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Volume 15, Issue 2 (2023)
Iran J War Public Health 2023, 15(2): 207-212 |
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Received: 2023/06/17 | Accepted: 2023/07/27 | Published: 2023/08/6
Received: 2023/06/17 | Accepted: 2023/07/27 | Published: 2023/08/6
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Taghdir R, Asgari M, Ganjparvar Z, Abdollahifar S, Kargar Jahromi S, Ghadami L et al . Validation of the Persian Version of the Picker Patient Experience Questionnaire. Iran J War Public Health 2023; 15 (2) :207-212
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Authors
R. Taghdir1, M. Asgari2, Z. Ganjparvar3, Sh. Abdollahifar1, S. Kargar Jahromi1, L. Ghadami4, M.R. Soroush *3
1- Nikan Education and Research Center (NERC), Tehran, Iran
2- Statistic Department, Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
3- Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
4- Department of Health Care Management, Tehran University of Medical Sciences, Tehran, Iran
2- Statistic Department, Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
3- Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
4- Department of Health Care Management, Tehran University of Medical Sciences, Tehran, Iran
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Introduction
Healthcare organizations, for their survival and success, need to make decisions in the field of improving the quality of their programs, leading to the improvement of patients' satisfaction. The World Health Organization has introduced patients' satisfaction with health services as one of the five health service quality indicators [1-4]. Customer satisfaction is a suitable indicator to measure the quality of services and how they are provided from the point of view of service recipients. Patient satisfaction can indicate the correct performance of services, and this satisfaction cannot be obtained only by providing high technology, rather, it is mostly obtained due to public services and the effective communication between the doctor and the staff with the patient [5]. Today, healthcare systems seek to provide services that are not only clinically effective, but also acceptable and beneficial to patients [6, 7]. One of the basic principles of healthcare service management is system evaluation. On the other hand, one of the system evaluations is the satisfaction level of the patients from the provided services, which is a criterion showing the high system efficiency [8]. The satisfaction level of service recipients not only causes the improvement of service quality but also has a considerable effect on improving the patient's health due to the mental effects on the patient [5].
Planning and providing healthcare and patient-centered medical services based on the comments, needs, and preferences of the patients is the key point in the healthcare systems in developed countries, as well as an essential factor for the improvement of healthcare and medical systems and obtaining public trust. So, more appropriateness and effectiveness of the provided services and ultimately, improvement of health outcomes, quality of life, and patient satisfaction are the satisfactory effects of these treatment systems. In this regard, accepting the patient as a partner in the treatment systems and generalizing the culture of acceptance and flexibility towards the opinions and criticisms of the patients is the growth lever of hospitals and is effective at the national level in formulating and regulating policies, plans and services and macro-health policies [9].
In the past decades, more attention has been paid to the evaluation and improvement of the healthcare experience from the perspective of patients [10]. In 1994, Harvey Picker, the founder of the Picker Institute, challenged the evaluation methods of healthcare services. Then, a system was designed to improve patient care by considering the entire patient experience. According to Harvey, care of the patients should be in a way that considers the feelings, concerns, comfort, values, and personal preferences of patients and the involvement of their family members. The originally designed form for adults had 40 items. Picker survey instruments had a high level of reliability [11, 12]. In 2002, a study was conducted in five countries of Sweden, Switzerland, England, United States, and Germany, and a short form of the questionnaire was designed for comparison between hospitals and the monitoring process. The validity and reliability of the Picker Patient Experience Questionnaire were confirmed in this study. The questionnaire with 15 items was considered a survey tool and used in national studies in the National Health Service (NHS) in England. The designed form is simple to be completed by patients and is easily scored [13]. This form has been used and approved in other countries. In most of the surveys, each treatment center has designed and used a checklist according to its desire and needs, which ultimately makes it impossible to make general comparisons and generalizations. Therefore, it seems necessary to use a proper and uniform checklist in hospitals and centers providing medical services [14, 15]. The use of appropriate and identical tools in medical service centers provides the possibility to compare and create competition between them and identifies their strengths and weaknesses. In Iran, many studies have considered the patients' satisfaction with healthcare services. In each of these studies, researcher-made or standard tools have been used according to the objectives of the studies, whereas, there was no suitable and uniform tool for evaluating patients' experience during hospitalization [16].
As a center for the transfer of medical knowledge and skills, the hospital is a powerful resource in terms of technological information, which improves the physical, mental and spiritual health of people by using facilities and providing special services, and ultimately ensures the satisfaction of customers. Therefore, this study aimed to investigate the validity of the Persian version of the Picker Patient Experience Questionnaire (PPE-15), a research tool for evaluating the satisfaction level of patients in Nikan Gharb and Nikan Aqdasiyeh hospitals in Tehran.
