Badejo Megan A, Ramtin Sina, Rossano Ayane, Ring David, Koenig Karl, Crijns Tom J
Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.
J Patient Exp. 2022 Feb 8;9:23743735221079144. doi: 10.1177/23743735221079144. eCollection 2022.
Social desirability bias (a tendency to underreport undesirable attitudes and behaviors) may account, in part, for the notable ceiling effects and limited variability of patient-reported experience measures (PREMs) such as satisfaction, communication effectiveness, and perceived empathy. Given that there is always room for improvement for both clinicians and the care environment, ceiling effects can hinder improvement efforts. This study tested whether weighting of satisfaction scales according to the extent of social desirability can create a more normal distribution of scores and less ceiling effect. In a cross-sectional study 118 English-speaking adults seeking musculoskeletal specialty care completed 2 measures of satisfaction with care (one iterative scale and one 11-point ordinal scale), a measure of social desirability, and basic demographics. Normality of satisfaction scores was assessed using Shapiro-Wilk tests. After weighting for social desirability, scores on the iterative satisfaction scale had a more normal distribution while scores on the 11-point ordinal satisfaction scale did not. The ceiling effects in satisfaction decreased from 47% (n = 56) to 2.5% (n = 3) for the iterative scale, and from 81% (n = 95) to 2.5% (n = 3) for the ordinal scale. There were no differences in mean satisfaction when the social desirability was measured prior to completion of the satisfaction surveys compared to after. The observation that adjustment for levels of social desirability bias can reduce ceiling effects suggests that accounting for personal factors could help us develop PREMs with greater variability in scores, which may prove useful for quality improvement efforts.
社会期望偏差（一种少报不良态度和行为的倾向）可能在一定程度上解释了患者报告体验指标（PREMs）（如满意度、沟通效果和感知同理心）存在显著的天花板效应以及有限变异性的原因。鉴于临床医生和护理环境总有改进的空间，天花板效应可能会阻碍改进工作。本研究测试了根据社会期望程度对满意度量表进行加权是否能使分数分布更正常且减少天花板效应。在一项横断面研究中，118名寻求肌肉骨骼专科护理的英语使用者完成了两项护理满意度测量（一个迭代量表和一个11点序数量表）、一项社会期望测量以及基本人口统计学信息。使用夏皮罗-威尔克检验评估满意度分数的正态性。在对社会期望进行加权后，迭代满意度量表的分数分布更正常，而11点序数量表的分数则不然。迭代量表的满意度天花板效应从47%（n = 56）降至2.5%（n = 3），序数量表的天花板效应从81%（n = 95）降至2.5%（n = 3）。在满意度调查完成之前测量社会期望与之后测量相比，平均满意度没有差异。对社会期望偏差水平进行调整可减少天花板效应这一观察结果表明，考虑个人因素有助于我们开发分数变异性更大的PREMs，这可能对质量改进工作有用。
