Satisfaction with hospitalization scale: adaptation and psychometric properties.
Taking into account the public opinion and satisfaction with the services received--both public and private--is an important instrument to evaluate the quality of such services and to manage them efficiently and rationally (Boersma, de Boer, & Maes, 2005; Kim, Cho, Ahn, Goh, & Kim, 2008; Souza & Melleiro, 2010).
In the specific case of a health care institution, it is increasingly necessary for the system to obtain and take into account users' opinions and judgments. As well as many other aspects, this feedback includes information about preferences and expectations, what is considered relevant at each moment, how preferences changes, and how to orient the organization towards the patients' changing needs (Abalo, Varela, & Rial, 2006; Mira, Peset, Rodriguez-Marin, & Ybarra, 2002).
The study of patients' and health-care service users' level of satisfaction is a very important criterion to evaluate the attention received. It is also useful as an indicator of the functioning of the systems and as a decisive factor for the managers of health care systems (Carmel, 1985; Puentes, Gomez, & Garrido, 2006).
In the assessment of the level of satisfaction, we find even more evaluations centred on factors which are not only based on clinical results (Leddy, Wolosin, & Robert, 2005; Limonero, Tomas-Sabado, Fernandez-Castro, Gomez-Romero, & Ardilla-Herrero, 2012; Stahl, 2010; Tarlov, 1996), for example, the patient's opinion and other qualitative elements concerning how they are being treated (Blanco, Sanchez, Chinchilla, Cobrero, & Mediavilla, 2010). This provides interesting information about patients' perceptions and feelings about the services received, and whether they fulfilled their expectations.
According to various studies, these expectations can vary depending on the area in which the patient is attended. For instance, the observations will not be the same in emergency, paediatric or primary health areas (Arends-Toth, Van de Vijver, & Poortinga, 2006; Chang et al., 2003; Dominguez et al., 1996). Some studies have pointed out that, in the specific case of emergency services, patients have very brief contact with the health care staff, they display a high level of anxiety and, in some cases, there is a long waiting time or a lack of information. All this will affect patients' subsequent rating of the services and satisfaction (Auerbach et al., 2005; Borrel, 1989; Downey & Zun, 2010; Mowen, Licata, & McPhail, 1990).
Differences have also been found in the patient's satisfaction with the level of attention received. In fact, it has been shown that the highest percentage of satisfaction is found in primary health services, followed by hospital attention and specialized attention (Garcia-Arque, 1997). The doctor-patient relation is one of the fundamental factors in satisfactory health care attention (Clever, Jin, Levinson, & Meltzer, 2008; Hojat et al., 2002). Patients' satisfaction with medical attention and health care is directly related to the adherence to the prescribed treatment and to the appointments, which will promote the patient's wellbeing (Gross, Zyzanski, Borowski, Cebul, & Stange, 1998).
Diverse methodological approaches have been used in health care areas to develop instruments to assess patients' satisfaction. These have identified the dimensions that should be considered when determining patients' satisfaction, both global and with specific factors in health care.
For the last decade, the concepts of quality and satisfaction have been closely related (Abalo et al., 2006; Martinez-Tur, Peiro, & Ramos, 2001). Rust and Oliver (1994), for example, showed that the most relevant aspect of service marketing studies was the interaction between quality, satisfaction, and value.
More recently, the most commonly accepted point of view considers a dynamic relationship, in which the quality the patient perceives is a predictor of satisfaction. At the same time, a higher level of user satisfaction will emphasize the perception of quality of the service (Berne, Mugica, & Yague, 1996). From this approach, the user is considered the sole judge of quality. In this sense, quality is described as the degree of discrepancy between the user's expectations about the service and the final perceptions of the outcome (Oliver, 1980).
The quality of health care is based on a complex set of factors that are difficult to measure. Some studies point out the following principal determinants of quality in health care: human talent, physical and financial resources, policies, and programs, technologies, medical and administrative processes, competence and efficiency in the services and in interaction with the general health care system (Malagon-Londono, Galan, & Ponton, 1999).
Diverse socio-demographic and psychological variables have been the centre of attention of many studies that examine aspects associated with patient satisfaction (Baudin, Aluja, Rolland, & Blanch, 2009; Dierssen-Sotos et al., 2009). Two of the variables most frequently studied in relation to patient satisfaction are age and gender, with higher levels of satisfaction found in women (Cohen, 1996). Whereas some studies have found no relevant relationship between satisfaction and age or gender (Liu & Wang, 2007; Sahin, Yilmaz, & Lee, 2007; Wallin, Lundgren, Ulander, & Holstein, 2000), others indicate that older individuals report greater satisfaction (Cohen, 1996, Moret et al., 2007; Rahmqvist, 2001; Sitzia & Wood, 1997).