Instrument and Methods
The Persian version of the Picker Patient Experience Questionnaire (PPE-15) was validated in this qualitative-quantitative study in April-May 2022.
The short form of the Picker questionnaire, provided by Jenkinson et al. in 2002, evaluates the experience of patients in an inpatient treatment center by 15 items in 7 areas of information and education (2 items), coordination of care (1 item), emotional support (3 items), respect for the patient's preferences (3 items), physical comfort (1 item), participation of family and friends (2 items), and continuity and transition (3 items). The range of points is between 0 and 15. A score of zero indicates the maximum positive experience, and a score of 15 indicates the maximum negative experience during hospitalization in the treatment center.
To achieve an accurate translation, the short form of the Picker questionnaire was first translated into Persian by a translator with sufficient skills in translation area. Then, the translation was provided to three translators (two professional translators and one expert, apart from the first translator) to translate it separately into English. After matching the translations with the original form of the English questionnaire and matching the three translations with each other, the ambiguous points of the translations were determined, and the Persian version of the questionnaire was prepared based on the opinion of all three translators.
The face validity of the questionnaire, regarding the compatibility of the Persian version with the original version, was assessed concerning the opinion of 10 experts in the subject area. The content validity of the questionnaire was studied by content validity ratio (CVR) and content validity index (CVI) [17]. For this purpose, 12 experts in the subject area were selected and filled out the questionnaire for evaluating the CVR (the items were: “it is necessary”, “it is useful, but it is not necessary”, and “it is not necessary”) and CVI (the items were: “unrelated”, “somewhat related”, “related”, and “fully related”) of each item of the questionnaire.
To check the tool validity, all patients discharged from different departments of Nikan Gharb (559 people) and Nikan Aqdasiyeh (456 people) hospitals in Tehran from 21 April to 21 May 2022, who were hospitalized for at least 4 days, with the age of over 18 years and the ability to communicate, were studied by census method. Patients who did not tend to fill out the questionnaire for any reason or died after discharge were excluded from the study. Data were collected using the questionnaire and telephone interview. Thus, within one week to a maximum of one month after the patient's discharge from the hospital, trained interviewers outside the hospital contacted the patients and filled out the questionnaire. To facilitate the work of the interviewers, the questionnaire was designed using the KoboCollect software, and the interviewers called the patients by linking to the hospital number.
How to communicate with the patient, observe the mental and physical condition of the patient, observe confidentiality, and maintain the patient's information was provided to the interviewers in the form of a guide. The objectives of the study were explained to the subjects, and the patients were assured that their personal information would be kept confidential. In case of any problem in the data collection process, if the form could be corrected, the necessary corrections were made, and otherwise, the form was excluded from the study process. The interviewers who were not careful enough were warned about the first mistake, and if the mistake was repeated, the interviewer was removed from the study process and replaced by a new subject.
Exploratory factor analysis was used to identify and discover the main dimensions and constructs of the questionnaire. Before the implementation of the factor analysis test, the assumptions of this analysis, namely the KMO test and Bartlett's sphericity test, were implemented and confirmed.
To check the tool's reliability, two samples of 15 patients who were interviewed in the first week after discharge and the fourth week after discharge were randomly selected, and Cronbach's alpha was calculated.
Findings
After the preparation of the initial form, the formal validity related to the compatibility of the Persian version with the original version was confirmed by the opinion of 10 experts in the subject area. The CVR and CVI of the items were confirmed by the opinion of the 10 experts (Table 1).
Table 1) Results of examining CVI and CVR of the Picker Patient Experience (PPE-15) Questionnaire
The result of KMO test for sample adequacy was calculated to be 0.787, and Bartlett's test (χ2=3947.28) with 105 degrees of freedom was significant at the 0.0001 level, so there was a high correlation between the items within each aspect, and there was no correlation between the items of the aspects.
By checking the validity of the questionnaire by factor analysis method, the items were included in 7 aspects, which were in accordance with the main sections of the questionnaire (information and education, coordination of care, emotional support, respect for patient preferences, physical comfort, involvement of family and friends, and continuity and transition). In total, 77.32% of the variance of the items was explained by the 7 aspects (Table 2). The tool reliability was confirmed for 7 aspects in the Cronbach's alpha range of 0.744 to 0.911. The overall reliability of the questionnaire was calculated to be 0.804 (Table 2).
Table 2) Results of the factor analysis on the data obtained from the picker questionnaire
The matrix obtained by rotating the items of each aspect is shown in Table 3. Only the highest factor loading of each item is shown in the table, which indicates the belonging of that item to its aspect.
