The Effect of Nudging on Compliance with Individual Prevention Measures against COVID-19: An Online Experiment on Greek University Students

Nudging has often been suggested as a means to promote health care efficiency and effectiveness by influencing behavior without restricting choice; its usefulness, however, has not been adequately assessed. We examined the effect of an altruistically framed awareness message about the novel coronavirus on the intention to comply with individual prevention measures against infection. A total of 425 Greek postgraduate students, which were randomly assigned into a treatment group and a control group, filled out a questionnaire on compliance and future intention to comply with six preventive measures. The results indicate that the altruistic message did not manage to influence the intention to comply. Moreover, compliance was positively associated with risk perception, whereas women showed both higher compliance and risk perception than men. Vulnerability to the novel coronavirus and a positive vaccination status against it were accompanied by a greater perception of risk, while one's personal history of COVID-19 was associated with a lower intention to comply, lower risk perception, and higher health risk preferences. We conclude that nudging interventions should be evaluated before being adopted in practice, taking into account timing, target groups, and means of communication.

Validation of the Greek version of the contact lens dry eye questionnaire-8 (CLDEQ-8)

PURPOSE

Contact lens discomfort (CLD) has been cited as one of the prime reasons for discontinuing contact lens wear. The CLDEQ-8 was created in 2008 to reflect status of and change in overall opinion of soft contact lenses. The purpose of this study is to examine the validity and reliability of a Greek version of the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8), using Rasch statistical analysis.

METHODS

This an observational prospective study of 150 consecutive patients who received soft contact lenses and were followed through with a single follow-up appointment up to a year following their initial one. The patients filled in the Greek versions of the CLDEQ-8, the Ocular Surface Disease Index (OSDI) and a self-report item on their experience of contact lens use. The CLDEQ-8 was analyzed with Rasch analytic methodology.

RESULTS

The original scoring system of the CLDEQ-8 had to be altered regarding the response categories collapsing in fewer options in items b, 2b, 3b and item 5 of the original scale. The revised scoring system proved more psychometrically valid and the CLDEQ-8 had good measurement precision, category threshold order, targeting and differential item functioning for gender. Two alternative result indexes are proposed, a symptom intensity index and a symptom frequency index to address dimensionality issues that are evident with the items relating to symptom intensity versus the rest. Results from the CLDEQ-8 correlated with the OSDI total score and the self-reported experience of contact lens use.

CONCLUSIONS

The Greek version of the CLDEQ-8 is a psychometrically valid and reliable assessment tool for contact lens discomfort in Greek-speaking populations.

Job satisfaction of primary healthcare professionals: a cross-sectional survey in Greece

BACKGROUND

The role of job satisfaction is essential for the operation of public Primary Healthcare Centers in Greece. The dimensions of job satisfaction can be used to gauge employees' engagement and performance.

METHODS

Job Satisfaction Survey was employed among healthcare professionals in 32 Primary Healthcare Centers, between June 2019 and October 2020. The 36 items of the questionnaire are expressed on a six-point Likert scale divided into 9 aspects: salary, promotion, supervision, fringe benefits, contingent rewards, operating procedures, co-workers, nature of work, and communication. Additional questions were added covering sociodemographic characteristics.

RESULTS

A total of 1,007 professionals completed the questionnaire (83.92% response rate), of which 51.04% were nurses, 27.61% physicians, and 21.35% other healthcare employees. The average overall job satisfaction score indicates ambivalence (3.63 out of 6). Participants were dissatisfied with salaries (2.38) and promotion (2.84) aspects and ambivalent regarding fringe benefits (3.04), operating procedures (3.23), and contingent rewards (3.30). Moderate satisfaction was reported for the nature of work (4.53), supervision (4.52), co-workers (4.37), and communication (4.22). Nurses by far reported the lower levels of satisfaction in all dimension except communication compared to the other groups.

CONCLUSIONS

The findings suggest that decreasing administrative workload and the improvement of working conditions, procedures, payment, and provision of better opportunities for the promotion of PHC professionals might be the most effective ways to subsequently improve their subjective well-being and their job satisfaction which in turn will improve their performance.

