Critical review of the validity of patient satisfaction questionnaires pertaining to oral health care

Chrisopoulos

et al. 2020

Comm Dent Oral Epid

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Objectives Trust and satisfaction in dental care settings are salient constructs to operationalize the concept of dentist‐patient relationships (DPR). This study aimed to compare the similarity of both constructs with regard to factor structure and revise the scales for better psychometric properties. Methods Data analysed in the study were collected in self‐complete questionnaires from a random sample of 4011 adults living in South Australia. Trust and satisfaction were assessed using the Dentist Trust Scale and the Dental Care Satisfaction scale. Items in the scales were initially examined with a split‐half sample in exploratory factor analysis and cluster analysis. Factor structures of different model designs were tested on the other half sample in confirmatory factor analysis. The final model was cross‐validated on the first half sample for structural invariance. Results Exploratory factor analysis revealed a three‐factor structure consisting of ‘trust’, ‘satisfaction’ and ‘distrust/dissatisfaction’ (60.2% of the variance explained; Cronbach's α = 0.94, 0.81, 0.73, respectively). Cluster analysis supported the factor solution with the same three major clusters except for a single‐item independent branch of the ‘cost’ domain from the satisfaction scale. The final model was designed with two correlated but distinct factors, ‘trust’ and ‘satisfaction’, with the modification of one inter‐item covariance and deleting the least associated item (GFI = 0.96, CFI = 0.98, RMSEA = 0.06). The stability of the final model was achieved through cross‐validation (P = .143, ∆CFI < 0.001). Conclusions Trust and satisfaction in dental care settings are unidimensionally different yet highly correlated factors concurrently. Demonstrating the discriminant and complementary functions of both constructs can justify the rationale to apply them together in further studies for DPR.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Are trust and satisfaction similar in dental care settings?

Song

Chrisopoulos

et al. 2020

Comm Dent Oral Epid

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“…A previous study assessed the difference in dental satisfaction with the Dental Satisfaction Index, and the findings were similar to those reported in the current study, with similar values for the overall index and the 2 subscales (Cost and Access), favoring public service provision through school dental services (Brennan et al 2001). Although the overall construct measured by the COPAS and Dental Satisfaction Index is similar, the theoretical basis for scale construction and the items are different (Nair et al 2018). This previous study (Brennan et al 2001) was conducted in 1 state in Australia (South Australia), and the current study comprised a national sample.…”

Section: Discussionmentioning

confidence: 99%

“…Since health care systems aim to meet the health care needs of people under their care, the evaluation of the differences between private and public care facilities needs a measurement from the perspective of the very individuals who are under the purview of these health care systems. Quality of care measured from the perspective of the patients or their caregivers would be appropriate for such a measurement (Nair et al 2018). This is especially important because health care providers often act as an agent to help make a choice for individuals who are seeking care (Donabedian 1971), and their ability to act as adequate proxies is unassessed.…”

Section: Introductionmentioning

confidence: 99%

Private Dental Care Benefits Non-Indigenous Children More Than Indigenous Children

Nair

JDR Clinical & Translational Research

Jamieson

et al. 2019

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Introduction: Various arrangements for funding health care facilities can have different levels of performance of care provision on different groups of people. Such differential performance of oral care is not previously known concerning Indigenous communities. Objective: This study aimed to assess the effect of visiting a public or private dental care facility on the performance of oral care experienced by Indigenous versus non-Indigenous children in Australia. Methods: Data from the National Child Oral Health Survey were used with a representative sample of children from all the states and territories of Australia. The performance of oral care was measured with the Child Oral Care Performance Assessment Scale (COPAS), which contains 37 items from 9 domains (Effective, Appropriate, Efficient, Responsive, Accessible, Safe, Continuous, Capable, and Sustainable) with a score ranging from 0 to 148. Mixed effects models that accounted for stratum and sampling weights were used for the stratified analyses (Indigenous vs. non-Indigenous) that assessed the effect of public versus private care on the COPAS. Relative excess risk due to interaction was calculated to assess effect modification. Results: Among the Indigenous children, private care was similar to public care (regression coefficient [RC] = −1.27, 95% CI = −9.5 to 6.97), whereas private care was higher than public care among non-Indigenous children (RC = 4.60, 95% CI = 3.67 to 6.18). This trend was similar among the 9 domains of the COPAS as well, except for Effectiveness, which was similar for private and public facilities among non-Indigenous children (RC = −0.03, 95% CI = −0.29 to 0.23). Based on the continuous COPAS score, effect modification was 4.46 (95% CI = 0.11 to 8.82) on the additive scale and 1.06 (1.01, 1.13) on the multiplicative scale. The relative excess risk due to interaction reported an excess chance of 1.17 (95% CI = 0.01 to 0.33), which was consistent with the stratified analyses and effect modification measured with the continuous score. Conclusion: Thus, this study found a higher performance of oral care in private care locations among non-Indigenous children versus Indigenous children. Knowledge Transfer Statement: The findings caution policy makers and other stakeholders that moving oral care from public to private care facilities can increase the inequity faced by Indigenous children in Australia.

“…A current critical review identified several instruments that measure dental satisfaction for overall oral care provision rather than those for specific treatments or subgroups within the overall oral care provision . These instruments measure the performance of care using multi‐item questionnaires, as the multidimensionality of the concept of oral care satisfaction requires.…”

Section: Introductionmentioning

confidence: 99%

Psychometric properties of the Child Oral‐care Performance Assessment Scale

Nair

et al. 2019

Comm Dent Oral Epid

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Objectives This study aimed to assess the psychometric properties of Child Oral‐care Performance Assessment Scale (COPAS). Methods Items for the instrument were developed and pilot tested. This questionnaire was implemented in the Australian National Child Oral Health Study 2012‐2014, whose aims included the assessment of oral care performance. This nationally representative sample of 23 538 respondents with complete data was divided into five groups: a main validation group and four cross‐validation groups, using blocked randomization. Two scales were constructed, full scale with 37 items (COPAS) and a partial scale with a subset of 31 items (COPAS‐Partial). Internal consistency was assessed using Cronbach's alpha. Construct validity was assessed using correlation coefficients, and structural validity was ascertained in the main validation group and confirmed in the cross‐validation groups using structural equation models. Results Cronbach's alpha for COPAS was 0.95, and for COPAS‐Partial was 0.94. The convergent validity of global satisfaction with oral care and the subscales was r = 0.29‐0.51, and that with the overall scales was r = 0.59 for COPAS and r = 0.59 for COPAS‐Partial. COPAS (Root mean squared error of approximation (RMSEA) = 0.06, Comparative fit index (CFI) = 0.90, Tucker‐Lewis index (TLI) = 0.89, and Coefficient of determination(COD) = 0.99) and COPAS‐Partial (RMSEA = 0.07, CFI = 0.91, TLI = 0.90, COD = 0.97) had adequate fit. Structural invariance was present (P‐value = 0.97). Conclusion There was acceptable structural validity, construct validity and internal consistency in the models tested for COPAS and COPAS‐Partial. COPAS has potential use in the evaluation of the delivery of dental services to children.