Table 3) Matrix of rotating factors (exploratory factor analysis)
Discussion
This study aimed to assess the validity of the Persian version of The Picker Patient Experience Questionnaire. In many countries, hospitals are now required to organize patient surveys at regular intervals. Patient experience, along with clinical performance and safety, is known as a critical criterion for improving healthcare performance [18, 19].
On the other hand, the evidence shows that the perception of nurses, managers or supervisors makes them perform better, and this can be investigated by examining the experiences of patients. Because the existence of this perception of caregivers as those who act based on their needs and to create their well-being and comfort increases the sense of support in caregivers [20, 21].
Several survey questionnaires have been used for such purposes, but these questionnaires have primarily obtained information about satisfaction with the service. Questionnaires asking patients to rate their satisfaction with their care typically receive very positive ratings that are insensitive to specific process-related problems that affect the quality of care provided [22]. While in the Picker questionnaire, by asking specific questions about whether certain processes and events occurred during a certain period of care, detailed reports are prepared about the patient's experiences, and the results are very practical. Based on the results of this study, all the items raised in the Picker questionnaire were well explained by 7 main aspects and the validity of the Persian Picker questionnaire (PPE-15) was confirmed. PPE-15 provided a different range of scores. In the first stage, it can be used to examine certain aspects of the patient's experience. For example, if patients report communicating with staff, programs can be considered to monitor and improve the situation.
According to the results of this study, the validity of the Picker questionnaire has been examined and confirmed in other languages through other studies. This survey tool can be used to monitor the fundamental aspects of services over time [23]. In a study in 2002, the Picker Institute used the Picker questionnaire (PPE-15) to assess the quality of care for hospitalized patients in 5 countries, including England (5 hospitals), Germany (6 hospitals), Sweden (9 hospitals), Switzerland (9 hospitals), and the United States (272 hospitals). Based on the results of the Picker Institute, the Picker questionnaire has achieved face validity, construct validity, and high reliability. Picker Patient Experience Questionnaire provides a step forward in evaluating patient experience because it presents a main set of items that may be added around more modules. Scores are easy to interpret. Based on this, the set of items can be included in the surveys of hospitalized patients in different areas and enable the comparison of the performance of hospitals and the creation of national or international standards [6-22].
In another study in 2002 in Sweden, the experience of patients with musculoskeletal problems was investigated using the Picker questionnaire. The questionnaire was evaluated using interviews with 11 respondents. Statistical analyses showed the validity and reliability of the questionnaire [24].
Another study was conducted in England in 2003. This study aimed to evaluate the performance of the 15-item Picker Patient Experience Questionnaire (PPE-15) as a shortened instrument compared to the longer form. A total of 1445 questionnaires were mailed to the patients of two hospitals. Patients randomly received the short form (4 pages) or the main form (12 pages). A total of 949 (65.67%) questionnaires were received. There was no difference in the response rate between the two versions of the questionnaire. The obtained results showed that the length of the questionnaire does not lead to a decrease in the response and also has no effect on the quality of the data. PPE-15 had internal consistency and necessary correlations between the items and the original form. As a result, the length of the questionnaire does not have a negative effect on its results [23].
In 2013, a systematic study was conducted to examine the evidence of the relationship between patient experience, safety, and clinical effectiveness. The findings of this study briefly showed a positive relationship between patient experience, patient safety, and clinical effectiveness. This study suggested the patient experience as one of the main pillars of quality in healthcare [25].
In Norway, a regular and annual assessment of patients is implemented as part of national quality indicators in specialized healthcare services. Although patient experience surveys are used in all hospitals, according to the Norwegian National Health and Care Services Act, municipalities are also required to collect patients' experiences to plan and organize health services. For this purpose, a study was conducted in 2017 to evaluate the experience of hospitalized patients in 5 municipal districts of Ostfold City using the PPE-15 tool. The results of this study confirmed the validity of the PPE-15 questionnaire in Norway [26].
A study was conducted to evaluate the Spanish and Catalan versions of the Picker questionnaire according to the patient's culture to measure the patients' experience in 2018. The acceptability, validity, and reliability of the questionnaire were evaluated through a cross-sectional validation study. The results of the study led to the compilation of questionnaires in Spanish and Catalan with sufficient conceptual and linguistic equivalence. Four factors were extracted by parallel analysis, explaining 43% of the total variance. The four aspects were information and communications received during hospitalization, low sensitivity attitude of professionals, evaluation of medical and nursing staff communication, and global items [27].
Findeklee et al. evaluated the care of women undergoing endoscopic surgery using the Picker questionnaire. According to their results, the questionnaire was a suitable tool to know the treatment quality of complications in patients undergoing endoscopic surgery [28].