Although there are currently various instruments to assess satisfaction with health care in the Spanish-speaking population, not many of these are specifically centred on satisfaction with hospital attention. Some of these questionnaires are not available or they are difficult to obtain, as they were specifically designed for research. Other questionnaires, even those used in public institutions, present validity and reliability problems, or else their psychometric properties have not been studied. Lastly, others were designed with greater complexity and extension, which makes it difficult for hospitalised patients to complete them, or else they were designed from conceptual and theoretical approximations that are too disparate from those currently used by most authors (Blanco et al., 2010; Dierssen-Sotos et al., 2009; Gonzalez et al., 2005; Rojo, Barbera, Plumed, Sanguesa, & Livianos, 2009).
The purpose of the present study is to adapt a valid and reliable instrument that is quick and easy to assess hospitalized patients' perceived satisfaction, taking into account diverse aspects of the hospitalization process and the attention received. We also hoped to describe in more detail some aspects of satisfaction with this process, seeking differences in some socio-demographical variables such as age and gender.
In order to accomplish this, we used the Satisfaction Scale with Primary Health Care Services (Varela, Rial, & Garcia, 2003), which we adapted, determining its psychometric properties.
The sample comprised 483 patients or close family members, randomly selected, hospitalized in eight hospital centres of Andalusia (Spain): University Hospital "Carlos Haya", Malaga (n= 77); University Hospital "San Cecilio", Granada (n= 53); Hospital of Poniente, El Ejido, Almeria (n= 63); University Medical-Surgical Hospital ("Virgen de las Nieves" Hospital Complex), Granada (n= 40); University Hospital of Torrecardenas, Almeria (n= 71); Hospital "Santa Ana", Motril (n= 61); University Hospital Complex of Jaen (n= 76), and University Hospital of Traumatology ("Virgen de las Nieves" Hospital Complex), Granada (n= 42). The participants were 216 men and 259 women, (8 of them did not report their gender) aged between 13 and 83, with a mean age of 40.36 years (SD= 14.52) (3 of them did not report their age). All of them had volunteered to participate in this study and had signed an informed consent. Quota sampling was used to select the subjects, with proportional assignation according to sex, health area, and duration of hospital stay, attempting to reach 50% of participants of each gender, at least 40 subjects from each one of the hospital centres considered, and a similar percentage in the three categories of hospital stay duration indicated below.
With regard to other sociodemographic variables that characterise the sample of participants, 54 of them had no studies, 149 had primary studies, 180 had middle studies, and 97 had higher studies, and 3 of the participants did not report their educational level. Of the participants, 99 were of immigrant origin and 348 were of non-immigrant origin.
With regard to the clinical characteristics of the sample, 337 subjects had been admitted through the emergency services and, in 145 cases, the admittance had been programmed. The reason for admittance, as well as the classification as a function of nights of hospital stay, is shown in Table 1. With regard to this variable, the mean stay was of 7.51 days (standard deviation 10.22), with a range of between 1 and 97 nights of hospital stay.
We adapted the Satisfaction Scale with Primary Health Care Services (Varela et al., 2003). This scale was initially designed to determine the level of satisfaction in patients attended in primary health care services. The original version of the scale includes 11 items, each of them rated on a 5-point scale ranging from 1 (not at all satisfied) to 5 (completely satisfied). The scale has four subscales, which determine the patient's level of satisfaction with the health care staff (4 items), with the auxiliary staff (2 items), with the facilities of the health centre (3 items), and with access to and the functioning of the services (2 items). The psychometric characteristics of the original scale are acceptable, with Cronbach alpha scores between .80 and .82 for the global expression and between .59 and .89 for the specific dimensions (Varela et al., 2003).
For our investigation, we carried out a number of modifications in the items of the original scale. These modifications were minimal and always aimed at changing aspects specifically about primary care in this initial scale to the equivalent factor in hospital attention. The common indicators, however, were not modified.
The four assessment dimensions were thus maintained so as to not alter construct validity. In the first two categories--hospital and auxiliary staff, respectively--, the items were the same as in the original scale, in accordance with our goals. In the third category, concerning health care facilities and conditions, some items were changed. Item S12, "Comfort and size of the waiting room" was changed to the item "Comfort and size of the hospital room". Item S13, "Facilities and equipment of the centre" remained the same, although referring to the hospital. In the category of access to the service, item S16, "Amount of waiting time until entering the surgery", was changed to the item "Amount of waiting time until admitted to hospital", specifying that it refers to the amount of time since arriving at the hospital. Finally, the following item was introduced: "Proximity of the hospital to the patient's home", which was not included in the Satisfaction with Primary Care Scale, although it was taken into account by the authors in the original validation studies (Varela et al., 2003). An initial pilot study with 87 patients allowed a prior analysis of the functioning of the scale, as well as some minor modifications to obtain the definite version, included in the appendix A.
In addition to the satisfaction scale, socio-demographic data was also recorded, specifically registering each participant's gender and age.
To collect the data, the investigators contacted the participant hospital centres and requested the pertinent authorizations. In all of them, the competent research-ethics committees assessed our study and accepted it. Then, the investigators visited the hospital, randomly selecting different floors or health services and rooms.
