1. Questionnaire validation: migrant perspective of hospital care Marc A. Bruijnzeels, PhD Gea C. van der Woerdt

2. Outline  Background  Aim of the study  Methods  Results  Conclusion

3. Background  Hospital Comparison System  36% ethnic minorities in Rotterdam area, main groups:  Moroccans  Turks  Cape Verdians (West Africa)  Surinamese (South America)  Dutch Antilleans (Caribbean)  Adapt and extend the questionnaires

4. Aim of the study To investigate whether the developed questionnaires are valid and reliable to measure the quality of hospital care from the migrants’ perspective

5. Migrant Inpatient Outpatient Questionnaires Based on:  Hospital Comparison System questionnaires  Inpatient  Outpatient  15 focus group interviews with migrant:  Inpatients  Outpatients

6. Method of research  Pilot study with nine Rotterdam hospitals  Translation questionnaires  Selection on surname  Face-to-face interviews at home by bilingual interviewers  Reliability  Item acceptability, non-missing  10%  Questions to evaluate language use etc.

7. Validity  Content validity  Answers on open questions  Construct validity  loading 0.60  alpha coefficient .70  Criterion validity  correlation with overall satisfaction

8. Response 398 respondents contacted, response 39%: 157 interviews, 155 useful

9. Reliability  Proportion missing data < 10%  4% thought language use was difficult  8% answer categories difficult (yes, actually yes, actually no, no)  77% found it important or very important interviewer from own culture

10. Validity Content:  answers on open questions suggested no missing items Constructs of outpatient questionnaire:  5 general dimension  1 new dimension  2 ethnic specific dimensions (with at least half of the items added)

11. General dimensions number of items HCSMOQ 1.Information received about disease/ treatment 6 5 “Patient knew why treatment or medical examination was necessary” 2.Knowledge of doctors about disease/treatment 2 2 3.General opinion waiting room 5 3 4.Attitude of assistant X-ray ward 3 3 5.Attitude of assistant Blood test 3 3  Attitude of doctors 8 -

12. New and ethnic specific dimensions Outpatient Q 1 new dimension with 2 general items:  Patients' autonomy “doctor let me decide too” “doctor asked for permission” 2 ethnic specific dimensions:  Attitude of doctors (take seriously and specific)  Attitude of doctors (time and attention)

13. Attitude of doctors (take seriously and specific)  Doctor has an open attitude towards my culture  Doctor took my health complains seriously  Doctor tried to understand me  Doctor told bad news tactically  Doctor gave me a feeling to have prejudices  Doctor discriminated

14. Relation with overall satisfaction Outpatients questionnaire  Attitude of doctors (take seriously and specific)F 34.763**  Attitude of doctors (time and attention)F 4.857* Inpatient questionnaire  Welcome on emergency admissionF 16.640**  Attitude (in general) of nursesF 11.406**  Attitude (specific) of nursesF 9.308**  Knowledge of nurses about disease/treatmentF 8.500**  Information from doctors and nurses on dischargeF 8.341**  Information from doctorsF 7.815** **p  0.01; *p  0.05; Cursive: specific dimensions

15. Conclusions Dimensions Migrant Inpatient and Outpatient Questionnaires  valid regarding:  content  construct  criterion  internal reliability Measuring quality of outpatient and inpatient hospital care from the perspective of ethnic minorities, valid and reliable, add ethnic specific items in questionnaire www.migranthealth.net