Based on the results of comparing the findings of this study with other studies, the translated forms of the Picker Patient Experience Questionnaire (PPE-15) into other languages, like the results of this research, have been confirmed as a useful tool for examining the experiences of hospitalized patients and providing a solution to improve service provision in healthcare centers.
Conclusion
The Persian version of Picker Patient Experience (PPE-15) Questionnaire has the necessary validity to evaluate the experience of hospitalized patients in Iranian hospitals and explains 77.32% of the variance of the components.
Acknowledgements: We are grateful to all the people who helped in any way to make this work, especially the patients who participated in this study and also Mrs. Fateme Eftekhari, Mrs. Marjan Golriz, and Mrs. Hamide Babaee, who helped the authors with data collection.
Ethical Permission: This study was approved by the ethics approval committee of Janbazan Medical and Engineering Research Center (JMERC) with ethical code 95-P-E-264.
Conflict of Interests: There is no conflict of interests.
Authors’ Contribution: Taghdir R (First Author), Assistant Researcher (10%); Asgari M (Second Author), Methodologist/Statistical Analyst (25%); Ganjparvar Z (Third Author), Introduction Writer/Discussion Writer (20%); Abdollahifar Sh (Fourth Author), Assistant Researcher (10%); Kargar Jahromi S (Fifth Author), Assistant Researcher (5%); Ghadami L (Sixth Author), Assistant Researcher (5%); Soroush MR (Seventh Author), Methodologist/Main Researcher (25%)
Funding: This study was financially supported by Nikan Education and Research Center (NERC).
Healthcare organizations, for their survival and success, need to make decisions in the field of improving the quality of their programs, leading to the improvement of patients' satisfaction. The World Health Organization has introduced patients' satisfaction with health services as one of the five health service quality indicators [1-4]. Customer satisfaction is a suitable indicator to measure the quality of services and how they are provided from the point of view of service recipients. Patient satisfaction can indicate the correct performance of services, and this satisfaction cannot be obtained only by providing high technology, rather, it is mostly obtained due to public services and the effective communication between the doctor and the staff with the patient [5]. Today, healthcare systems seek to provide services that are not only clinically effective, but also acceptable and beneficial to patients [6, 7]. One of the basic principles of healthcare service management is system evaluation. On the other hand, one of the system evaluations is the satisfaction level of the patients from the provided services, which is a criterion showing the high system efficiency [8]. The satisfaction level of service recipients not only causes the improvement of service quality but also has a considerable effect on improving the patient's health due to the mental effects on the patient [5].
Planning and providing healthcare and patient-centered medical services based on the comments, needs, and preferences of the patients is the key point in the healthcare systems in developed countries, as well as an essential factor for the improvement of healthcare and medical systems and obtaining public trust. So, more appropriateness and effectiveness of the provided services and ultimately, improvement of health outcomes, quality of life, and patient satisfaction are the satisfactory effects of these treatment systems. In this regard, accepting the patient as a partner in the treatment systems and generalizing the culture of acceptance and flexibility towards the opinions and criticisms of the patients is the growth lever of hospitals and is effective at the national level in formulating and regulating policies, plans and services and macro-health policies [9].
In the past decades, more attention has been paid to the evaluation and improvement of the healthcare experience from the perspective of patients [10]. In 1994, Harvey Picker, the founder of the Picker Institute, challenged the evaluation methods of healthcare services. Then, a system was designed to improve patient care by considering the entire patient experience. According to Harvey, care of the patients should be in a way that considers the feelings, concerns, comfort, values, and personal preferences of patients and the involvement of their family members. The originally designed form for adults had 40 items. Picker survey instruments had a high level of reliability [11, 12]. In 2002, a study was conducted in five countries of Sweden, Switzerland, England, United States, and Germany, and a short form of the questionnaire was designed for comparison between hospitals and the monitoring process. The validity and reliability of the Picker Patient Experience Questionnaire were confirmed in this study. The questionnaire with 15 items was considered a survey tool and used in national studies in the National Health Service (NHS) in England. The designed form is simple to be completed by patients and is easily scored [13]. This form has been used and approved in other countries. In most of the surveys, each treatment center has designed and used a checklist according to its desire and needs, which ultimately makes it impossible to make general comparisons and generalizations. Therefore, it seems necessary to use a proper and uniform checklist in hospitals and centers providing medical services [14, 15]. The use of appropriate and identical tools in medical service centers provides the possibility to compare and create competition between them and identifies their strengths and weaknesses. In Iran, many studies have considered the patients' satisfaction with healthcare services. In each of these studies, researcher-made or standard tools have been used according to the objectives of the studies, whereas, there was no suitable and uniform tool for evaluating patients' experience during hospitalization [16].