Determining dimensions of job satisfaction in healthcare using factor analysis

BACKGROUND

Job satisfaction in health care has a great impact as it affects quality, productivity, effectiveness, and healthcare costs. In fact, it is an indicator of the well-being and quality of life of the organization's employees, as it has been variously linked with increased performance and negatively to absenteeism and turnover. Better knowledge of healthcare employees' job satisfaction and performance can directly contribute to the quality of the services provided to patients and is critical for the success of organizations.

METHODS

The Cronbach's alpha coefficient, split-half reliability, exploratory factor and confirmatory factor analysis were employed to assess the reliability and validity of JSS.

RESULTS

Six underlying dimensions were extracted (benefits and salary, management's attitude, supervision, communication, nature of work, and colleagues' support). Internal consistency reliability was satisfactory since Cronbach's alpha for the overall scale was 0.81 and for the various dimensions ranged from 0.61 to 0.81, respectively. Exploratory factor analysis showed a KMO value of 0.912. The confirmatory factor analysis indicated good fit: SRMR = 0.050, RMSEA = 0.055, IFI = 0.906 and CFI = 0.906.

CONCLUSION

Job satisfaction is a multidimensional construct that encompasses different facets of satisfaction. There is a lack of consensus as to which factors are more important and a researcher may find satisfaction with some factors while at the same time dissatisfaction with others. Our findings are significant for improving our understanding of the nature and assessment of job satisfaction in the Greek healthcare context, providing a more stable ground in a rapidly changing environment. A short JSS developed that could be much more widely used in the future.

Factors Influencing Motivation and Work Engagement of Healthcare Professionals

Background:

Low level of health professionals’ work motivation is a critical challenge for countries’ health care system. A survey of ministries of health in many countries showed that low motivation was seen as the second most important health workforce problem after staff shortages.

Objective:

The aim of the study was to examine in detail the factors which can affect motivation and work engagement, to assess the motivation levels of personnel working in public hospitals and to identify any differences between the various categories of healthcare professionals employed at the 1st Regional Health Authority of Attica.

Methods:

Frederick Herzberg’s motivation-hygiene theory was used as the theoretical framework. Twelve phrases were used that correspond to intrinsic and extrinsic motivating factors, namely achievement, recognition, nature of work, responsibility, advancement, growth, organizational policies, supervision, interpersonal relationships, working conditions, salary and job security. Phrases 1-6 covered the internal motivators and 7-12 correspond to the external. Additional questions were added covering the socio-demographic characteristics of respondents.

Results:

The response rate was 81.95% and 3,278 questionnaires were collected. Findings suggest that extrinsic motivation factors have slightly higher mean scores (MS=8.30) than intrinsic motivation factors (7.81). The role of factors like salary (9.31), organizational policies (8.91), growth (8.89) and job security (8.86) was significant. However, every category of hospital staff is affected in a different way and degree by each factor. In periods of crisis, the need of extrinsic factors of motivation increased.

Conclusions:

Providing a motivating environment for employees becomes more fundamental in the healthcare system. Motivation of healthcare employees was affected by factors related to supervision, financial benefits, job training and growth. Efforts should be made to provide such benefits to health employees as appropriate especially, to those who did not get any such benefits. Officially recognizing best performance is suggested.

Job satisfaction and associated factors in Greek public hospitals

BACKGROUND AND AIM

To investigate the level of job satisfaction of health care professionals in the public hospitals of the 1st Regional Health Authority of Attica and further to assess its determining factors.

METHODS

The Job Satisfaction Survey questionnaire was administered to health professionals in thirteen hospitals. The 36 items of the questionnaire are expressed on a Likert scale and are divided into nine dimensions. Additional questions were added covering the demographic and socio-economic characteristics.

RESULTS

The reliability of the tool was: α Cronbach = 0.89. The response rate was 81.95%, 3,278 questionnaires were collected overall, of which 52,96% (n=1,736) originated from the nursing staff, 24.50% (n=803) from the medical staff and 22.54% (n=739) from other health employees. The average overall job satisfaction is moderate (3.33 out of 6). The category with the lowest score in job satisfaction was that concerning salaries (2.12). Questions related to promotion (2.45), additional benefits (2.67), operating procedures (2.82) received low job satisfaction rates. Instead, the categories that garnered positive job satisfaction concerned questions related to the supervision (4.66), the nature of work (4.34), and co-workers (4.25). Questions related to communication received 3.79.

