Quality of care and service as perceived by adults with developmental disabilities, their parents, and primary caregivers.

How adults with developmental disabilities perceive quality of the care and service they receive was investigated and these perceptions compared with those of their parents and primary caregivers. The sample was 34 adults with developmental disabilities, one of their parents, and their primary caregiver, all from a small Swedish municipality. We adapted Quality From the Patient's Perspective by using simple words and fewer response choices. Results showed it was possible to assess how adults with developmental disabilities evaluated actual care and service conditions. Evaluations of the subjective importance ascribed to these conditions proved too difficult. A high degree of similarity was found in ratings of perceived reality of care and service conditions by the adults with developmental disabilities, their parents, and caregivers.

Patients' views on quality of care: a comparison of men and women.

AIM: This study set out to explore gender differences among medical and surgical acute care inpatients regarding their perceptions of actual care conditions as well as their evaluation of the subjective importance of various care conditions. BACKGROUND: Firstly, the literature reports inconsistent findings regarding male and female patients' views on care. Secondly, the instruments used in most previous research are not derived from a patient perspective. METHODS: The sample consisted of 831 patients (48% were women and 52% were men) at two Swedish hospitals. Data were collected using the questionnaire 'Quality from the Patient's Perspective'. FINDINGS: Male and female patients tended to evaluate the actual care received similarly. However, women tend to assign the different care aspects higher subjective importance. CONCLUSION: More research is needed to illuminate the reasons why men and women hold these different values. Until these issues are better understood, there is no valid basis on a group (gender) level to give specific practical recommendations to nursing managers.

Patients' views on quality of care: do they merely reflect their sense of coherence?

The aim was to explore the relationship between patients' perceptions of the quality of care and their sense of coherence. The sample consisted of 782 Swedish in-patients at a gynaecological, a medical, an orthopaedic, and a surgical department. The median age was 59 years and 55% of the patients were women. Data were collected using the Quality from the Patient's Perspective (QPP) Questionnaire and the Sense of Coherence Questionnaire. The QPP consists of 61 items designed to measure the following four quality dimensions: the medical-technical competence and the degree of identity-orientation in the actions of the caregivers, the physical-technical conditions and the socio-cultural atmosphere of the care organization. Each question is posed in two different ways in the QPP; one measures perceived reality of the item in question and one the subjective importance the patient ascribes to it. Results showed that patients' ratings of perceived reality covaried systematically with their sense of coherence. This was particularly the case on questions rated by experts to be more abstract and emotionally loaded. Patients' ratings of the subjective importance of the items were weakly related to their sense of coherence. The results are discussed in terms of negative affectivity and culturally shared ideals regarding quality of care.

Patients' views on quality of care: age effects and identification of patient profiles.

Age differences among physically ill inpatients, regarding their evaluation of the subjective importance of various care conditions, as well as their actual evaluations of these conditions, were explored. Subjective importance ratings were found to be unrelated to age. Patients' perceptions of the care they actually received indicated increasingly more positive evaluations with increasing age. Profiles of more and less satisfied patients were obtained using cluster analysis. Lowest satisfaction was reported by younger and well-educated women with a lower sense of coherence (as measured by Antonovsky's (1987) version of the Sense of Coherence Questionnaire) who stayed for a short period of time in hospital. It was concluded that caregivers need to focus on individual patient characteristics when looking at quality of care from a patient perspective. Generalizations based on age alone tend to be misleading.

Refinement of the questionnaire 'quality of care from the patient's perspective' using structural equation modelling.

In 1994, the questionnaire 'Quality of Care from the Patient's Perspective' (QPP) was developed using a conventional factor analytical approach (Wilde et al. 1994). The items and conceptual framework of this questionnaire were derived from a theoretical model, which, in turn, was developed from qualitative patient interviews, using a grounded theory method of analysis (Wilde et al. 1993). The aims of this study were to develop further the dimensionality of the QPP using structural equation modelling combined with advances in factor analysis modelling, and to refine the instrument. This comparatively new methodology extracts more information out of questionnaire data and is considered to be superior to traditional scaling methods. The sample consisted of 611 somatic inpatients from four departments at a Swedish hospital. Data collected with the QPP were explored with the new tool tracing the dimensions postulated in the theoretical model underlying the QPP. A nested factor model was developed fulfilling statistical criteria for adjustment between model and data. The model consists of a general factor and 16 subordinate factors. Most of the original QPP scales were reproduced with the new statistical technique. However, some content changes were made which appear to bring the QPP scales closer to patients' meaning representations of the area. Some changes were also made to the response format, changes which appear to strengthen the psychometric properties of the instrument. The refined QPP will hopefully contribute to a more differentiated picture of quality of care when applied in the field. All scales, items, and response formats of the revised QPP are presented in an appendix.