As a center for the transfer of medical knowledge and skills, the hospital is a powerful resource in terms of technological information, which improves the physical, mental and spiritual health of people by using facilities and providing special services, and ultimately ensures the satisfaction of customers. Therefore, this study aimed to investigate the validity of the Persian version of the Picker Patient Experience Questionnaire (PPE-15), a research tool for evaluating the satisfaction level of patients in Nikan Gharb and Nikan Aqdasiyeh hospitals in Tehran.
Instrument and Methods
The Persian version of the Picker Patient Experience Questionnaire (PPE-15) was validated in this qualitative-quantitative study in April-May 2022.
The short form of the Picker questionnaire, provided by Jenkinson et al. in 2002, evaluates the experience of patients in an inpatient treatment center by 15 items in 7 areas of information and education (2 items), coordination of care (1 item), emotional support (3 items), respect for the patient's preferences (3 items), physical comfort (1 item), participation of family and friends (2 items), and continuity and transition (3 items). The range of points is between 0 and 15. A score of zero indicates the maximum positive experience, and a score of 15 indicates the maximum negative experience during hospitalization in the treatment center.
To achieve an accurate translation, the short form of the Picker questionnaire was first translated into Persian by a translator with sufficient skills in translation area. Then, the translation was provided to three translators (two professional translators and one expert, apart from the first translator) to translate it separately into English. After matching the translations with the original form of the English questionnaire and matching the three translations with each other, the ambiguous points of the translations were determined, and the Persian version of the questionnaire was prepared based on the opinion of all three translators.
The face validity of the questionnaire, regarding the compatibility of the Persian version with the original version, was assessed concerning the opinion of 10 experts in the subject area. The content validity of the questionnaire was studied by content validity ratio (CVR) and content validity index (CVI) [17]. For this purpose, 12 experts in the subject area were selected and filled out the questionnaire for evaluating the CVR (the items were: “it is necessary”, “it is useful, but it is not necessary”, and “it is not necessary”) and CVI (the items were: “unrelated”, “somewhat related”, “related”, and “fully related”) of each item of the questionnaire.
To check the tool validity, all patients discharged from different departments of Nikan Gharb (559 people) and Nikan Aqdasiyeh (456 people) hospitals in Tehran from 21 April to 21 May 2022, who were hospitalized for at least 4 days, with the age of over 18 years and the ability to communicate, were studied by census method. Patients who did not tend to fill out the questionnaire for any reason or died after discharge were excluded from the study. Data were collected using the questionnaire and telephone interview. Thus, within one week to a maximum of one month after the patient's discharge from the hospital, trained interviewers outside the hospital contacted the patients and filled out the questionnaire. To facilitate the work of the interviewers, the questionnaire was designed using the KoboCollect software, and the interviewers called the patients by linking to the hospital number.
How to communicate with the patient, observe the mental and physical condition of the patient, observe confidentiality, and maintain the patient's information was provided to the interviewers in the form of a guide. The objectives of the study were explained to the subjects, and the patients were assured that their personal information would be kept confidential. In case of any problem in the data collection process, if the form could be corrected, the necessary corrections were made, and otherwise, the form was excluded from the study process. The interviewers who were not careful enough were warned about the first mistake, and if the mistake was repeated, the interviewer was removed from the study process and replaced by a new subject.
Exploratory factor analysis was used to identify and discover the main dimensions and constructs of the questionnaire. Before the implementation of the factor analysis test, the assumptions of this analysis, namely the KMO test and Bartlett's sphericity test, were implemented and confirmed.
To check the tool's reliability, two samples of 15 patients who were interviewed in the first week after discharge and the fourth week after discharge were randomly selected, and Cronbach's alpha was calculated.
Findings
After the preparation of the initial form, the formal validity related to the compatibility of the Persian version with the original version was confirmed by the opinion of 10 experts in the subject area. The CVR and CVI of the items were confirmed by the opinion of the 10 experts (Table 1).
Table 1) Results of examining CVI and CVR of the Picker Patient Experience (PPE-15) Questionnaire
The result of KMO test for sample adequacy was calculated to be 0.787, and Bartlett's test (χ2=3947.28) with 105 degrees of freedom was significant at the 0.0001 level, so there was a high correlation between the items within each aspect, and there was no correlation between the items of the aspects.
By checking the validity of the questionnaire by factor analysis method, the items were included in 7 aspects, which were in accordance with the main sections of the questionnaire (information and education, coordination of care, emotional support, respect for patient preferences, physical comfort, involvement of family and friends, and continuity and transition). In total, 77.32% of the variance of the items was explained by the 7 aspects (Table 2). The tool reliability was confirmed for 7 aspects in the Cronbach's alpha range of 0.744 to 0.911. The overall reliability of the questionnaire was calculated to be 0.804 (Table 2).
