Malawi Liverpool Wellcome Trust Clinical Research Program, P.O. Box 30096, Chichiri, Blantyre 3, Malawi.
Health Economics and Policy Unity, Kamuzu University of Health Sciences, Blantyre, Malawi.
BMC Health Serv Res. 2023 Feb 9;23(1):133. doi: 10.1186/s12913-023-09129-9.
Perspectives of patients as clients on healthcare offer unique insights into the process and outcomes of care and can facilitate improvements in the quality of services. Differences in the tools used to measure these perspectives often reflect differences in the conceptualization of quality of care and personal experiences. This systematic review assesses the validity and reliability of instruments measuring client experiences and satisfaction with healthcare in low- and middle-income countries (LMICs).
We performed a systematic search of studies published in PubMed, SCOPUS, and CINAHL. This review was reported according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Studies describing the development and psychometric properties of client experience and satisfaction with general health care were included in the review. Critical appraisal of study design was undertaken using the Appraisal tool for Cross-Sectional Studies (AXIS). The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and Terwee's criteria were used to appraise the psychometric properties of the included studies. A narrative synthesis approach was used in the interpretation of the findings.
Of the 7470 records identified, 12 studies with 14 corresponding instruments met the inclusion criteria and were included in the final review. No study assessed all the psychometric properties highlighted by the COSMIN criteria. In most instruments, we found evidence that initial development work incorporated client participation. The most evaluated measurement properties were content validity, internal consistency, and structural validity. Measurement error and responsiveness were not reported in any study.
Reliability and validity should be considered important elements when choosing or developing an instrument for professionals seeking an effective instrument for use within the population. Our review identified limitations in the psychometric properties of patient experience and satisfaction instruments, and none met all methodological quality standards. Future studies should focus on further developing and testing available measures for their effectiveness in clinical practice. Furthermore, the development of new instruments should incorporate clients' views and be rigorously tested or validated in studies with high methodological quality.
CRD42020150438.
从患者作为客户的角度看待医疗保健提供了对护理过程和结果的独特见解，并可以促进服务质量的提高。用于衡量这些观点的工具的差异通常反映了对护理质量的概念化和个人经验的差异。本系统评价评估了在中低收入国家（LMICs）衡量客户对医疗保健的体验和满意度的工具的有效性和可靠性。
我们在 PubMed、SCOPUS 和 CINAHL 中进行了系统搜索。本综述按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行报告。综述中包括描述一般医疗保健客户体验和满意度的开发和心理测量特性的研究。使用横断面研究评价工具（AXIS）对研究设计进行批判性评价。使用共识基础健康测量仪器选择标准（COSMIN）清单和特威的标准来评估纳入研究的心理测量特性。使用叙述性综合方法解释研究结果。
在确定的 7470 条记录中，有 12 项研究和 14 个相应的工具符合纳入标准，并包含在最终的综述中。没有研究评估 COSMIN 标准强调的所有心理测量特性。在大多数工具中，我们发现证据表明最初的开发工作纳入了客户的参与。评价最多的测量特性是内容有效性、内部一致性和结构有效性。没有研究报告测量误差和反应性。
在选择或开发专业人员在人群中使用的有效工具时，可靠性和有效性应被视为重要因素。我们的综述发现，患者体验和满意度工具的心理测量特性存在局限性，没有一种工具符合所有方法学质量标准。未来的研究应侧重于进一步开发和测试现有措施，以评估其在临床实践中的有效性。此外，新工具的开发应纳入客户的观点，并在具有较高方法学质量的研究中进行严格测试或验证。
CRD42020150438。
