but also employed the traditional approach in order to compare the findings. Our analysis was therefore based on ordinal measures such as the polychoric correlation, Kendall's Tau b coefficient and ordinal Cronbach's alpha. Exploratory factor analysis was followed by an assessment of internal consistency reliability, test-retest reliability, construct validity and sensitivity. RESULTS: Analyses with ordinal and interval scale measures produced in essence very similar results and identified four multi-item scales. Three of these were found to be reliable and valid: socioeconomic change, staff skills and attitudes and service appropriateness. A fourth dimension -service planning- had lower internal consistency reliability and yet very satisfactory test-retest reliability, construct validity and floor and ceiling effects. The global satisfaction scale created was also quite reliable. Overall, participants were satisfied -yet not very satisfied- with home care services. More room for improvement seems to exist for the socio-economic and planning aspects of care and less for staff skills and attitudes and appropriateness of provided services. CONCLUSIONS: The methods developed seem to be a promising tool for the measurement of home care satisfaction in Greece.

Mapping the cancer-specific EORTC QLQ-C30 to the preference-based EQ-5D, SF-6D, and 15D instruments.

OBJECTIVES: To estimate models, via ordinary least squares regression, for predicting Euro Qol 5D (EQ-5D), Short Form 6D (SF-6D), and 15D utilities from scale scores of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). METHODS: Forty-eight gastric cancer patients, split up into equal subgroups by age, sex, and chemotherapy scheme, were interviewed, and the survey included the QLQ-C30, SF-36, EQ-5D, and 15D instruments, along with sociodemographic and clinical data. Model predictive ability and explanatory power were assessed by root mean square error (RMSE) and adjusted R(2) values, respectively. Pearson's r between predicted and reported utility indices was compared. Three random subsamples, half in size the initial sample, were created and used for "external" validation of the modeling equations. RESULTS: Explanatory power was high, with adjusted R(2) reaching 0.909, 0.833, and 0.611 for 15D, SF-6D, and EQ-5D, respectively. After normalization of RMSE to the range of possible values, the prediction errors were 12.0, 5.4, and 5.6% for EQ-5D, SF-6D, and 15D, respectively. The estimation equations produced a range of utility scores similar to those achievable by the standard scoring algorithms. Predicted and reported indices from the validation samples were comparable thus confirming the previous results. CONCLUSIONS: Evidence on the ability of QLQ-C30 scale scores to validly predict 15D and SF-6D utilities, and to a lesser extent, EQ-5D, has been provided. The modeling equations must be tried in future studies with larger and more diverse samples to confirm their appropriateness for estimating quality-adjusted life-year in cancer-patient trials including only the QLQ-C30.

Valuation and preliminary validation of the Greek 15D in a sample of patients with coronary artery disease.

OBJECTIVE: To replicate, using the Greek version of the 15D instrument, the three-stage valuation procedure, using a sample of coronary artery disease patients; to assess on a preliminary basis the psychometric properties of the instrument in the Greek health-care environment; to evaluate the health-related quality of life of patients with coronary artery disease. METHODS: The generic instrument 15D was translated and culturally adapted into the Greek language and setting. It was then administered during October 2005 to May 2006 to 420 coronary artery disease patients. The three-stage valuation procedure was employed and, with the use of elicited preference weights, a single health-related quality of life index score for the patients was derived. Scores were also calculated using the original Finnish valuation system and compared with the previously derived utilities. Sensitivity, reliability, and validity were assessed by examining response distributions, floor and ceiling effects, item-scale correlations, Cronbach's alpha coefficients, and hypothesized relationships between sociodemographic variables and health-related quality of life. RESULTS: The Greek valuation systematically generated higher 15D utilities than the Finnish one. Nevertheless, the utilities derived with the original Finnish valuation algorithm differed significantly with respect to sex, age, and education, just as they did using the Greek valuation system. In most cases, the full range of possible responses has been used satisfactorily and floor and ceiling effects were generally moderate. In general, internal consistency reliability was also satisfactory. CONCLUSION: The valuation system generated results demonstrating satisfactory psychometric properties. Further research should validate the 15D in the general Greek population.