Table 2) Results of the factor analysis on the data obtained from the picker questionnaire
The matrix obtained by rotating the items of each aspect is shown in Table 3. Only the highest factor loading of each item is shown in the table, which indicates the belonging of that item to its aspect.
Table 3) Matrix of rotating factors (exploratory factor analysis)
Discussion
This study aimed to assess the validity of the Persian version of The Picker Patient Experience Questionnaire. In many countries, hospitals are now required to organize patient surveys at regular intervals. Patient experience, along with clinical performance and safety, is known as a critical criterion for improving healthcare performance [18, 19].
On the other hand, the evidence shows that the perception of nurses, managers or supervisors makes them perform better, and this can be investigated by examining the experiences of patients. Because the existence of this perception of caregivers as those who act based on their needs and to create their well-being and comfort increases the sense of support in caregivers [20, 21].
Several survey questionnaires have been used for such purposes, but these questionnaires have primarily obtained information about satisfaction with the service. Questionnaires asking patients to rate their satisfaction with their care typically receive very positive ratings that are insensitive to specific process-related problems that affect the quality of care provided [22]. While in the Picker questionnaire, by asking specific questions about whether certain processes and events occurred during a certain period of care, detailed reports are prepared about the patient's experiences, and the results are very practical. Based on the results of this study, all the items raised in the Picker questionnaire were well explained by 7 main aspects and the validity of the Persian Picker questionnaire (PPE-15) was confirmed. PPE-15 provided a different range of scores. In the first stage, it can be used to examine certain aspects of the patient's experience. For example, if patients report communicating with staff, programs can be considered to monitor and improve the situation.
According to the results of this study, the validity of the Picker questionnaire has been examined and confirmed in other languages through other studies. This survey tool can be used to monitor the fundamental aspects of services over time [23]. In a study in 2002, the Picker Institute used the Picker questionnaire (PPE-15) to assess the quality of care for hospitalized patients in 5 countries, including England (5 hospitals), Germany (6 hospitals), Sweden (9 hospitals), Switzerland (9 hospitals), and the United States (272 hospitals). Based on the results of the Picker Institute, the Picker questionnaire has achieved face validity, construct validity, and high reliability. Picker Patient Experience Questionnaire provides a step forward in evaluating patient experience because it presents a main set of items that may be added around more modules. Scores are easy to interpret. Based on this, the set of items can be included in the surveys of hospitalized patients in different areas and enable the comparison of the performance of hospitals and the creation of national or international standards [6-22].
In another study in 2002 in Sweden, the experience of patients with musculoskeletal problems was investigated using the Picker questionnaire. The questionnaire was evaluated using interviews with 11 respondents. Statistical analyses showed the validity and reliability of the questionnaire [24].
Another study was conducted in England in 2003. This study aimed to evaluate the performance of the 15-item Picker Patient Experience Questionnaire (PPE-15) as a shortened instrument compared to the longer form. A total of 1445 questionnaires were mailed to the patients of two hospitals. Patients randomly received the short form (4 pages) or the main form (12 pages). A total of 949 (65.67%) questionnaires were received. There was no difference in the response rate between the two versions of the questionnaire. The obtained results showed that the length of the questionnaire does not lead to a decrease in the response and also has no effect on the quality of the data. PPE-15 had internal consistency and necessary correlations between the items and the original form. As a result, the length of the questionnaire does not have a negative effect on its results [23].
In 2013, a systematic study was conducted to examine the evidence of the relationship between patient experience, safety, and clinical effectiveness. The findings of this study briefly showed a positive relationship between patient experience, patient safety, and clinical effectiveness. This study suggested the patient experience as one of the main pillars of quality in healthcare [25].
In Norway, a regular and annual assessment of patients is implemented as part of national quality indicators in specialized healthcare services. Although patient experience surveys are used in all hospitals, according to the Norwegian National Health and Care Services Act, municipalities are also required to collect patients' experiences to plan and organize health services. For this purpose, a study was conducted in 2017 to evaluate the experience of hospitalized patients in 5 municipal districts of Ostfold City using the PPE-15 tool. The results of this study confirmed the validity of the PPE-15 questionnaire in Norway [26].
A study was conducted to evaluate the Spanish and Catalan versions of the Picker questionnaire according to the patient's culture to measure the patients' experience in 2018. The acceptability, validity, and reliability of the questionnaire were evaluated through a cross-sectional validation study. The results of the study led to the compilation of questionnaires in Spanish and Catalan with sufficient conceptual and linguistic equivalence. Four factors were extracted by parallel analysis, explaining 43% of the total variance. The four aspects were information and communications received during hospitalization, low sensitivity attitude of professionals, evaluation of medical and nursing staff communication, and global items [27].