CONCLUSIONS

The findings showed lowest satisfaction levels in pay, fringe benefits, contingent rewards, promotion and operating procedures dimensions of job satisfaction. Participants were more satisfied with the nature of work, supervision and co-workers. The findings can be used as a set of reference levels and indicators for the human resources development component of the quality management system in the public hospitals.

Examining different outcome measures for reliability in assessing the impact of cataract surgery in quality of health

INTRODUCTION

The aim of this study was to determine a reliable combination of vision-specific measures and general health measures to assess the improvement on the patient's QoL following cataract surgery either when patients had first time surgery or had already received successful surgery in the fellow eye for cataract.

METHODS

Study sample included two waves of data measurement in 150 patients undergoing uncomplicated cataract surgery who were assessed for visual acuity, vision-specific quality of life, and general health. Data were acquired pre-surgery and 2 months post-surgery. About 90 patients haven't had prior cataract surgery while 60 patients had prior successful cataract surgery in the fellow eye.

RESULTS

There was considerable improvement in all outcome measures following cataract surgery. Patients who have had prior surgery presented with modestly higher scores in the vision-specific QoL measures and minimal benefit pre-operatively compared to those who haven't had any surgery in the general health measure. They also had more gains post-surgery in the vision-specific QoL measures only.

CONCLUSIONS

There is a possibility that gains in QoL plateau after a certain level of visual acuity improvement. While improvement can be detected with a general health QoL measure, this measure may require additional psychometric validation to the particular population beforehand. Otherwise, a combination of vision-specific outcome measures will provide the most reliable estimate.

Improvement in general health after cataract surgery is not limited to vision-specific function

Cataract surgery is known to have a beneficial impact on quality of life. Recent studies claimed that disease-specific measures of functional impairment are more sensitive to preoperative functional impairment and gains from surgery than are generic measures of general health and quality of life. The purpose of this study is to ascertain whether measures of general health provide additional information on the improvement of patients following cataract surgery over measures of visual function. This is an observational prospective study of a cohort of 150 consecutive patients who underwent phacoemulsification surgery and were evaluated for changes in health-related quality of life with the Medical Outcomes Study Short-Form 36 (SF-36) and improvement in visual-related functioning with the 14-item Visual Function test (VF-14). All of the SF-36 subscales improved post operatively with the magnitude of improvement in VF-14 significantly affecting all subscales except for the Vitality subscale. Treatment effects were significant for the SF-36 subscales 'Role limitations due to physical health', 'Role limitations due to emotional problems', 'Social Functioning' and 'General Health', while taking into account the difference in VF-14 scores pre and postoperatively (p < 0.001). The outcome of phacoemulsification surgery for cataract cannot be completely ascertained solely by the measurement of improvement on tasks related to visual functioning, leaving unaccounted a component related to self-appraisal of ability in everyday and social function, as well as the general feeling of subjective health. The concurrent use of general health measures with visual functioning measures to account for the general improvement on health status following cataract surgery is thus justified.

Rasch Validation of the LVQOL Scale

AIM

This study proceeds to rigorously examine and validate the Low Vision Quality-of-Life Questionnaire (LVQOL) on a Greek population of ophthalmic patients employing Rasch measurement techniques.

METHODS

It is a prospective observational study of 150 cataract patients and 150 patients with other ophthalmic diseases, all followed longitudinally for a period of two months pending surgical or other corrective therapy, after which they were administered the LVQOL for a second time.

RESULTS

The original 25-item LVQOL demonstrated high reliability and validity, excellent measurement precision and ordered response category thresholds. A small number of items carry an acceptable level of measurement error while three items had some differential functioning for gender, Age and underlying disorder that did not exceed the established thresholds.

CONCLUSIONS

This validation study is the first to employ Rasch measurement to examine the validity of the LVQOL and it supports its use with no changes to the original structure. The LVQOL can be employed in a large range of ophthalmic diseases and reliably assess improvements in quality-of-life following phacoemulsification surgery or any other intervention.

