Difficulty in measuring views of service users in quality of care evaluations.

Assessing the opinions of health service users plays an increasingly important part in quality evaluations, but how best to measure this? A study in South Africa analysed findings from 14 focus group discussions (FGDs) and 337 exit interviews to obtain users' views on the same set of primary health care providers. In the absence of explicit and universal standards, users evaluated providers against their own experience in other health care services. Responses were thus highly context-specific. The FGDs provided a different and generally more negative picture of providers than the exit interviews, suggesting that where and how views are elicited has a bearing on results obtained. The FGDs appeared to encourage dramatic representations of what was, on observation, banal everyday reality. Both methods defied superficial reading and had limitations in establishing people's true opinions. User opinion must be seen as a social phenomenon, dynamic, bound to particular contexts and difficult to capture in single assessments, regardless of how well designed. (1)

(1.) Schneider H, Palmer N. Getting to the truth? Researching user views of primary health care. Health Policy and Planning 2002; 17(1):32-41.