Findeklee et al. evaluated the care of women undergoing endoscopic surgery using the Picker questionnaire. According to their results, the questionnaire was a suitable tool to know the treatment quality of complications in patients undergoing endoscopic surgery [28].
Based on the results of comparing the findings of this study with other studies, the translated forms of the Picker Patient Experience Questionnaire (PPE-15) into other languages, like the results of this research, have been confirmed as a useful tool for examining the experiences of hospitalized patients and providing a solution to improve service provision in healthcare centers.
Conclusion
The Persian version of Picker Patient Experience (PPE-15) Questionnaire has the necessary validity to evaluate the experience of hospitalized patients in Iranian hospitals and explains 77.32% of the variance of the components.
Acknowledgements: We are grateful to all the people who helped in any way to make this work, especially the patients who participated in this study and also Mrs. Fateme Eftekhari, Mrs. Marjan Golriz, and Mrs. Hamide Babaee, who helped the authors with data collection.
Ethical Permission: This study was approved by the ethics approval committee of Janbazan Medical and Engineering Research Center (JMERC) with ethical code 95-P-E-264.
Conflict of Interests: There is no conflict of interests.
Authors’ Contribution: Taghdir R (First Author), Assistant Researcher (10%); Asgari M (Second Author), Methodologist/Statistical Analyst (25%); Ganjparvar Z (Third Author), Introduction Writer/Discussion Writer (20%); Abdollahifar Sh (Fourth Author), Assistant Researcher (10%); Kargar Jahromi S (Fifth Author), Assistant Researcher (5%); Ghadami L (Sixth Author), Assistant Researcher (5%); Soroush MR (Seventh Author), Methodologist/Main Researcher (25%)
Funding: This study was financially supported by Nikan Education and Research Center (NERC).
Keywords:
References
1. Ebrahimnia M, Ameriun A, Azizabadi Farahani M, Khodami Vishte H. Satisfaction rate of hospitalized patients in military hospitals from presented services. Millitary Med. 2010;12(2):101-5. [Persian] [Link]
2. Andres EB, Song W, Song W, Johnston JM. Can hospital accreditation enhance patient experience? Longitudinal evidence from a Hong Kong hospital patient experience survey. BMC Health Serv Res. 2019;19(1):623. [Link] [DOI:10.1186/s12913-019-4452-z]
3. Price R, Elliott M, Zaslavsky A, Hays RD, Lehrman WG, Rybowsky L, et al. Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev. 2014;71(5):522-54. [Link] [DOI:10.1177/1077558714541480]
4. Sherri L, LaVela SL. Evaluation and measurement of patient experience. Patient Exp J. 2014;1(1):28-36. [Link]
5. Farzadi F, Maftoon F, Aeenparast A, Azin A, Omidvari S, Jahangiri K, et al. Determinants of satisfaction with health care system: A population-based study from Iran. Payesh. 2011;10(3):323-30. [Persian] [Link]
6. Torres EJ, Guo KL. Quality improvement techniques to improve patient satisfaction. Int J Health Care Qual Assur Inc Leadersh Health Serv. 2004;17(6):334-8. [Link] [DOI:10.1108/09526860410557589]
7. Hajavi A, Haqani H, Akhlaqi F, Mehdi Pur U. Evaluating the performance of the medical records departments of Mashhad medical university teaching hospital (1381). J Health Manag. 2005;7(18):7-13. [Persian] [Link]
8. Jafari H, Esmaeeli R, Nasiri E, Haydari J, Mohammadpour R, Mahmmodi G. Assessment of satisfaction rate among the working staff of Mazandaran University of supplemental insurance company in 2005. J Mazandaran Univ Med Sci. 2007;17(58):117-24. [Persian] [Link]
9. Dehghan A, Mirjalili MR, Zare Mehrjoodi MH, Raghebian M, Samyeh Zargar A, Kazemini SK. Studying the satisfaction of patients referring to university hospitals with the level of quality of medical services after the implementation of the health system transformation plan in Yazd province. Hakim Health Syst Res J. 2017;3(78). [Persian] [Link]
10. LaVela SL, Gallan A. Evaluation and measurement of patient experience. Patient Exp J. 2014;1(1):28-36 [Link]
11. Institute of Picker. The Picker Institute Implementation Manual. Boston: Institute of Picker; 1999 [Link]
