WHO standards-based tools to measure service providers’ and service users’ views on the quality of hospital child care: development and validation in Italy

Abstract

ObjectivesEvidence showed that, even in high-income countries, children and adolescents may not receive high quality of care (QOC). We describe the development and initial validation, in Italy, of two WHO standards-based questionnaires to conduct an assessment of QOC for children and young adolescents at inpatient level, based on the provider and user perspectives.DesignMultiphase, mixed-methods study.Setting, participants and methodsThe two questionnaires were developed in four phases equally conducted for each tool. Phase 1 which included the prioritisation of the WHO Quality Measures according to predefined criteria and the development of the draft questionnaires. In phase 2 content face validation of the draft questionnaires was assessed among both experts and end-users. In phase 3 the optimised questionnaires were field tested to assess acceptability, perceived utility and comprehensiveness (N=163 end-users). In phase 4 intrarater reliability and internal consistency were evaluated (N=170 and N=301 end-users, respectively).ResultsThe final questionnaires included 150 WHO Quality Measures. Observed face validity was excellent (kappa value of 1). The field test resulted in response rates of 98% and 76% for service users and health providers, respectively. Among respondents, 96.9% service users and 90.4% providers rated the questionnaires as useful, and 86.9% and 93.9%, respectively rated them as comprehensive. Intrarater reliability was good, with Cohen’s kappa values exceeding 0.70. Cronbach alpha values ranged from 0.83 to 0.95, indicating excellent internal consistency.ConclusionsStudy findings suggest these tools developed have good content and face validity, high acceptability and perceived utility, and good intrarater reliability and internal consistency, and therefore could be used in health facilities in Italy and similar contexts. Priority areas for future research include how tools measuring paediatric QOC can be more effectively used to help health professionals provide the best possible care.

WHO Standards-based questionnaire to measure health workers’ perspective on the quality of care around the time of childbirth in the WHO European region: development and mixed-methods validation in six countries

“…In addition, a QMNC index, to be used as a complementary measure of QMNC, in line with other studies,30 31 65–67 was developed through the Delphi process. Further testing of this index is ongoing.…”

“…The process of developing this questionnaire was based on existing guidance32–37 and had several strengths. The questionnaire was based on previous pilot studies 29–33 75. The characteristics of the questionnaire were defined in advance, based on previous experience developing measurement tools 29–33 74.…”

“…During July 2020–June 2021, the questionnaire was further optimised and adapted for the IMAgiNE project among countries of the WHO European Region, and updated to collect data on QMNC during the COVID-19 pandemic. The process included three phases (figure 1), based on recommendations for development of health-related questionnaires35–40 and previous pilot studies 29–33. The characteristics of the questionnaire are synthesised in table 1.…”

“…There are a lack of WHO Standards-based validated tools for collecting data on health workers perspectives of the QMNC 13 28–31. A unified comprehensive approach to measure QMNC as defined by the WHO Standards, through validated tools, would allow for comparisons of data across settings and over time, and allow for efficient monitoring 22–25.…”

“…Since 2016, the WHO Collaborating Centre for Maternal and Child Health Burlo Garofolo, Trieste, Italy, has worked on developing and validating tools to collect data on priority WHO Quality Measures. Pilot studies were conducted in Italy between 2016 and 201929–33 and were scaled up in a multicountry project in the WHO European Region, called IMAgiNE (Improving Maternal Newborn CarE) 34…”