International Journal for Quality in Health Care Advance Access originally published online on March 12, 2009
International Journal for Quality in Health Care 2009 21(3):190-197; doi:10.1093/intqhc/mzp010
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Psychometric evaluation of an instrument to assess patient-reported ‘psychosocial care by physicians’: a structural equation modeling approach
1 Center for Health Services Research Cologne, University Hospital of Cologne, Cologne 50933, Germany
2 Institute for Psychology, University of Education Freiburg, Freiburg, Germany
3 Division of Medical Sociology, Institute and Polyclinic for Occupational and Social Medicine, Cologne, Germany
Objective. The objective of our study was to develop a theory-based and empirically tested instrument for measuring patient-reported ‘psychosocial care by physicians’. We propose a model integrating patients' perceptions with respect to: (i) devotion by physicians, (ii) support by physicians, (iii) information by physicians and (iv) shared decision-making (SDM).
Design. Data were gathered during 2001 within a cross-sectional, retrospective mail survey.
Participants and setting. A total of 4192 inpatients of six German hospitals.
Main outcome measure. Specific scales of the Cologne Patient Questionnaire were used. A two-step structural equation model procedure was applied. In the first structural equation model, all items were modeled as indicators of the intended underlying latent construct, ‘psychosocial care by physicians’. In the second structural equation model, criterion-related validity of the intended construct was tested with respect to patients' ‘satisfaction’, ‘trust in physicians’ and the ‘image of the hospital’.
Results. The results confirmed that the aspects of psychosocial care provided by physicians measured by the scale items are indeed indicators of the same construct. Furthermore, indicator reliabilities and selectivities revealed that the content of all 13 items was highly representative of the underlying construct. The second structural equation model showed that ‘psychosocial care by physicians’ is related to ‘patients’ satisfaction', ‘trust in physicians’ and ‘hospital-image’ in a significant and relevant manner.
Conclusion. On the basis of our instrument's reported psychometric characteristics and of the initial validity indicators, it may be regarded as an adequate measure for further use in outcome and intervention research, and as a quality indicator for the physician-patient relationship.
Keywords: physician–patient interaction, psychosocial care, quality measurement, psychometric evaluation, structural equation model
Address reprint requests to: Oliver Ommen, Center for Health Services Research Cologne, University Hospital of Cologne, Eupener Strasse 129, Cologne 50933, Germany. Tel: +49 221 97112/478 97112; Fax: +49 221 97118/478 97118; E-mail: oliver.ommen{at}uk-koeln.de
Accepted for publication February 18, 2009.