Rasch Validation of the VF-14 Scale of Vision-Specific Functioning in Greek Patients

The Visual Functioning-14 (VF-14) scale is the most widely employed index of vision-related functional impairment and serves as a patient-reported outcome measure in vision-specific quality of life. The purpose of this study is to rigorously examine and validate the VF-14 scale on a Greek population of ophthalmic patients employing Rasch measurement techniques. Two cohorts of patients were sampled in two waves. The first cohort included 150 cataract patients and the second 150 patients with other ophthalmic diseases. The patients were sampled first while pending surgical or other corrective therapy and two months after receiving therapy. The original 14-item VF-14 demonstrated poor measurement precision and disordered response category thresholds. A revised eight-item version, the VF-8G (‘G’ for ‘Greek’), was tested and confirmed for validity in the cataract research population. No differential functioning was reported for gender, age, and underlying disorder. Improvement in the revised scale correlated with improvement in the mental and physical component of the general health scale SF-36. In conclusion, our findings support the use of the revised form of the VF-14 for assessment of vision-specific functioning and quality of life improvement in populations with cataracts and other visual diseases than cataracts, a result that has not been statistically confirmed previously.

A Contingent Valuation Study for Eliciting a Monetary Value of a Quality-Adjusted Life-Year in the General Greek Population

OBJECTIVES

To elicit a willingness-to-pay (WTP) per quality-adjusted life-year (QALY) estimate for the general Greek population and assess the impact of individuals' socio-demographic characteristics and motives on this estimate.

METHODS

A telephone-based survey was carried out employing a representative sample of the general Greek population (n = 1342). A computer-assisted telephone-interview method was adopted to ensure random sampling. A total of 528 participants reported a WTP value for a utility improvement from their current health to perfect health. Those individuals' motives were assessed through predefined statements. Test-retest reliability was assessed using intraclass correlation coefficient (ICC). Multiple linear regression (MLR) and one-way analysis of variance (ANOVA) tests were conducted to assess the effect of socioeconomic/demographic determinants and motive statements, respectively, on WTP/QALY. MLR was re-estimated considering as dependent variable the WTP/QALY estimate calculated for participants: (1) stating a WTP value ≤ their household income and (2) presenting higher certainty regarding stated WTP value (sensitivity analysis).

RESULTS

Analysis revealed good reliability for WTP/QALY estimates and motive statements (ICC values > 0.8). Mean WTP/QALY was €26 280. The respective 5% trimmed value was €14 862. Being a student and household income affected WTP/QALY. Sensitivity analysis did not produce markedly different WTP/QALY predictors, implying the robustness of results, irrespective of the participant group considered. Individuals who indicated the inability to cover basic family needs or pay tax claims as motives reported lower WTP/QALY values compared with those not viewing these aspects as motives.

CONCLUSIONS

Findings confirm that the World Health Organization's criterion used currently in Greek cost-effectiveness studies is not unreasonable. Additional research is essential to further explore WTP/QALY estimates in the Greek setting and facilitate informed decision making.

Successful Cataract Surgery Leads to an Improvement in Depressive Symptomatology

INTRODUCTION

Cataract is the most common reversible cause of blindness worldwide, and the associated vision impairment has been associated with an adverse impact on health-related quality of life and mental health in particular. However, findings from studies on the mental health improvement of patients after cataract surgery remain inconclusive. The objective of this study is to ascertain whether the outcome on best-corrected visual acuity (BCVA) following cataract surgery is associated with depressive symptomatology.

METHODS

This is an observational prospective study of a cohort of 150 consecutive patients who underwent phacoemulsification surgery and who were evaluated for changes in depressive symptomatology with Beck's Depression Inventory-II (BDI-II).

RESULTS

The difference in BDI-II scores pre- and postoperatively correlated with the difference in BCVA pre- and postoperatively (p < 0.001). A paired-samples t test revealed a statistically significant difference in the preoperative and postoperative BDI-II scores (p < 0.001). A related-samples Wilcoxon signed-rank test revealed a statistically significant improvement of depression status among the patients (p = 0.004). A stepwise regression analysis concluded that the only statistically significant predictor in assessing the difference in total BDI-II score before and after the operation was the respective difference in visual acuity.

