Los instrumentos para medir la satisfacción del usuario de los servicios
                  de salud: una revisión sistemática

Almeida, Renato Santos de; Bourliataux-Lajoinie, Stephane; Martins, Mônica

doi:10.1590/0102-311X00027014

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Review • Cad. Saúde Pública 31 (1) • Ene 2015 • https://doi.org/10.1590/0102-311X00027014 copiar

Los instrumentos para medir la satisfacción del usuario de los servicios de salud: una revisión sistemática

Autoría SCIMAGO INSTITUTIONS RANKINGS

Los cuestionarios para la satisfacción del paciente pueden ser una buena opción de mejorar la calidad y discutir la atención centrada en el paciente. El objetivo era llevar a cabo una revisión sistemática, en relación con los instrumentos previamente validados para medir la satisfacción de los pacientes. La revisión sistemática realizó búsquedas en las bases de datos MEDLINE/PubMed, LILACS, SciELO, Scopus y Web of Knowledge. La estrategia de búsqueda fue: "Patient Satisfaction" AND "Patient centered care" AND "Healthcare survey OR Satisfaction questionnaire" AND "Psychometric properties". Se incluyeron treinta y siete estudios y casi todos han demostrado que la satisfacción es multidimensional. Se encontraron 34 instrumentos y la mayoría contaba con las dimensiones: interacción paciente-profesional de la salud, entorno físico y procesos administrativos. La puntuación COSMIN en calidad metodológica indica que la mayoría de los estudios tiene un valor bueno o medio. No existe un estándar clave para la medición de la satisfacción del paciente, pero algunas dimensiones son esenciales para este constructo.

Calidad de la Atención de Salud; Atención Dirigida al Paciente; Satisfacción del Paciente; Psicometría