12. Berkowitz B. The patient experience and patient satisfaction: Measurement of a complex dynamic. Issues Nurs. 2016;1(21):1. [Link] [DOI:10.3912/OJIN.Vol21No01Man01]
13. Jenkinson C, Coulter A, Bruster S. The picker patient experience questionnaire: Development and validation using data from in-patient surveys in five countries. Qual Health Care. 2002;14(5):353-8. [Link] [DOI:10.1093/intqhc/14.5.353]
14. Wong EL, Coulter A, Hewitson P, Cheung AW, Yam CH, fai Lui S, et al. Patient experience and satisfaction with inpatient service: Development of short form survey instrument measuring the core aspect of inpatient experience. PLoS One. 2015;10(4):e0122299. [Link] [DOI:10.1371/journal.pone.0122299]
15. Holzer BM, Minder CE. A simple approach to fairer hospital benchmarking using patient experience data. Int J Qual Health Care. 2011;23(5):524-30. [Link] [DOI:10.1093/intqhc/mzr047]
16. Nemati Doplani F, Mohammadnezhad E, Tabatabaie A, Rhsani Noohi Kheili SR, Sahadi A, Haji Esmaiel Pour A. Evaluation of patients' satisfaction with medical services in teaching hospitals. Med Ethics. 2014;8(28):29-50. [Persian] [Link]
17. Almanasreh E, Moles R, Chen TF. Evaluation of methods used for estimating content validity. Res Soc Adm Pharm. 2019;15(2):214-21. [Link] [DOI:10.1016/j.sapharm.2018.03.066]
18. Ogbonnaya C, Babalola MT. A closer look at how managerial support can help improve patient experience: Insights from the UK's National Health Service. Human Relat. 2021; 74(11):1820-40 [Link] [DOI:10.1177/0018726720938834]
19. Murrells T, Robert G, Adams M, Morrow E, Maben J. Measuring relational aspects of hospital care in England with the 'Patient Evaluation of Emotional Care during Hospitalisation' (PEECH) survey questionnaire. BMJ Open. 2013;3(1):1-9. [Link] [DOI:10.1136/bmjopen-2012-002211]
20. Kirrane M, Lennon M, O'Connor C, Na F. Linking perceived management support with employees' readiness for change: The mediating role of psychological capital. J Change Manag. 2017;17(1):47-66. [Link] [DOI:10.1080/14697017.2016.1214615]
21. Kurtessis JN, Eisenberger R, Ford MT. Buffardi LC, Stewar KA, Adis CA. Perceived organizational support: A meta-analytic evaluation of organizational support theory. Manag. 2017;43(6):1854-84. [Link] [DOI:10.1177/0149206315575554]
22. Jenkinson C, Coulter A, Bruster S, Richards N, Chandola T. Patients' experiences and satisfaction with health care: Results of a questionnaire study of specific aspects of care. Qual Saf Health Care. 2002;11(4):335-9. [Link] [DOI:10.1136/qhc.11.4.335]
23. Jenkinson C, Coulter A, Reeves R, Bruster S, Richards N. Properties of the picker patient experience questionnaire in a randomized controlled trial of long versus short form survey instruments. Publ Health. 2003;25(3):197-201. [Link] [DOI:10.1093/pubmed/fdg049]
24. Jenkinson C, Coulter A, Gyll R, Lindström P, Avner L, Höglund E. Measuring the experiences of health care for patients with musculoskeletal disorders (MSD): development of the Picker MSD questionnaire. Scand J Caring Sci. 2002;16(3):329-33. [Link] [DOI:10.1046/j.1471-6712.2002.00088.x]
25. Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. 2013;3(1):e001570 [Link] [DOI:10.1136/bmjopen-2012-001570]
26. Leonardsen ACL, Grøndahl VA, Ghanima W, Storeheier E, Schönbeck A, Løken TA, et al. Evaluating patient experiences in decentralised acute care using the Picker Patient experience questionnaire; methodological and clinical findings. BMC Health Serv Res. 2017;17(1):68 [Link] [DOI:10.1186/s12913-017-2614-4]
27. Bertran M, Viñarás M, Salamero M, Garcia F, Graham C, McCulloch A, et al. Spanish and Catalan translation, cultural adaptation and validation of the Picker Patient Experience Questionnaire-15. Health Qual Res. 2018;33(1):10-17. [Link] [DOI:10.1016/j.cali.2017.12.004]
28. Findeklee S, Radosa JC, Schafhaupt S, Younes S, Radosa CG, Mothes A, et al. Evaluating the use of Clavien- Dindo classification and Picker Patient experience questionnaire as quality indicators in gynecologic endoscopy. Arch Gynecol Obstet. 2019;300:1317-24. [Link] [DOI:10.1007/s00404-019-05302-w]