Department of Public Health, Erasmus University Rotterdam, Postbus 2040, Rotterdam, The Netherlands; World Health Organization, Ave. Appia 20, CH1211 Geneva, Switzerland.
World Health Organization, Ave. Appia 20, CH1211 Geneva, Switzerland.
Soc Sci Med. 2015 Aug;138:152-60. doi: 10.1016/j.socscimed.2015.04.022. Epub 2015 Jun 9.
Health systems' responsiveness encompasses attributes of health system encounters valued by people and measured from the user's perspective in eight domains: dignity, autonomy, confidentiality, communication, prompt attention, social support, quality of basic amenities and choice. The literature advocates for adjusting responsiveness measures for reporting behaviour heterogeneity, which refers to differential use of the response scale by survey respondents. Reporting behaviour heterogeneity between individual respondents compromises comparability between countries and population subgroups. It can be studied through analysing responses to pre-defined vignettes - hypothetical scenarios recounting a third person's experience in a health care setting. This paper describes the first comprehensive approach to studying reporting behaviour heterogeneity using vignettes. Individual-level variables affecting reporting behaviour are grouped into three categories: (1) sociodemographic, (2) health-related and (3) health value system. We use cross-sectional data from 150,000 respondents in 64 countries from the World Health Organization's World Health Survey (2002-03). Our approach classifies effect patterns for the scale as a whole, in terms of strength and in relation to the domains. For the final eight variables selected (sex; age; education; marital status; use of inpatient services; perceived health (own); caring for close family or friends with a chronic illness; the importance of responsiveness), the strongest effects were present for education, health, caring for friends or relatives with chronic health conditions, and the importance of responsiveness. Patterns of scale elongation or contraction were more common than uniform scale shifts and were usually constant for a particular factor across domains. The dependency of individual-level reporting behaviour heterogeneity on country is greatest for prompt attention, quality of basic amenities and confidentiality domains.
卫生系统的响应能力包括人们所重视的卫生系统接触的属性，并从用户的角度在八个领域进行衡量：尊严、自主性、保密性、沟通、及时关注、社会支持、基本设施的质量和选择。文献提倡调整响应性措施，以报告行为的异质性，这是指调查受访者对响应尺度的不同使用。个别受访者的报告行为异质性会影响国家和人口亚组之间的可比性。它可以通过分析对预定义情景的反应来研究，这些情景描述了医疗保健环境中第三人的经历。本文描述了使用情景研究报告行为异质性的第一种综合方法。影响报告行为的个体水平变量分为三类：（1）社会人口统计学，（2）与健康相关，（3）健康价值体系。我们使用来自世界卫生组织世界卫生调查（2002-2003 年）的 64 个国家的 15 万名受访者的横断面数据。我们的方法根据强度和与各领域的关系，对整个量表的效应模式进行分类。对于最终选择的八个变量（性别、年龄、教育、婚姻状况、住院服务的使用、自身感知健康、照顾患有慢性病的亲密家人或朋友、对响应性的重视），教育、健康、照顾患有慢性病的朋友或亲戚以及对响应性的重视，其效应最强。量表伸长或收缩的模式比均匀的量表变化更为常见，并且在特定因素在各领域通常是恒定的。个人层面报告行为异质性对国家的依赖性在及时性关注、基本设施质量和保密性领域最大。