Study (year)	N	Health care setting	Study design	Instrument used	Construct dimensions (*)	Measurement proprieties **	Psychometric values	COSMIN scores **
Meehan et al. ⁴⁵ (2002)	356	Hospital	Validation	Inpatient Evaluation of Service Questionnaire (IESQ)	Multidimensional (3)	1-Internal consistency 2-Structural validity 3-Hypotheses testing 4-Content validity	α > 0.86; correlation with overall satisfaction measure (r = 0.78)	1-Fair 2-Fair 3-Fair 4-Excellent
Hendriks et al. ⁵⁰ (2004)	728	Hospital	Adaptation	Satisfaction with Hospital Care Questionnaire	Multidimensional (12)	1-Internal consistency 2-Structural validity	α > 0.6; inter-scales correlations (r = 0.3-0.7)	1-Fair 2-Fair
Scholle et al. ³¹ (2004)	1,202	Clinic	Validation	Primary Care Satisfaction Survey for Women (PCSSW)	Multidimensional (3)	1-Structural validity 2-Internal consistency 3-Hypotheses testing 4-Content validity	α > 0.80; correlation between scales (r = 0.65-0.69); correlation with other instruments (r > 0.42)	1-Good 2-Good 3-Good 4-Excellent
Lam et al. ³⁴ (2005)	711	Hospital	Trans cultural adaptation	Medical Interview Satisfaction Scale (C-MISS)	Bidimensional	1-Internal consistency 2-Structural validity 3-Cross-culrural validity 4-Hypotheses testing 5-Reliability	α > 0.84; inter-item and item-total correlations (r > 0.3) ; sub-scales to total correlation (r > 0.87); inter-scales (r = 0.58)	1-Good 2-Good 3-Fair 4-Fair 5-Fair
Gonzalez et al. ⁴² (2005)	1,910	Hospital	Validation	In-patient Satisfaction Questionnaire	Multidimensional (6)	1-Internal consistency 2-Structural validity 3-Hypotheses testing 4-Content validity	α > 0.60; inter-scales correlations (r = 0.16-0.62)	1-Excellent 2-Excellent 3-Fair 4-Excellent
Wilde & Hendriks ³⁶ (2005)	262	Clinic	Adaptation	Client Satisfaction Questionnaire (CSQ)	Unidimensional	1-Structural validity 2-Internal consistency 3-Hypotheses testing	α = 0.92; correlations between other instruments (r > 0.46)	1-Good 2-Excellent 3-Good
Gerkensmeyer & Austin ²² (2005)	278	Clinic Children Mental Health Service	Validation	Parent Satisfaction Scale (PSS)	Unidimensional	1-Internal consistency 2-Structural validity 3-Hypotheses testing	α > 0.70; correlation with other instruments (r = 0.86)	1-Fair 2-Fair 3-Fair
Otani et al. ⁵³ (2005)	8,465	Hospital	Adaptation	Patient Satisfaction Survey	Multidimensional (3)	1-Internal consistency 2-Structural validity 3-Measurement error	α > 0.8; RMSEA = 0.12	1-Fair 2-Fair 3-Fair
Poinsot et al. ⁴⁰ (2006)	416	Hospital (Oncology Center)	Validation	Out-Patsat35	Bidimensional	1-Structural validity 2-Internal consistency	α > 0.90; inter-tem correlations (r = 0.33-0.91); correlation with other instrument (r = 0.38)	1-Poor 2-Poor
Tso et al. ²⁵ (2006)	344	Hospital	Validation	Concise Outpatient Department User Satisfaction Scale	Bidimensional	1-Internal consistency 2-Structural validity 3-Hypotheses testing	α > 0.90; Guttman split-half reliability (0.93); Spearman-Brown reliability (0.94)	1-Fair 2-Fair 3-Fair
Gagnon et al. ⁴⁷ (2006)	873	Clinic	Validation	Health Care Satisfaction Questionnaire (HCSQ)	Multidimensional (3)	1-Structural validity 2-Internal consistency 3-Content validity 4-Reliability	α > 0,74; KMO (0.95); CFI = 0.93; NFI = 88; AGFI = 0.87; RMSEA = 0.6; correlations between factor (r > 0.6); ICC (> 0.45)	1-Excellent 2-Excellent 3-Excellent 4-Fair
Campbell et al. ⁴⁹ (2007)	1,250	Out-of-our health service	Validation	Out-of-hours Patient Questionnaire (OPQ)	Multidimensional (8)	1-Internal consistency 2-Structural validity 3-Reliability 4-Content validity	α = 0.70, inter-item and total item correlation (r > 0.20)	1-Fair 2-Fair 3-Fair 4-Fair
Moret et al. ²⁸ (2007)	2,684	Hospital	Adptation	Echelle de Qualité des Soins en Hospitalisation (EQS-H scale)	Bidimensional	1-Internal consistency 2-Structural validity 3-Content validity 4-Measurement error	α > 0.80; correlation inter-item (r > 0.40) and item-total (r < 0.40); RMSEA = 0.063	1-Good 2-Good 3-Fair 4-Good