The participants completed the scale during their hospital stay, administered by the investigators. When the patients could not answer the questionnaire by themselves because of the severity of their illness, indisposition, age, or other reasons, a close family member filled it in for them, if this member had been with the patient throughout the entire hospitalization process. The data was collected either the patients' room or in the hospital corridor in the cases in which the investigators' presence could affect the medical and hospital staff's work.
Inclusion criteria were: having spent at least one night in the hospital, voluntary participation in the study (with signed informed consent), and not yet having been discharged.
Exclusion criteria were any situations that could prevent or hinder patients' completing the questionnaires, for example, patients with limiting conditions, presence of pain or other difficulties, recently operated patients, or patients who had undergone invasive diagnostic tests, terminally ill patients, etc., very poor comprehension of the Spanish language, not signing the informed consent, or their refusal to participate in the study.
The purpose of the study was explained to the respondents, that is, to assess the patient's satisfaction with the hospitalization process. The voluntary nature of their participation and anonymity of their responses was also clarified as well as the need for sincerity of the responses. They were also informed about the possibility of dropping out of the process of responding to the questionnaires at any time, and they were requested to sign an informed consent. The questionnaires were administered individually.
Analysis of the data was carried out with the SPSS statistical package, version 15.0.1., and the EQS 6.1 software.
In table 2 are shown the Cronbach alpha coefficients for each scale, both for our version and for the original primary health care scale. In our version, all four coefficients and the global satisfaction expression were over .75, indicating good reliability. In all cases, our results were higher than the reliability scores in the original scale. As seen in the initial study, the dimension with the lowest score was Satisfaction with Access to and Functioning of the Health Services.
In order to verify the factor structure of the scale, we performed confirmatory factor analysis (CFA), with maximum likelihood criterion. Table 3 shows the fit index both for the global sample and the men and women sub-samples.
Table 3 shows that the indices obtained in the global model indicate a sufficient, albeit moderate, fit. The analysis was repeated in order to verify whether the fit of the model was adequate in the subsamples of men and women. Table 3 shows the indices for both subsamples, and the results are very similar to those found in the general sample.
The results are fairly similar to those obtained in the original scale. In our case, a slightly lower AGFI value was obtained in comparison to the original scale. This result can be explained by the insertion, in our case, of item 12, which did not appear in Varela's scale. As a positive aspect, the GFI, NFI, and CFI indicators found both in the global sample and in the gender subsamples are always higher than .90. Moreover, there are no significant differences between the two subsamples, as seen in the chi-square analyses presented in table 4.
Figures 1, 2, and 3 show the factor loadings as well as the measurement errors for each item, and the covariances among the factors. In all three cases, the errors are acceptable.
Satisfaction, gender and age
In order to determine whether there were differences in satisfaction as a function of age, we formed age groups following the criteria of Moret et al. (2007). On the basis of other studies, they worked with 5 age groups (18-34, 35-49, 50-64, 65-79 and 80 years old and over), although, as we only have one subject over 80 years old, we reduced this classification to four groups, with the last group including subjects over 65 years old. In table 5 are displayed the means and standard deviations for satisfaction in age groups and in men and women.
[FIGURE 1 OMITTED]
[FIGURE 2 OMITTED]
[FIGURE 3 OMITTED]
Then we carried out an ANOVA, with the total score of satisfaction as the dependent variable and gender and age as the independent variables. As seen in table 6, the analysis yielded significant differences between age groups but we found no gender differences in general satisfaction.
The Bonferroni post-hoc test shown in table 7 shows no significant differences between some age groups but it yields a clear increase in the satisfaction of people older than 65 years old. Figure 4 shows a higher level of global satisfaction in older participants, and no significant differences were found in satisfaction among the groups of subjects under 65 years of age. The subjects under 34 years of age seem to be the least satisfied.
Likewise, as seen in table 6, we found no significant effect for the interaction between age and gender.
[FIGURE 4 OMITTED]
The purpose of the present investigation was to develop the Satisfaction with Hospital Health Care Services Scale in a normative sample, and to determine its psychometric properties and some descriptive results. The scale was designed to measure satisfaction with some aspects of hospitalization, conceptualized in four dimensions. We adapted the original work by Varela et al. (2003), who elaborated an instrument for the assessment the satisfaction with primary health care services, and we developed a version for the hospitalization process and health care in this context. The current study was carried out to determine the statistical properties (reliability and validity) and the structure of the instrument.
This study incorporates modifications to the Primary Health Care version, ensuring that such changes were minimal so as to maintain the validity and reliability of the original instrument. The results presented in this article confirm that our version has adequate psychometric properties. The subscales show high internal consistency in the sample of patients and in their families. The findings obtained with the present version of the scales are quite similar to those obtained with the previous version of the instrument administered in other health care services. Despite the modification of some of the items, the four-dimensional structure of the original study (Varela et al., 2003) is maintained.
A high Cronbach alpha was reported not only for the total score, but also for the four first-order dimensions, indicating that the complete scale and its dimensions are internally consistent.
