How sophisticated are consumers about the medical care delivery system?

A 10-item questionnaire was administered to non-elderly persons (N = 4,976) to measure their sophistication or knowledgeability about the medical care delivery system. Such sophistication seems germane to views about the appropriate role consumers might play in decisions affecting resource allocation, especially whether competition or cost-sharing strategies should be pursued or whether certain regulatory strategies are more promising. Analyses of individual items suggest that consumers are knowledgeable about some matters and uninformed about others. If a pro-competitive strategy is pursued, efforts at educating consumers about board certification, staff privileges and other information pertinent to choosing a regular source of care seems warranted. Factor analyses indicated that a substantial amount of the information contained in item responses can be summarized in a multi-item scale score. The reliability and validity of this scale as a measure of patient sophistication was supported.

Factors associated with relief from chest pain following emergency care

A preliminary study was conducted to explore a range of factors that may be associated with relief from chest pain. Nonhospitalized ambulatory patients (N = 150) were interviewed in their homes shortly after seeking care at one of two hospital emergency rooms. Bivariate and multivariate analyses identified four factors positively correlated with symptom relief: whether someone accompanied the patient to the emergency room; whether the patient feared a heart attack or heart problem; whether the patient believed that providers are able to help their patients; and whether the patient was told that he had not had a heart attack. A fifth factor, the number of history and examination items recorded in the medical record, was found to be inversely related to pain relief. It is suggested that in addition to sociodemographic characteristics of patients and measures of medical care process which are frequently studied, social and psychologic factors be considered as important explanatory variables in studies of health status outcomes.

Measuring components of children's health status

Measures of physical, mental and social components of health status and general health ratings were studied for children ages 0-4 (N = 679) and 5-13 (N = 1473). Questionnaires were completed by adult proxies (usually mothers) in three generally healthy populations. Hypothesized multi-item scales were tested; reliability was estimated and preliminary attempts at validation were undertaken. Items in ten scales pertaining to mental health (Anxiety, Depression, Positive Well-Being, Mental Health Index), social health (Social Relations), general health ratings (Current Health, Prior Health, Resistance/Susceptibility to Illness, General Health Rating Index), as well as parental satisfaction with child development satisfied Likert-type and discriminant validity criteria. Because functional limitation items were endorsed for very few children, scales to measure physical health could not be tested. Almost all scales were sufficiently reliable for group comparisons; reliability coefficients were lower in the most disadvantaged population. Interrelationships among scales and validity variables generally supported their construct validity and supported a multi-component model of children's health status.

Effects of acquiescent response set on patient satisfaction ratings

This paper summarizes the results of three studies of bias in patient satisfaction questionnaires due to acquiescent response set (ARS), a tendency to agree with statements of opinion regardless of content. Three independent surveys (N = 1,280) were fielded using the Patient Satisfaction Questionnaire. Across the three field tests, 40 to 60 per cent of respondents manifested some degree of ARS and from 2 to 10 per cent demonstrated noteworthy ARS tendencies. Occurrences of ARS accounted for significant upward bias in satisfaction scores computed from favorably worded questionnaire items and scales constructed from those items and significant downward bias in scores computed from unfavorably worded items and scales constructed from those items. These biases were greatest for groups reporting lower educational attainment or less income. An example was presented to show that mean satisfaction scores for groups differing in education were biased by ARS to such an extent that group differences in satisfaction were overestimated by favorably worded items and were missed entirely by unfavorably worded items. Balanced satisfaction scales, i.e., those containing both favorably and unfavorably worded items, were not correlated or correlated only slightly with ARS; therefore, group means for balanced scales were not biased by ARS or were biased only slightly.