DISCUSSION/CONCLUSION

The success of phacoemulsification surgery for cataract as evaluated with the change in BCVA is related to the rate of improvement in depressive symptomatology.

Gynecology healthcare professionals towards safety procedures in operation rooms aiming to enhanced quality of medical services in Greece

PURPOSE

The purpose of this paper is to investigate the attitudes of healthcare professionals in Greece toward safety practices in gynecological Operation Rooms (ORs).

DESIGN/METHODOLOGY/APPROACH

An anonymous self-administered questionnaire was distributed to surgical personnel asking for opinions on safety practices during vaginal deliveries (VDs) and gynecological operations (e.g. sponge/suture counting, counting documentation, etc.). The study took place in Hippokration Hospital of Thessaloniki including 227 participants. The team assessed and statistically analyzed the questionnaires.

FINDINGS

Attitude toward surgical counts and counting documentation, awareness of existence and/or implementation in their workplace of other surgical safety objectives (e.g. WHO safety control list) was assessed. In total, 85.2 percent considered that surgical counting after VDs is essential and 84.9 percent admitted doing so, while far less reported counting documentation as a common practice in their workplace and admitted doing so themselves (50.5/63.3 percent). Furthermore, while 86.5 percent considered a documented protocol as necessary, only 53.9 percent admitted its implementation in their workplace. Remarkably, 53.1 percent were unaware of the WHO safety control list for gynecological surgeries.

ORIGINALITY/VALUE

Most Greek healthcare professionals are well aware of the significance of surgical counting and counting documentation in gynecology ORs. However, specific tasks and assignments are unclear to them. Greek healthcare professionals consider surgical safety measures as important but there is a critical gap in knowledge when it comes to responsibilities and standardized processes during implementation. More effective implementation and increased personnel awareness of the surgical safety protocols and international guidelines are necessary for enhanced quality of surgical safety in Greece.

Greek gynecology healthcare professionals towards quality management systems

PURPOSE

Today, quality management systems (QMS) are a promising candidate for the improvement of healthcare services. The purpose of this paper is to investigate the opinions/attitudes of gynecology healthcare professionals toward quality and quality management in healthcare facilities (HFs) in Greece.

DESIGN/METHODOLOGY/APPROACH

An anonymous self-administered questionnaire was distributed to healthcare professionals, asking for opinions on quality objectives associated with the everyday workflow in HFs (e.g. management of patients, resources, etc.) and on QMS. The study was conducted in Hippokration Hospital of Thessaloniki, including 187 participants. Statistical assessment and analysis of the questionnaires were carried out.

FINDINGS

Although 87.5 percent recognized the importance of potential QMS implementation and accreditation, over 50 percent believed that it would lead rather to increased workload and bureaucracy than to any considerable quality improvement. More than 60 percent were completely unaware of the implementation of quality objectives such as quality handbook, quality policy, audit meetings and accreditation status in their HFs. This unawareness was also reported in terms of patient, data, human and general resources management. Finally, awareness over medical malpractice and positive attitude toward official reporting were detected.

ORIGINALITY/VALUE

Most respondents acknowledged the significance of quality, QMS implementation and accreditation in Greek hospitals. However, there was a critical gap in knowledge about quality management objectives/processes that could be possibly resolved by expert teams and well-organized educational programs aiming to educate personnel regarding the various quality objectives in Greek HFs.

Greek students' attitudes, perception and knowledge regarding generic medicines in times of economic crisis: a cross-sectional study

BACKGROUND

The penetration of generic medicines in the pharmaceutical market is influenced, among others, by the consumer's attitude upon them. The attitude of students in health management and recent alumni is particularly important, as they constitute tomorrow's policymakers. The aim of our study was to assess their attitude, perception and knowledge towards generic medicines.