The scale maintains a four-factor structure, focused on the assessment of the level of satisfaction with hospital staff, auxiliary staff, the facilities of the hospital and the access to the service, respectively. These dimensions include nuclear aspects of hospital attention and provide an indicator of global or general satisfaction.
This instrument has many advantages: it is brief (12 items, clearly grouped into four basic dimensions) and simple, and as well easy to apply to patients and close family members.
The crossed validation analyses in the subsamples of men and women continue to show stability similar to that of the general scale, and no significant differences were found between the subsamples.
As a limitation of these results, we note that the insertion of item 12 seems to be responsible for some slightly low fit indicators of the model, in addition to the questionability of this item. We decided to maintain this item because of the theoretical interest of an indicator of accessibility, which, according to other study (Fernandez-Castillo & Vilchez-Lara, 2009), is important. Nevertheless, this issue should be studied in future studies. Despite this, the scale has acceptable reliability and validity.
Regarding gender and age differences, no significant gender differences were found in the global satisfaction, either interaction between age and gender. This result is in accordance with other studies which have found similar results (Liu & Wang, 2007; Sahin et al., 2007; Sitzia & Wood, 1997).
When determining differences as a function of age, our data show a higher level of satisfaction in older people. This result disagrees with some studies that have indicated that age is not a good predictor of satisfaction (Sahin et al., 2007); however, it coincides with many others that have found the same relation between age and satisfaction (Cohen, 1996; Liu & Wang, 2007; Moret et al., 2007; Rahmqvist, 2001; Sitzia & Wood, 1997). A possible explanation of this result could be that the younger population is more demanding than the older population. Older people, sometimes undergoing situations of lack of attention, loneliness, chronic health problems, etc., could value the hospital attention received more positively in comparison to other age groups. However, this result deserves more attention, for example, examining specific differences as a function of age groups, disease typology and severity, time spent in hospital, etc., to determine in more detail the specific variables that could explain the differences found as a function of age. Regarding this result, it is also interesting to note that the relation between satisfaction and age may not be linear, which would be in accordance with other studies (Moret et al., 2007).
As a limitation we note the lack of generalizability of the results due to sample characteristics and selection. It would be interesting to work with larger samples that would cover the entire spectrum of people over 65 years. It would have been interesting to use, for example, data such as the patients' socioeconomic status or psychological indicators such as affective and emotional level because of the influence of these variables on satisfaction, an aspect to consider in future studies.
This study is important, as it show the reliability and the stability of the factor structure of the scale in a normative sample. The scale is thus shown to be an adequate instrument to assess satisfaction with health care functioning, taking into account the above-mentioned dimensions (Mira et al., 2002). It is particularly useful when considering the importance of satisfaction as an indicator of service quality and an element in institutional decisions (Boersma et al., 2005).
Hospital administrators in the current competitive environment are concerned about patient satisfaction, in order to maximize patient loyalty, market share, and financial performance. Having an adequate, agile and reliable instrument provides data that could be used by hospital administrators to address the areas requiring improvement. Furthermore, hospitals could compare their results with those of other hospitals with similar characteristics.
Thus, the Primary Health Care Scale was an important step in investigating the multidimensional structure of satisfaction with the health care received. The Hospital Health Care version proposed in the present study provides a parsimonious, reliable, and valid measure of satisfaction with the hospitalization both in patients and in close family members.
Appendix A. ESCALA DE SATISFACCION CON LA HOSPITALIZACION (Satisfaction with Hospital Health Care Services Scale) Datos personales (Personal Data) Hospital: (tache el indicado): Masculino Femenino Edad Gender(Cross the (Male) (Female) (age): Corresponding) Cuestionario de satisfaccion (Satisfaction Scale) A continuacion se presenta una serie de cuestiones relacionadas con su estancia en el hospital durante la hospitalizacion. Rodee con un circulo la opcion que mas refleje su grado de acuerdo o desacuerdo. Intente responder a todas las cuestiones. Responda con sinceridad. Muchas gracias por su participacion. Nada satisfecho (Not satisfied at all) Personal sanitario (Hospital staff): 1 Tiempo que le dedica su medico. 1 (Amount of time your doctor gives you). 2 Solucion que el medico/enfermera le da. 1 (Solutions the doctor and/or nurse give you). 3 Interes del medico en explicarle la 1 dolencia (enfermedad o problema). (Interest shown by the doctor when explaining the illness or problem). 4 Informacion proporcionada sobre el 1 tratamiento. (Information provided about the treatment). Personal de apoyo (Auxiliary staff): 5 Trato recibido por el resto del 1 personal. (Treatment received by the auxiliary staff). 6 Disposicion del personal para ayudarle. 1 (Staff's disposition to help you). Condiciones fisicas (Facilities and conditions of the health centre): 7 Comodidad y amplitud de la habitacion. 1 (Comfortableness and amplitude of the room). 8 Instalaciones y equipamiento del 1 centro (hospital). (Facilities and equipment of the hospital centre). 9 Senalizacion interna del centro. 