Granado de la Orden et al. ⁴⁴ (2007)	651	University hospital	Validation	Satisfacción de los Usuarios de las Consultas Externas (SUCE)	Bidimensional	1-Internal consistency 2-Structural validity 3-Hypotheses testing 4-Content validity	α > 0.90; correlation with other instrument (r = 0.85); item-total correlation (r = 0.52-0.73)	1-Good 2-Good 3-Fair 4-Excellent
Shea et al. ³⁷ (2008)	3,215	Private clinic	Adaptation	The Consumer Assessment of Healthcare Providers and Systems Surveys (CAHPS)	Multidimensional (7)	1-Internal consistency 2-Hypotheses testing 3-Content validity	α = 0.39-0.90	1-Fair 2-Poor 3-Fair
Kristensson & Ekwall ²⁷ (2008)	128	Hospital	Adaptation	Consumer Emergency Care Satisfaction Scale (CECSS)	Multidimensional (3)	1-Structural validity 2-Internal consistency	α > 0.85	1-Fair 2-Fair
Clark et al. ⁵¹ (2008)	1,415	Clinic and hospital (mental health services)	Validation	Consumer Perceptions of Care (CPC)	Multidimensional (4)	1-Internal consistency 2-Structural validity 3-Reliability 4-Hypotheses testing 5-Content validity	α > 0.70; correlations between instruments and different moments (r = 0.34-0.56)	1-Good 2-Good 3-Fair 4-Fair 5-Good
Coluccia et al. ³⁹ (2009)	1,804	Hospital	Adaptation	Questionnaire of Quality Perception (QQP)	Multidimensional (4)	1-Structural validity	Correlations between factors 0.56-0.87; GFI = 0.92; RMSEA = 0.18; CFI = 0.96; NFI = 0.96	1-Excellent
Arraras et al ²⁰ (2009)	80	Hospital	Adaptation	European Organization for Research and Treatment of Cancer In-patient Questionnaire (EORTC IN-PATSAT 32)	Multidimensional (13)	1-Internal consistency 2-Hypotheses testing	α > 0.70; correlations with other instruments > 0.40	1-Fair 2-Fair
Orden et al. ²⁴ (2010)	296	Hospital emergency	Validation	Satisfacción del Usuario con el Área de Urgencia Hospitalaria (SUAUH)	Bidimensional	1-Internal consistency 2-Structural validity 3-Hypotheses testing 4-Content validity	α > 0.83; correlation with other instrument and global satisfaction measures (r = 0.37-0.51); item-total correlation (r = 0.56-0.71)	1-Fair 2-Fair 3-Fair 4-Excellent
Danielsen et al. ³⁸ (2010)	225	Clinic	Validation	Users’ experiences and satisfaction with casualty clinics	Multidimensional (4)	1-Internal consistency	α > 0.82	1-Fair
Ekwall & Davis ²⁶ (2010)	157	Hospital	Transcultural adaptation	Consumer Emergency Care Satisfaction Scale (CECSS)	Multidimensional (3)	1-Structural validity 2-Internal consistency 3-Cross-cultural validity	α > 0.77	1-Fair 2-Fair 3-Fair
Charalambous ³³ (2010)	194	Hospital (oncology center)	Transcultural adaptation	Risser Patient Satisfaction Scale (RPSS)	Multidimensional (3)	1-Structural validity 2-Internal consistency 3-Reliability 4-Cross-cultural validity	α = 0.89; Kappa = 0.84; inter-item (r = 0.45) and item-total correlations (r = 0.51); sub-scale correlation (r = 0.55-0.70)	1-Fair 2-Fair 3-Fair 4-Fair
Erci & Ciftcioglu ³⁰ (2010)	381	Clinic (primary care)	Transcultural adaptation	Primary Care Satisfaction Survey for Women (PCSSW)	Multidimensional (3)	1-Internal consistency 2-Structural validity 3-Content validity 4-Cross-cultural validity 5-Reliability	α > 0.80; item-total correlations (r = 0.43-0.73); test-retest correlation (r = 0.85)	1-Fair 2-Fair 3-Fair 4-Fair 5-Fair
Soufi et al. ²⁹ (2010)	214	University hospital	Adaptation	Echelle de Qualité des Soins en Hospitalisation (EQS-H scale)	Bidimensional	1-Internal consistency 2-Structural validity 3-Content validity 4-Cross-cultural validity	α > 0.88; GFI = 0.96; RMSEA = 0.090; CFI = 0.93	1-Fair 2-Fair 3-Fair 4-Fair