METHODS

A cross-sectional study was undertaken, involving students in Health Management and recent alumni. The ATtitude TOwards GENerics (ATTOGEN) validated questionnaire was used, which consists of 18 items, yielding 6 scales (trust, state audit, knowledge, drug quality, drug substitution and fiscal impact), with all item responses expressed on a 5-point Likert scale and higher scores denoting greater disagreement. Correlation coefficients were computed and independent sample tests were performed using non-parametrical statistical methods.

RESULTS

A total of 1402 students were interviewed, with a female predominance (62.88%). The mean (SD) scores for the six scales of the ATTOGEN questionnaire were: Trust: 2.877 (0.940), State audit: 3.251 (0.967), Knowledge: 1.537 (0.688), Drug quality: 2.708 (0.971), Drug substitution: 3.828 (1.127) and Fiscal impact: 2.299 (0.860). Trust over generics was statistically significantly associated with all ATTOGEN scales (all p < 0.001). In addition, the increased level of knowledge about generics was associated with recognition of the generic medicines' quality equivalence (p < 0.001) and positive fiscal impact (p = 0.018). Pharmacists declared having a superior knowledge of generic medicines, being more satisfied with the information they receive about them and strongly believing in drug substitution (p < 0.001). Comparatively to other professionals, pharmacists also indicated substantial differences between branded and generic medicines more often (p < 0.001). They also argued to a greater extent that generic medicines were invented and promoted to resolve the financial crisis of social security institutions at the expense of citizens (p < 0.001).

CONCLUSIONS

This study demonstrated a mixed attitude of students regarding generic medicines. Trust and knowledge emerged as key factors shaping the students' attitude towards generics. Among students, pharmacists exhibited a distinct response pattern. This study underlines the importance of addressing and correcting health management students' misbeliefs about generics' quality and utility.

Eliciting the Monetary Value of a Quality-Adjusted Life Year in a Greek Outpatient Department in Times of Economic Austerity

BACKGROUND AND OBJECTIVE

Contingent valuation is widely used to determine individuals' willingness to pay (WTP) for a health gain. Our study aimed to elicit an empirical estimate of the monetary value of a quality-adjusted life year (QALY) in a Greek outpatient setting in times of economic austerity and assess the impact of patients' characteristics on their valuations.

METHODS

We used a questionnaire as a survey tool to determine the maximum WTP for a health gain of a hypothetical therapy and to evaluate patients' health-related quality of life (EuroQoL-5D-3L) and demographic and socioeconomic characteristics. EuroQoL tariffs were used to estimate health utilities. Mean WTP values were computed and ordinary least squares regressions performed on transformed Box-Cox and logarithmic dependent WTP per QALY variables to remedy observed skewness problems.

RESULTS

Analyses were performed for 167 patients with utility values less than unity. Mean WTP per QALY reported was similar for both payment vehicles examined: payments made out-of-pocket (€2629) and payments made through new tax imposition (€2407). Regression results showed that higher net monthly family income was associated with higher WTP per QALY for both payment vehicles. Moreover, the presence of a chronic condition and higher level of education were associated with higher out-of-pocket WTP per QALY and WTP per QALY through taxes, respectively.

CONCLUSION

The very low WTP per QALY estimates could be explained by the recent severe economic depression and austerity in Greece. In fact, family income was found to be a significant predictor of WTP per QALY. Since these estimates deviate significantly from the cost-effectiveness thresholds still employed in economic evaluations in this country, research should be undertaken promptly to further examine this important issue using a nationwide representative sample of the general population along with WTP and other methodologies.

Development and validation of a tool to assess knowledge and attitudes towards generic medicines among students in Greece: The ATtitude TOwards GENerics (ATTOGEN) questionnaire

INTRODUCTION

The use of generic medicines is a cost-effective policy, often dictated by fiscal restraints. To our knowledge, no fully validated tool exploring the students' knowledge and attitudes towards generic medicines exists. The aim of our study was to develop and validate a questionnaire exploring the knowledge and attitudes of M.Sc. in Health Care Management students and recent alumni's towards generic drugs in Greece.