1 (Internal signaling of the centre). Acceso y funcionamiento del servicio (Access and functioning of the service): 10 Horario de atencion a los pacientes. 1 (Timetable and attention to the patients). 11 Tiempo de espera para realizar el 1 ingreso (desde que llegan al hospital). Amount of waiting time to be admitted (from the moment patients arrive at the hospital). 12 Proximidad del hospital (a su 1 domicilio). Proximity of the hospital (to your home). Poco Satisfecho (Not very satisfied) Personal sanitario (Hospital staff): 1 Tiempo que le dedica su medico. 2 (Amount of time your doctor gives you). 2 Solucion que el medico/enfermera le da. 2 (Solutions the doctor and/or nurse give you). 3 Interes del medico en explicarle la 2 dolencia (enfermedad o problema). (Interest shown by the doctor when explaining the illness or problem). 4 Informacion proporcionada sobre el 2 tratamiento. (Information provided about the treatment). Personal de apoyo (Auxiliary staff): 5 Trato recibido por el resto del 2 personal. (Treatment received by the auxiliary staff). 6 Disposicion del personal para ayudarle. 2 (Staff's disposition to help you). Condiciones fisicas (Facilities and conditions of the health centre): 7 Comodidad y amplitud de la habitacion. 2 (Comfortableness and amplitude of the room). 8 Instalaciones y equipamiento del 2 centro (hospital). (Facilities and equipment of the hospital centre). 9 Senalizacion interna del centro. 2 (Internal signaling of the centre). Acceso y funcionamiento del servicio (Access and functioning of the service): 10 Horario de atencion a los pacientes. 2 (Timetable and attention to the patients). 11 Tiempo de espera para realizar el 2 ingreso (desde que llegan al hospital). Amount of waiting time to be admitted (from the moment patients arrive at the hospital). 12 Proximidad del hospital (a su 2 domicilio). Proximity of the hospital (to your home). Algo Satisfecho (A little satisfied) Personal sanitario (Hospital staff): 1 Tiempo que le dedica su medico. 3 (Amount of time your doctor gives you). 2 Solucion que el medico/enfermera le da. 3 (Solutions the doctor and/or nurse give you). 3 Interes del medico en explicarle la 3 dolencia (enfermedad o problema). (Interest shown by the doctor when explaining the illness or problem). 4 Informacion proporcionada sobre el 3 tratamiento. (Information provided about the treatment). Personal de apoyo (Auxiliary staff): 5 Trato recibido por el resto del 3 personal. (Treatment received by the auxiliary staff). 6 Disposicion del personal para ayudarle. 3 (Staff's disposition to help you). Condiciones fisicas (Facilities and conditions of the health centre): 7 Comodidad y amplitud de la habitacion. 3 (Comfortableness and amplitude of the room). 8 Instalaciones y equipamiento del 3 centro (hospital). (Facilities and equipment of the hospital centre). 9 Senalizacion interna del centro. 3 (Internal signaling of the centre). Acceso y funcionamiento del servicio (Access and functioning of the service): 10 Horario de atencion a los pacientes. 3 (Timetable and attention to the patients). 11 Tiempo de espera para realizar el 3 ingreso (desde que llegan al hospital). Amount of waiting time to be admitted (from the moment patients arrive at the hospital). 12 Proximidad del hospital (a su 3 domicilio). Proximity of the hospital (to your home). Bastante Satisfecho (Quite satisfied) Personal sanitario (Hospital staff): 1 Tiempo que le dedica su medico. 4 (Amount of time your doctor gives you). 2 Solucion que el medico/enfermera le da. 4 (Solutions the doctor and/or nurse give you). 3 Interes del medico en explicarle la 4 dolencia (enfermedad o problema). (Interest shown by the doctor when explaining the illness or problem). 4 Informacion proporcionada sobre el 4 tratamiento. (Information provided about the treatment). Personal de apoyo (Auxiliary staff): 5 Trato recibido por el resto del 4 personal. (Treatment received by the auxiliary staff). 6 Disposicion del personal para ayudarle. 4 (Staff's disposition to help you). Condiciones fisicas (Facilities and conditions of the health centre): 7 Comodidad y amplitud de la habitacion. 4 (Comfortableness and amplitude of the room). 8 Instalaciones y equipamiento del 4 centro (hospital). (Facilities and equipment of the hospital centre). 9 Senalizacion interna del centro. 4 (Internal signaling of the centre). Acceso y funcionamiento del servicio (Access and functioning of the service): 10 Horario de atencion a los pacientes. 4 (Timetable and attention to the patients). 11 Tiempo de espera para realizar el 4 ingreso (desde que llegan al hospital). Amount of waiting time to be admitted (from the moment patients arrive at the hospital). 12 Proximidad del hospital (a su 4 domicilio). Proximity of the hospital (to your home). Muy satisfecho (Completely satisfied) Personal sanitario (Hospital staff): 1 Tiempo que le dedica su medico. 5 (Amount of time your doctor gives you). 2 Solucion que el medico/enfermera le da. 5 (Solutions the doctor and/or nurse give you). 3 Interes del medico en explicarle la 5 dolencia (enfermedad o problema). (Interest shown by the doctor when explaining the illness or problem). 4 Informacion proporcionada sobre el 5 tratamiento. (Information provided about the treatment). Personal de apoyo (Auxiliary staff): 5 Trato recibido por el resto del 5 personal. (Treatment received by the auxiliary staff). 6 Disposicion del personal para ayudarle. 5 (Staff's disposition to help you). Condiciones fisicas (Facilities and conditions of the health centre): 7 Comodidad y amplitud de la habitacion. 5 (Comfortableness and amplitude of the room). 8 Instalaciones y equipamiento del 5 centro (hospital). (Facilities and equipment of the hospital centre). 9 Senalizacion interna del centro. 5 (Internal signaling of the centre). Acceso y funcionamiento del servicio (Access and functioning of the service): 10 Horario de atencion a los pacientes. 5 (Timetable and attention to the patients). 11 Tiempo de espera para realizar el 5 ingreso (desde que llegan al hospital). Amount of waiting time to be admitted (from the moment patients arrive at the hospital). 12 Proximidad del hospital (a su 5 domicilio). Proximity of the hospital (to your home).