The meaning of health: understanding functional limitations

Results of psychometric studies of 14 questionnaire items commonly used to define chronic functional limitations due to poor health are reported. Self-administered questionnaires were used to gather data from 1,209 persons 14 years of age and older. Data were used to study: scalability of items; test-retest reliability of alternate forms of scales; validity of scales in relation to 13 health status variables and age; and precision of scales in detecting differences in health. Three scales pertaining to chronic limitations in mobility, physical activity, and social role activity functions satisfied the criteria of scalogram analysis. Four-month test-retest reliability estimates for alternate forms were very high. Strong associations (some curvilinear) were observed among functional limitation scales, and between these scales and survey measures of physical abilities, general health perceptions, health worry/concern, chronic disease conditions, and age. Measures of physical abilities and functional limitations appeared to define opposite ends of a function-dysfunction continuum. Statistical modeling of precision indicates that, due to the skewed distribution of scores, large sample sizes would be required to detect differences in functional limitations in studies using only a posttest.

Scales for measuring general health perceptions

This article reports on the construction and testing of eight health perception scales from 32 items on a standardized survey instrument designed for self-administration, the Health Perceptions Questionnaire (Form II). The scales measure perceptions of prior health, current health, health outlook, resistance/susceptibility to illness, health worry/concern, sickness orientation, rejection of sick role, and attitude toward going to the doctor. Field testing revealed that the scales are valid, reliable, and stable over time for diverse populations. It is recommended that the scales be used in studies requiring general health measures. Suggestions for future research are offered.

Income group differences in relationships among survey measures of physical and mental health

The present research tested the hypothesis that the experience of health is hierarchically organized such that gratification of physical health needs must precede gratification of mental health needs. It was reasoned that because the nondisadvantaged possess greater resources for the gratification of health needs in general, symptoms of mental illness would be more salient for this group and thus better able to explain variance in both mental and physical illness. On the other hand, it was reasoned that symptoms of physical illness would be more salient and thus better able to explain variance in both mental and physical illness for the disadvantaged. Results of the study indicate income group differences in patterns of relationships among health variables, supporting the hypothesis and suggesting important differences in the validity of health measures across income groups. The results are related to previous findings in medical sociology, and suggestions for future research are made.

Dimensions of patient attitudes regarding doctors and medical care services

The factor analytic development and validation of numerous index scores to measure patient attitudes regarding characteristics of doctors and medical care services is described. Index scores meeting factor analytic criteria and found to be reliable were used to study the nature and number of attitudinal dimensions underlying patient satisfaction. The use of index scores which have met logical and empirical criteria is in contrast to the common practice of using individual questionnaire items as the unit of analysis. Four major dimensions of patient attitudes were identified and described, including attitudes toward doctor conduct (humanness and quality) and such enabling components as availability of services, continuity/convenience of care and access mechanisms (cost, payment mechanisms, and ease of emergency care). Measures of attitudes toward caring (humanness) and curing (quality/competence) aspects of doctor conduct appear to reflect the same underlying attitudinal dimension. Findings are discussed in relation to concepts and measures mentioned in the published literature and suggestions are offered for future research.

Health as a value: methodological and theoretical considerations

The concept of value placed on health is very important in several different theoretical approaches to the study of health behavior. In practice, however, health value is generally assumed to be universally high rather than being directly measured. If this assumption is incorrect, then theories that include health value have rarely been adequately tested. This paper presents a short 4-item Likert scale designed to measure the value placed on health. Norms from the utilization of this scale in five different samples are presented. Health value is found to increase with age among girls, but the increase apparently stops by late adolescence, before full adult levels of health value are achieved. Middle-aged women place a higher value on health than do middle-aged men, although no comparable sex difference appears in a sample of undergraduates. Consistent with theoretical predictions, both health locus of control beliefs and beliefs in the efficacy of certain preventive health behaviors correlate more highly with the performance of those same behaviors 5 to 9 months later among respondents who place a high value of health relative to those who do not value health so highly. However, this interaction is found only when it can be safely assumed that health is the primary value underlying the behavior. The importance of considering a variety of values in addition to health as possible motivators of preventive health behavior is stressed.