Crawford Allison, Kirvan Anne, Sanches Marcos, Gambin Amanda, Canso Denise, Serhal Eva
Centre for Addiction and Mental Health, Toronto, ON, Canada.
J Med Internet Res. 2025 Jan 3;27:e49844. doi: 10.2196/49844.
The onset of the COVID-19 pandemic precipitated a rapid shift to virtual care in health care settings, inclusive of mental health care. Understanding clients' perspectives on virtual mental health care quality will be critical to informing future policies and practices.
This study aimed to outline the process of redesigning and validating the Virtual Client Experience Survey (VCES), which can be used to evaluate client and family experiences of virtual care, specifically virtual mental health and addiction care.
The VCES was adapted from a previously validated telepsychiatry survey. All items were reviewed and updated, with particular attention to the need to ensure relevance across mental health care sectors and settings. The survey was then revalidated using the 6 domains of health care quality of the Institute of Medicine (IOM) as a guiding framework. These 6 domains include being safe, effective, patient-centered, efficient, timely, and equitable. The VCES was piloted with a convenience sample of clients and family members accessing outpatient care at the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario, through video or telephone. A confirmatory factor analysis (CFA) was conducted in MPlus and used to test the factorial structures of the VCES, with minor respecification of the model based on modification indices, factor loadings, reliability, and item-total correlation. The respecifications were checked for alignment with the construct definitions and item interpretation. The reliability of the constructs was estimated by the Cronbach α coefficient.
The survey was completed 181 times. The construct reliability was generally high. Timely was the only subscale with an α lower than 0.7; all others were above 0.8. In all cases, the corrected item-total correlation was higher than 0.3. For the CFA, the model was adjusted after multiple imputations with 20 datasets. The mean chi-square value was 437.5, with df=199 (P<.001). The mean root mean square error of approximation (RMSEA) was 0.08 (SD 0.002), the mean confirmatory fit index (CFI) was 0.987 (SD 0.001), the mean Tucker-Lewis Index (TLI) was 0.985 (SD 0.001), and the mean standardized root mean square residual (SRMR) was 0.04 (SD 0.001).
This study describes the validation of the VCES to evaluate client and family experiences of virtual mental health and addictions care. Given the widespread uptake of virtual care, this survey has broad applicability across settings that provide mental health and addiction care. The VCES can be used to guide targeted quality improvement initiatives across health care quality domains. By effectively addressing challenges as they emerge, it is anticipated that we will continue to move toward hybrid modalities of practice that leverage the strengths and benefits of telephone, video, and in-person care to effectively respond to unique client and family needs and circumstances.
新冠疫情的爆发促使医疗保健机构迅速转向虚拟护理，包括心理健康护理。了解客户对虚拟心理健康护理质量的看法对于为未来的政策和实践提供信息至关重要。
本研究旨在概述重新设计和验证虚拟客户体验调查（VCES）的过程，该调查可用于评估客户和家庭对虚拟护理的体验，特别是虚拟心理健康和成瘾护理。
VCES改编自先前经过验证的远程精神病学调查。对所有项目进行了审查和更新，特别关注确保跨心理健康护理部门和环境的相关性的必要性。然后以医学研究所（IOM）的医疗保健质量的6个领域为指导框架对该调查进行重新验证。这6个领域包括安全、有效、以患者为中心、高效、及时和公平。通过视频或电话对安大略省多伦多成瘾与心理健康中心（CAMH）接受门诊护理的客户和家庭成员的便利样本进行了VCES试点。在MPlus中进行了验证性因素分析（CFA），并用于测试VCES的因子结构，并根据修正指数、因子载荷、信度和项目-总分相关性对模型进行了轻微重新设定。检查重新设定是否与结构定义和项目解释一致。通过Cronbach α系数估计结构的信度。
该调查共完成181次。结构信度总体较高。及时性是唯一一个α低于0.7的子量表；其他所有子量表均高于0.8。在所有情况下，校正后的项目-总分相关性均高于0.3。对于CFA，在对20个数据集进行多次插补后对模型进行了调整。平均卡方值为437.5，自由度为199（P<.001）。平均近似均方根误差（RMSEA）为0.08（标准差0.002），平均验证性拟合指数（CFI）为0.987（标准差0.001），平均塔克-刘易斯指数（TLI）为0.985（标准差0.001），平均标准化均方根残差（SRMR）为0.04（标准差0.001）。
本研究描述了VCES的验证，以评估客户和家庭对虚拟心理健康和成瘾护理的体验。鉴于虚拟护理的广泛采用，该调查在提供心理健康和成瘾护理的环境中具有广泛的适用性。VCES可用于指导跨医疗保健质量领域的有针对性的质量改进举措。通过有效应对出现的挑战，预计我们将继续朝着混合实践模式发展，利用电话、视频和面对面护理的优势，有效应对客户和家庭的独特需求和情况。