Abalo, J., Varela, J., & Rial, A. (2006). El analisis de importancia-valoracion aplicado a la gestion de servicios [The analysis of importance-rating applied to the management of services]. Psicothema, 18, 730-737.
Arends-Toth, J., Van de Vijver, F. J. R., & Poortinga, Y. H. (2006). The influence of method factors on the relation between attitudes and self-reported behaviors in the assessment of acculturation. European Journal of Psychological Assessment, 22, 4-12.
Auerbach, S. M., Kiesler, D. J., Wartella, D. F., Rausch, S., Ward, K. R., & Ivatury, R. (2005). Optimism, satisfaction with needs met, interpersonal perceptions of the healthcare team, and emotional distress in patients' family members during critical care hospitalization. American Journal of Critical Care, 14, 202-210.
Baudin, N., Aluja, A., Rolland, J. P., & Blanch, A. (2011). The role of personality in satisfaction with life and sport. Behavioral Psychology/Psicologia Conductual, 19, 333-345.
Berne, C., Mugica, J. M., & Yague, M. J. (1996). La gestion estrategica y los conceptos de calidad percibida, satisfaccion del cliente y lealtad [Strategic management and concepts of perceived quality, customer satisfaction and loyalty]. Economia Industrial, 307, 63-74.
Blanco, S., Sanchez, F., Chinchilla, M. A., Cobrero, E. M., & Mediavilla, M. (2010). Satisfaccion de los pacientes de urgencias con los cuidados enfermeros [Patient satisfaction with emergency nursing care]. Enfermeria Clinica, 20, 23-31.
Boersma, S., de Boer, C., & Maes, S. (2005). Goal facilitation as an independent predictor of patient satisfaction after hospitalization. Psychology & Health, 20, 31-31.
Borrell, F. (1989). Manual de entrevista clinica [Clinical interview handbook]. Barcelona: Doyma.
Carmel, S. (1985). Satisfaction with hospitalization: a comparative analysis of 3 types of services. Social Science & Medicine, 21, 1243-1249.
Clever, S. L., Jin, L., Levinson, W., & Meltzer, D. O. (2008). Does doctor-patient communication affect patient satisfaction with hospital care? Results of an analysis with a novel instrumental variable. Health Services Research, 43, 1505-1519.
Cohen, G. (1996). Age and health status in a patient satisfaction survey. Social Science & Medicine, 42, 1085-1093.
Chang, E., Hancock, K., Chenoweth, L., Jeon, Y., Glasson, J., Gradidge, K., & Graham, E. (2003). The influence of demographic variables and ward type on elderly patient's perceptions of needs and satisfaction during acute hospitalization. International Journal of Nursing Practice, 9, 191-201.
Dierssen-Sotos, T., Rodriguez-Cundin, P., Robles-Garcia, M. Brugos-Llamazares, V., Gomez-Acebo, I., & Llorca, J. (2009). Factors associated with patient satisfaction with hospital care. Anales del Sistema Sanitario de Navarra, 32, 317-325.
Dominguez, D., Cervera, G. L., Disdier, M. T., Hernandez, M., Martin, M. C., & Rodriguez, J. (1996). Como se informa a los pacientes en un servicio de urgencias hospitalario? [How to inform patients in a hospital emergency ward?]. Atencion Primaria, 17, 280-283.
Downey, L. V. A., & Zun, L. S. (2010). The correlation between patient comprehension of their reason for hospital admission and overall patient satisfaction in the emergency department. Journal of the National Medical Association, 102, 637-643.
Fernandez-Castillo, A., & Vilchez-Lara, M. J. (2009). Opinion profesional sobre la hospitalizacion infantil de inmigrantes de origen latinoamericano en Andalucia, Espana [Professional opinion about hospitalization of immigrant children of Latin-American origin in Andalusia, Spain]. Revista de Salud Publica, 11 , 336-346.