The effect of environmental factors on technical and scale efficiency of primary health care providers in Greece.

BACKGROUND: The purpose of this study was to compare technical and scale efficiency of primary care centers from the two largest Greek providers, the National Health System (NHS) and the Social Security Foundation (IKA) and to determine if, and how, efficiency is affected by various exogenous factors such as catchment population and location. METHODS: The sample comprised of 194 units (103 NHS and 91 IKA). Efficiency was measured with Data Envelopment Analysis (DEA) using three inputs, -medical staff, nursing/paramedical staff, administrative/other staff- and two outputs, which were the aggregated numbers of scheduled/emergency patient visits and imaging/laboratory diagnostic tests. Facilities were categorized as small, medium and large (<15,000, 15,000-30,000 and >30,000 respectively) to reflect catchment population and as urban/semi-urban or remote/island to reflect location. In a second stage analysis, technical and scale efficiency scores were regressed against facility type (NHS or IKA), size and location using multivariate Tobit regression. RESULTS: Regarding technical efficiency, IKA performed better than the NHS (84.9% vs. 70.1%, Mann-Whitney P < 0.001), smaller units better than medium-sized and larger ones (84.2% vs. 72.4% vs. 74.3%, Kruskal-Wallis P < 0.01) and remote/island units better than urban centers (81.1% vs. 75.7%, Mann-Whitney P = 0.103). As for scale efficiency, IKA again outperformed the NHS (89.7% vs. 85.9%, Mann-Whitney P = 0.080), but results were reversed in respect to facility size and location. Specifically, larger units performed better (96.3% vs. 90.9% vs. 75.9%, Kruskal-Wallis P < 0.001), and urban units showed higher scale efficiency than remote ones (91.9% vs. 75.3%, Mann-Whitney P < 0.001). Interestingly 75% of facilities appeared to be functioning under increasing returns to scale. Within-group comparisons revealed significant efficiency differences between the two primary care providers. Tobit regression models showed that facility type, size and location were significant explanatory variables of technical and scale efficiency. CONCLUSION: Variations appeared to exist in the productive performance of the NHS and IKA as the two main primary care providers in Greece. These variations reflect differences in primary care organization, economical incentives, financial constraints, sociodemographic and local peculiarities. In all technical efficiency comparisons, IKA facilities appeared to outperform NHS ones irrespective of facility size or location. In respect to scale efficiency, the results were to some extent inconclusive and observed differences were mostly insignificant, although again IKA appeared to perform better.

Development and preliminary validation of a Greek-language outpatient satisfaction questionnaire with principal components and multi-trait analyses.

BACKGROUND: In the recent years there is a growing interest in Greece concerning the measurement of the satisfaction of patients who are visiting the outpatient clinics of National Health System (NHS) general acute hospitals. The aim of this study is therefore to develop a patient satisfaction questionnaire and provide its preliminary validation. METHODS: A questionnaire in Greek has been developed by literature review, researchers' on the spot observation and interviews. Pretesting has been followed by telephone surveys in two short-term general NHS hospitals in Macedonia, Greece. A proportional stratified random sample of 285 subjects and a second random sample of 100 outpatients, drawn on March 2004, have been employed for the analysis. These have resulted in scale creation via Principal Components Analysis and psychometric testing for internal consistency, test-retest and interrater reliability as well as construct validity. RESULTS: Four summated scales have emerged regarding the pure outpatient component of the patients' visits, namely medical examination, hospital environment, comfort and appointment time. Cronbach's alpha coefficients and Pearson, Spearman and intraclass correlations indicate a high degree of scale reliability and validity. Two other scales--lab appointment time and lab experience--capture the apparently distinct yet complementary visitor experience related to the radiographic and laboratory tests. Psychometric tests are equally promising, however, some discriminant validity differences lack statistical significance. CONCLUSION: The instrument appears to be reliable and valid regarding the pure outpatient experience, whereas more research employing larger samples is required in order to establish the apparent psychometric properties of the complementary radiographic and laboratory-testing process, which is only relevant to about 25% of the subjects analysed here.