Patients' satisfaction with stroke services

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Abstract
Patient satisfaction with stroke services is a key aspect of the evaluation of the quality of services but there are no adequate means of assessing satisfaction in this area. A questionnaire derived from in-depth interviews was piloted on two samples. The resulting questionnaire consisted of two sections, one on inpatient services (Hospsat) and the other on services in the community (Homesat). It was sent to 219 patients, who had had a stroke six months previously, along with postal versions of the Barthel ADL index, the Nottingham Extended ADL Scale, the Nottingham Health Profile, the short form of the Geriatric Depression Scale and the Faces Scale. The response rate for the questionnaires was 87%. Test-retest reliability and tests of internal consistency of the satisfaction scales were carried out on a subsample of this population. Convergent and discriminant validity were explored by examining correlations with the above measures. The satisfaction questionnaire had construct validity with significant correla tions between the Barthel ADL Index ( r = 0.39), the Nottingham Extended ADL Scale ( r= 0.38) and the physical mobility subsection of the Nottingham Health Profile ( r= -0.36). Internal consistency was high for both sections (Cronbach's Alpha: Hospsat 0.86; Homesat 0.77). Test-retest reliability was fair; the mean difference for total scores was 0.59 (SD = 2.4) for Hospsat, and 0.32 (SD = 2.1) for Homesat. A high level of dissatisfaction was uncovered. Just under half (48%) of people were dissatisfied with some aspect of the care they received in hospital and over half (53%) were dissatisfied with some aspect of the services they received in the community. The highest rate (54%) of dissatisfaction was with the amount of therapy received. Good patient satisfaction measures are useful since they complement 'objective' outcome measures and may highlight areas in need of evaluation and improvement.