Validation of a patient satisfaction scale: theory, methods and practice.

This communication discusses more than a decade of developments in the measurements of attitudes toward physicians and medical care. Particular emphasis is given to a scale first reported in 1970 and to a 1981 publication attempting to validate this scale. The analytic strategies proposed as validation techniques are reviewed with respect to their technical properties, underlying assumptions and interpretability. Constraints on each of these features are noted. The most restrictive feature of these analyses is the presumption that validity can be achieved only through a unidimensional framework. Attitudes toward medical care are based on a diversity of substantive issues, and they are influenced by individual experiences and psychological characteristics as well as the circumstances surrounding scale administration. We propose that validation of patient attitude scales be based on a more generous conceptualization of their content and some consideration of their purpose and uses.