MATERIALS AND METHODS

The development of the questionnaire was a result of literature review and pilot-testing of its preliminary versions to researchers and students. The final version of the questionnaire contains 18 items measuring the respondents' knowledge and attitude towards generic medicines on a 5-point Likert scale. Given the ordinal nature of the data, ordinal alpha and polychoric correlations were computed. The sample was randomly split into two halves. Exploratory factor analysis, performed in the first sample, was used for the creation of multi-item scales. Confirmatory factor analysis and Generalized Linear Latent and Mixed Model analysis (GLLAMM) with the use of the rating scale model were used in the second sample to assess goodness of fit. An assessment of internal consistency reliability, test-retest reliability, and construct validity was also performed.

RESULTS

Among 1402 persons contacted, 986 persons completed our questionnaire (response rate = 70.3%). Overall Cronbach's alpha was 0.871. The conjoint use of exploratory and confirmatory factor analysis resulted in a six-scale model, which seemed to fit the data well. Five of the six scales, namely trust, drug quality, state audit, fiscal impact and drug substitution were found to be valid and reliable, while the knowledge scale suffered only from low inter-scale correlations and a ceiling effect. However, the subsequent confirmatory factor and GLLAMM analyses indicated a good fit of the model to the data.

CONCLUSIONS

The ATTOGEN instrument proved to be a reliable and valid tool, suitable for assessing students' knowledge and attitudes towards generic medicines.

A window-DEA based efficiency evaluation of the public hospital sector in Greece during the 5-year economic crisis

The main objective of this study was to apply the non-parametric method of Data Envelopment Analysis (DEA) to measure the efficiency of Greek NHS hospitals between 2009–2013. Hospitals were divided into four separate groups with common characteristics which allowed comparisons to be carried out in the context of increased homogeneity. The window-DEA method was chosen since it leads to increased discrimination on the results especially when applied to small samples and it enables year-by-year comparisons of the results. Three inputs -hospital beds, physicians and other health professionals- and three outputs—hospitalized cases, surgeries and outpatient visits- were chosen as production variables in an input-oriented 2-year window DEA model for the assessment of technical and scale efficiency as well as for the identification of returns to scale. The Malmquist productivity index together with its components (i.e. pure technical efficiency change, scale efficiency change and technological scale) were also calculated in order to analyze the sources of productivity change between the first and last year of the study period. In the context of window analysis, the study identified the individual efficiency trends together with “all-windows” best and worst performers and revealed that a high level of technical and scale efficiency was maintained over the entire 5-year period. Similarly, the relevant findings of Malmquist productivity index analysis showed that both scale and pure technical efficiency were improved in 2013 whilst technological change was found to be in favor of the two groups with the largest hospitals.

Developing and testing an instrument for identifying performance incentives in the Greek health care sector

BACKGROUND

In the era of cost containment, managers are constantly pursuing increased organizational performance and productivity by aiming at the obvious target, i.e. the workforce. The health care sector, in which production processes are more complicated compared to other industries, is not an exception. In light of recent legislation in Greece in which efficiency improvement and achievement of specific performance targets are identified as undisputable health system goals, the purpose of this study was to develop a reliable and valid instrument for investigating the attitudes of Greek physicians, nurses and administrative personnel towards job-related aspects, and the extent to which these motivate them to improve performance and increase productivity.

METHODS

A methodological exploratory design was employed in three phases: a) content development and assessment, which resulted in a 28-item instrument, b) pilot testing (N = 74) and c) field testing (N = 353). Internal consistency reliability was tested via Cronbach's alpha coefficient and factor analysis was used to identify the underlying constructs. Tests of scaling assumptions, according to the Multitrait-Multimethod Matrix, were used to confirm the hypothesized component structure.

RESULTS

Four components, referring to intrinsic individual needs and external job-related aspects, were revealed and explain 59.61% of the variability. They were subsequently labeled: job attributes, remuneration, co-workers and achievement. Nine items not meeting item-scale criteria were removed, resulting in a 19-item instrument. Scale reliability ranged from 0.782 to 0.901 and internal item consistency and discriminant validity criteria were satisfied.

CONCLUSION

Overall, the instrument appears to be a promising tool for hospital administrations in their attempt to identify job-related factors, which motivate their employees. The psychometric properties were good and warrant administration to a larger sample of employees in the Greek healthcare system.