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Papers: S Grogan, M Conner, P Norman, D Willits, and I Porter Validation of a questionnaire measuring patient satisfaction with general practitioner services Qual Health Care 2000; 9: 210-215 [Abstract] [Full text] [PDF]

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Re: Patient satisfaction questionnaire - Authors' response

Sarah Grogan   (24 January 2001)

Patient Satisfaction Questionnaire - Further validation required

Lesley Roberts, "Andrea Roalfe, Sue Wilson"   (22 December 2000)

Re: Patient satisfaction questionnaire - Authors' response 24 January 2001
Sarah Grogan, Senior Lecturer, Department of Psychology and Speech Pathology Manchester Metropolitan University, UK Send letter to journal: Re: Re: Patient satisfaction questionnaire - Authors' response sarah.grogan{at}virgin.net Sarah Grogan	Dear Editor, Roberts et al[1] provide a commentary on the Patient Satisfaction Questionnaire (PSQ) that we have developed and validated.[2][3] Whilst they accept that the PSQ is a valid and internally reliable tool for assessing patient satisfaction with primary care services, they suggest that further work is required before the measure is adopted. In particular they point to the need to assess the acceptability of the items to different patient groups. In the development of a measure such as the PSQ, continuing assessment of reliability, validity and acceptability is clearly worthwhile. Nevertheless we would argue that there already exists sufficient data on the reliability and validity of the scale[2][3] to warrant its adoption as means of assessing patient satisfaction with primary care services. In relation to the specific points raised by Roberts et al[1]: First, in relation to the issue that certain items may be unacceptable and produce low response rates. Analysis of items included in both the original study where the questionnaire was developed[2] and the validation study[3] has failed to show any differences in response rates on individual items. Also, all items originated in interviews and open-ended questionnaires with patients, and we have no reason to believe that they would be unacceptable to other patients. Second, in relation to whether particular items may distress or offend respondents. As all items were originally derived from interviews with patients, the wording reflects the way in which patients talk about these services. In reproducing the questionnaire we allow practitioners the opportunity to judge the potential offensiveness of the items. We have not received any negative feedback about items from practitioners or respondents to the questionnaires used in our validation study in terms of their distressing nature or offensiveness. There is no evidence to support the suggestion that any of the items in the PSQ will distress or offend respondents. Third, in relation to the suggestion that the PSQ as a whole may not be completed by particular groups: This is not an issue we have specifically addressed in our research. To do so would require the assessment of response rates in different groups where we might expect differences. A further analysis might then compare the numbers of fully versus partially completed PSQs. In relation to this latter point, from the data reported in Grogan et al,[3] we were able to make a comparison of questionnaires that were fully completed versus those that were only partially completed. This indicated no significant impact of various demographic groups (eg, age, gender) on completion rates. In summary, whilst we accept that further work to assess the reliability, validity, and acceptability of the PSQ is warranted, we believe that the measure has been sufficiently tested to make it suitable for adoption by those wishing to assess patient's satisfaction with primary care services. Sarah Grogan, PhD (Address for correspondence) Senior Lecturer Department of Psychology and Speech Pathology Manchester Metropolitan University Elizabeth Gaskell Building Manchester M13 OJA, UK Mark Conner, PhD Senior Lecturer School of Psychology University of Leeds Leeds LS2 9JT, UK References (1) Roberts L, Roalfe A, Wilson S. Patient Satisfaction Questionnaire - Further validation required [Rapid Response]. Qual Health Care 22 December 2000. http://www.qualityhealthcare.com/cgi/eletters/9/4/210#EL1 (2) Grogan S, Conner M, Willits D, Norman P. Development of a questionnaire to measure patients' satisfaction with general practitioners' services. British Journal of General Practice 1995;45:525- 29. (3) Grogan S, Conner M, Norman P, Willits, Porter I. Validation of a questionnaire measuring patient satisfaction with general practitioner services. Qual Health Care 2000;9:210-15.
Patient Satisfaction Questionnaire - Further validation required 22 December 2000
Lesley Roberts, Research Fellow Department of Primary Care and General Practice, University of Birmingham, UK, "Andrea Roalfe, Sue Wilson" Send letter to journal: Re: Patient Satisfaction Questionnaire - Further validation required l.m.roberts{at}bham.ac.uk Lesley Roberts, et al.	Dear Editor: Grogan et al[1] report that their Patient Satisfaction Questionnaire (PSQ) is a valid and internally reliable tool for assessing patient satisfaction with primary care services despite the acknowledgement in their discussion that further research is required to confirm other aspects of reliability and validity. We feel that their conclusion is premature. Having recently been involved in the validation of a postal questionnaire to assess quality of life in dyspeptic patients we are aware of the importance of a full evaluation. Our principal concerns with the published study[1] relate to the lack of information relating to representativeness and acceptability. The need to demonstrate acceptability is heightened when questionnaires are to be self-completed. Response rate data were not provided because of the study design. Response rates give not only an indication of the acceptability of the questions used, but also provide information about the acceptability of the concept, e.g. will patients answer questions about their doctor? Full data sets were available for 1151/1390 returned questionnaires; 17% of patients chose not to complete all questions, which may indicate lack of acceptability of certain items. Acceptability is important for several reasons: 1) ethically we should not be utilising tools which may distress/offend 2) financially we should not use a tool which will not be returned or where intense effort is required to generate responses 3) in the interests of quality we should not use a tool where differential acceptability may cause bias. Before recommending the PSQ as a tool we would like to see some evidence that acceptability has been demonstrated in different patient groups. Other evidence that would be useful before concluding that the questionnaire should be adopted includes data on reproducibility (consistency of response) and responsiveness over time. Before using the questionnaire for repeated audit or to evaluate change in practice, it is important to confirm that the questionnaire is able to reflect changes in satisfaction over time. Whilst the data provided indicates the PSQ to be valid and reliable, these data must be interpreted with some caution given the lack of information about sample selection and representativeness. Other issues pertinent to questionnaire evaluation have not been fully explored and, given that this is designed to be a self-completion questionnaire for use in an area in which traditionally patients have not been consulted, acceptability of the questionnaire and individual questions should be assessed before concluding that the tool be adopted. Reference (1) Grogan S, Conner M, Norman P, Willits, Porter I. Validation of a questionnaire measuring patient satisfaction with general practitioner services. Quality in Health Care 2000;9:210-15