Schröder et al. ⁴⁶ (2011)	1,340	Hospital	Validation	Quality in Psychiatric Care – Outpatient (QPC-OP)	Multidimensional (7)	1-Internal consistency 2-Structural validity	α = 0.66; CFI = 1.0, RMSEA = 0.036; SRMR = 0.053; inter-scales correlations (r = 0.35-0.67)	1-Excellent 2-Excellent
Webster et al. ⁴¹ (2011)	486	Hospital	Validation	Patient Assessment of Healthcare for Inpatient Care (I-PAHC); Patient Assessment of Healthcare for Outpatient Care (O-PAHC)	Multidimensional (5)	1-Internal consistency 2-Structural validity 3-Content validity	α > 0.70; inter-scales and item correlations (r = 0.2-0.6)	1-Good 2-Good 3-Poor
Sjetne et al. ⁴⁸ (2011)	1,324	Hospital	Validation	Generic Short Patient Experiences Questionnaire (GS-PEQ)	Multidimensional (7)	1-Content validity	Theorical approach	-
Latour et al. ⁵² (2012)	441	University hospital (neonatal intensive care)	Validation	Empowerment of Parents in the Intensive Care-Neonatology (EMPATHIC-N)	Multidimensional (5)	1-Internal consistency 2-Structural validity 3-Reliability 4-Hypotheses testing 5-Content validity	α > 0.82; correlation with other instrument and global satisfaction measures (r = 0.37-0.51)	1-Good 2-Good 3-Good 4-Fair 5-Good
Evans et al. ²³ (2012)	397	Clinic (mental health)	Validation	Views on Inpatient Care (VOICE)	Multidimensional (7)	1-Structural validity 2-Internal consistency 3-Content validity 4-Hypotheses testing 5-Reliability validity	α > 0.92; correlation with other instrument (r = 0.82); Kappa (ρ = 0.88)	1-Poor 2-Poor 3-Fair 4-Fair 5-Fair
Manaf et al. ⁴³ (2012)	424	Clinic	Validation	Oupatient satisfaction instrument	Bidimensional	1-Internal consistency 2-Structural validity 3-Hypotheses testing 4-Content validity	α > 0.94 ; correlation with other instruments and overall satisfaction measure (r = 0.59-0.62)	1-Excelent 2-Excellent 3-Good 4-Excellent
Milutinović et al. ³² (2012)	235	Hospital	Transcultural adaptation	Patient Satisfaction Nursing Care Quality Questionnaire	Unidimensional	1-Structural validity 2-Internal consistency 3-Cross-cultural validity	α > 0.90; inter-item correlation and item total correlation (r =0,52-0.92); GFI (AUC = 0.82)	1-Good 2-Good 3-Good
Ottonello et al. ²¹ (2012)	7,093	Hospital (emergency care)	Adaptation	SAT-16	Bidimensional	1-Structural validity 2-Internal consistency	α > 0.99; correlation between item (r < 0.30); Rasch reliability values (Item separation index: 18.1 and 20.7; item separation reliability: 1; person separation index: 0.70)	1-Excellent 2-Excellent
Castillo et al. ⁵⁴ (2012)	483	Hospital	Adaptation	Satisfaction Scale with Primary Health Care Services	Multidimensional (4)	1-Structural validity 2-Internal consistency	α > 0.75; RMSEA = 0,09; GFI = 0.92; AGFI = 0.87; NFI = 0.94; CFI = 0.95	1-Fair 2-Fair
Dyer et al. ⁵⁵ (2012)	21,318	Hospital/Clinic	Adaptation	Consumer Assessment of Healthcare Providers and Systems (CAHPS-CG)	Multidimensional (3)	1-Structural validity 2-Internal consistency 3-Reliabilty	α > 0.75; RMSEA = 0.05; SRMR = 0.04; CFI = 0.97; ICC = 0.01-0.11	1-Good 2-Good 3-Good
Vanti et al. ³⁵ (2013)	317	Hospital	Transcultural adaptation	Physical Therapy Patient Satisfaction Questionnaire (PTPSQ-I)	Multidimensional (3)	1-Structural validity 2-Internal consistency 3-Cross-cultural validity 4-Hypotheses testing	α > 0.90; correlations between item and global perceive measures (r = 0.1-0.42)	1-Fair 2-Fair 3-Good 4-Fair
Vanti et al. ⁵⁶ (2013)	354	Hospital	Transcultural adaptation	Physical Therapy Patient Satisfaction Questionnaire (PTPSQ-I)	Multidimensional (4)	1-Structural validity 2-Internal consistency 3-Cross-cultural validity 4-Reliability 5-Hypotheses testing	α > 0.75; ICC = 0.62-0.93; correlations between item and global perceive measures (r = 0.28-0.42)	1-Fair 2-Fair 3-Good 4-Fair 5-Fair

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[1] Correspondence R. S. Almeida Rua Botucatu 56, apto. 602, Rio de Janeiro, RJ 20541-340, Brasil. renato.fisio@gmail.com