Garcia-Arque, R. M. (1997). Actitudes de la poblacion ante el sector sanitario [Attitudes of the population to the health sector]. Madrid: Centro de Investigaciones Sociologicas.
Gonzalez, N., Quintana J. M., Bilbao, A., Escobar, A., Aizpuru, F., Thompson, A., Esteban, C., San Sebastian, J. A., & de la Sierra, E. (2005). Development and validation of an in-patient satisfaction questionnaire. International Journal for Quality in Health Care, 17, 465-472.
Gross, D., Zyzanski, S., Borowski, E., Cebul, R., & Stange, K. (1998). Patient satisfaction with time spent with their physician. Journal of Family Practice, 47, 133-137.
Hojat, M., Gonella, J., Nasca, T., Mangione, S., Vergare, M., & Magee, M. (2002). Physician empathy: definition, components, measurement, and the relationship to gender and specialty. The American Journal of Psychiatry, 159, 1563- 1569.
Kim, Y. K., Cho, C. H., Ahn, S. K., Goh, I. H., & Kim, H. J. (2008). A study on medical services quality and its influence upon value of care and patient satisfaction. Focusing upon outpatients in a large-sized hospital. Total Quality Management, 19, 1155-1171.
Leddy, K., Wolosin, M., & Robert, J. (2005). Patient satisfaction with pain control during hospitalization. The Joint Commission Journal on Quality and Patient Safety, 31, 507-513.
Limonero, J. T., Tomas-Sabado, J., Fernandez-Castro, J. Gomez-Romero, M. J., & Ardilla-Herrero, A. (2012). Estrategias de afrontamiento resilientes y regulacion emocional: predictores de satisfaccion con la vida [Resilient coping strategies and emotion regulation: predictors of life satisfaction]. Behavioral Psychology/Psicologia Conductual, 20, 183-196.
Liu, Y., & Wang, G. (2007). Inpatient satisfaction with nursing care and factors influencing satisfaction in a teaching hospital in China. Journal of Nursing Care Quality, 22, 266-271.
Malagon-Londono, G., Galan, R., & Ponton, G. (1999). Garantia de calidad en Salud [Health quality guarantee]. Bogota: Medica Internacional.
Martinez-Tur, V., Peiro, J. M., & Ramos, J. (2001). Calidad de servicio y satisfaccion del cliente [Quality of service and customer satisfaction]. Madrid: Sintesis.
Mira, J. J., Peset, R., Rodriguez-Marin, J., & Ybarra, J. (2002). Causas de satisfaccion y de insatisfaccion de los pacientes en hospitales y atencion primaria [Causes of patients' satisfaction and dissatisfaction in hospitals and primary care]. Revista Calidad Asistencial, 17, 273-283.
Moret, L., Nguyen, J. M., Volteau, C., Falissard, B., Lombrail, P., & Gasquet, I. (2007). Evidence of a non-linear influence of patient age on satisfaction with hospital care. International Journal for Quality in Health Care, 19, 382-389.
Mowen, J. C., Licata, J. V., & McPhail, J. (1990). Waiting in the emergency room: How to improve patient satisfaction. Journal of Health Care Marketing, 10, 6-15.
Oliver, R. L. (1980). A cognitive model of antecedents and consequences of satisfaction decisions. Journal of Marketing Research, 17, 460-469.
Puentes, E., Gomez, O., & Garrido, F. (2006). Trato a los usuarios en los servicios publicos de salud en Mexico [Treatment of users in the public health services in Mexico]. Revista Panamericana de Salud Publica, 19, 394-402.
Rahmqvist, M. (2001). Patient satisfaction in relation to age, health status, and other background factors: a model for comparisons of care units. International Journal of Quality & Health Care, 13, 385-390.
Rojo, L., Barbera, M., Plumed, J., Sanguesa, M. C., & Livianos, L. (2009). Hospitalization due to eating behavior disorders. Patient and family satisfaction. Actas Espanolas de Psiquiatria, 37, 267-275.
Rust, R. T., & Oliver, R. L. (1994). Service quality: new directions in theory and practice. London: Sage Publications.
Sahin, B., Yilmaz, F., & Lee, K. H. (2007). Factors affecting inpatient satisfaction: structural equation modelling. Journal of Medical Systems, 31, 9-16.
Sitzia, J., & Wood, N. (1997). Patient satisfaction: a review of issues and concepts. Social Science & Medicine, 45, 1829-1843.
Souza, W. B., & Melleiro, M. M. (2010). Assessment levels of the user's satisfaction in a private hospital. Revista da Escola de Enfermagem da USP, 44, 145-151.
Stahl, K. (2010). Revalidation of a questionnaire assessing women's satisfaction with maternity care in hospital. Psychotherapie Psychosomatik Medizinische Psychologie, 60, 358-367.
Tarlor, A. R. (1996). The intersection of patient, doctor, society and technology. Monitor, 1, 2-4.
Varela, J., Rial, A., & Garcia, E. (2003). Presentacion de una Escala de Satisfaccion con los Servicios Sanitarios de Atencion Primaria [Introducing a Scale of Satisfaction with Primary Health Care Services]. Psicothema, 15, 656-661.
Wallin, E., Lundgren, P., Ulander, K., & Holstein, C. S. (2000). Does age, gender or educational background effect patient satisfaction with short stay surgery? Ambulatory Surgery, 8, 79-88.
Received: December 7, 2010
Accepted: February 2, 2011
Antonio Fernandez-Castillo (1), Maria Jose Vilchez-Lara (2), and Emilio Sada-Lazaro (1)
(1) University of Granada; (2) "Virgen de las Nieves" Hospital Complex, Granada (Spain)
This study is part of an investigation project supported by the Autonomous Andalusian Government (Consejeria de Salud de la Junta de Andalucia) (Investigation project code: 0142/08).
We wish to thank Ana Belen Garcia Berben for statistical assistance. Finally, we thank all patients and their families.
Correspondence: Antonio Fernandez-Castillo, Facultad de Ciencias de la Educacion, Campus de Cartuja, s/n, 18071 Granada (Spain). E-mail: firstname.lastname@example.org
Table 1 Descriptive statistics of clinical aspects Variables N % Hospital stay * Less than 3nights 193 40.5 3-7 nights 149 31.3 More than 7 nights 134 28.2 Reason for admittance High-risk pregnancy 41 8.5 Childbirth 64 13.3 Infectious symptoms 65 13.5 Performance of complementary tests 24 5 Accidents-traumatisms 112 23.2 Respiratory symptoms 19 3.8 Digestive symptoms 16 3.3 Neurological symptoms 18 3.7 Oncology--cancer 42 8.7 Plastic surgery 40 8.3 Miscellaneous/other 42 8.7 Note: * 7 subjects did not report this datum. Table 2 Internal consistency coefficients for the hospitalization and the original versions Cronbach's alpha Scale Hospitalization Primary Health scale Care scale * Global satisfaction .92 .82 Satisfaction with the hospital .92 .89 staff Satisfaction with the auxiliary .93 .69 staff Satisfaction with the facilities .86 .65 of the health centre Satisfaction with the access and .75 .59 functioning of the health services Note: * Varela, Rial, & Garcia (2003) Table 3 Fit indices for the overall model and for the subsamples of men and women Samples [chi square] p [chi square]/df SRMR RMSEA Global sample 232.75 <.00 4.85 .042 .089 Men's sample 133.35 <.00 2.78 .048 .091 Women's sample 287.47 <.00 2.66 .060 .084 Samples GFI AGFI NFI CFI Global sample .92 .87 .94 .95 Men's sample .91 .85 .92 .95 Women's sample .91 .86 .93 .95 Table 4 Differences between models for men and women Item [chi square] Probability Item 1 1.79 .18 Item 2 1.34 .25 Item 3 .46 .50 Item 4 3.27 .07 Item 5 1.98 .16 Item 6 .01 .91 Item 7 .01 .91 Item 8 .01 .91 Item 9 .01 .93 Item 10 .73 .39 Item 11 .52 .47 Item 12 1.06 .30 Table 5 Descriptive statistics of satisfaction Variables N M SD Less than 34 years old 189 41.81 10.19 35 to 49 years old 182 44.39 8.99 50 to 64 years old 64 44.13 9.32 65 years old or older 45 48.24 8.55 Men 216 44.18 9.18 Women 259 43.37 10 Table 6 Univariate tests of between-subject effects Source Type III df Mean Square F Sig. Sum of Squares Corrected model 1961.626 * 7 280.232 3.135 .00 Intercept 642061.179 1 642061.179 7182.846 .00 Age 1361.022 3 453.674 5.075 .00 Sex 2.969 1 2.969 .033 .865 Age*Sex 295.067 3 98.356 1.100 .35 Error 41565.482 465 89.388 Total 950739.000 473 Corrected total 43527.108 472 Note: * [R.sup.2] = .05 (Corrected [R.sup.2] = .03) Table 7 Multiple comparisons: Bonferroni test (I) Age Group (J) Age Group (I-J) Mean SE Sig. difference Less than 34 years old 35 to 49 years old -2.60 .99 .05 50 to 64 years old -2.22 1.37 .64 65 years old or older -6.34 1.57 .00 35 to 49 years old 50 to 64 years old .38 1.38 1.00 65 years old or older -3.74 1.58 .11 50 to 64 years old 65 years old or older -4.12 1.84 .15
|Printer friendly Cite/link Email Feedback|
|Author:||Fernandez-Castillo, Antonio; Vilchez-Lara, Maria Jose; Sada-Lazaro, Emilio|
|Publication:||Behavioral Psychology/Psicologia Conductual|
|Date:||May 1, 2012|
|Previous Article:||Desarrollo y validacion preliminar de un cuestionario para evaluar la calidad asistencial de los servicios de urgencias hospitalarios.|
|Next Article:||Resultados del tratamiento en un caso con trastorno de asperger.|