Chronic kidney-disease screening service quality: questionnaire survey research evidence from Taichung city

<p>Abstract</p> <p>Background</p> <p>Chronic kidney disease (CKD) is a serious public health problem in Taiwan and the world. The most effective, affordable treatments involve early prevention/detection/intervention, requiring screening. Successfully implementing CKD programs requires good patient participation, affected by patient perceptions of screening service quality. Service quality improvements can help make such programs more successful. Thus, good tools for assessing service quality perceptions are important. Aim: to investigate using a modified SERVQUAL questionnaire in assessing patient expectations, perceptions, and loyalty towards kidney disease screening service quality.</p> <p>Method</p> <p>1595 kidney disease screening program patients in Taichung City were requested to complete and return a modified kidney disease screening SERVQUAL questionnaire. 1187 returned them. Incomplete ones (102) were culled and 1085 were chosen as effective for use. Paired t-tests, correlation tests, ANOVA, LSD test, and factor analysis identified the characteristics and factors of service quality. The paired t-test tested expectation score and perception score gaps. A structural equation modeling system examined satisfaction-based components' relationships.</p> <p>Results</p> <p>The effective response rate was 91.4%. Several methods verified validity. Cronbach's alpha on internal reliability was above 0.902. On patient satisfaction, expectation scores are high: 6.50 (0.82), but perception scores are significantly lower 6.14 (1.02). Older patients' perception scores are lower than younger patients'. Expectation and perception scores for patients with different types of jobs are significantly different. Patients higher on education have lower scores for expectation (r = -0.09) and perception (r = -0.26). Factor analysis identified three factors in the 22 item SERVQUAL form, which account for 80.8% of the total variance for the expectation scores and 86.9% of the total variance for the satisfaction scores. Expectation and perception score gaps in all 22 items are significant. The goodness-of-fit summary of the SEM results indicates that expectations and perceptions are positively correlated, perceptions and loyalty are positively correlated, but expectations and loyalty are not positively correlated.</p> <p>Conclusions</p> <p>The results of this research suggest that the SERVQUAL instrument is a useful measurement tool in assessing and monitoring service quality in kidney disease screening services, enabling the staff to identify where service improvements are needed from the patients' perspectives.</p

The development and validation of the concise outpatient department user satisfaction scale

Objectives. To develop and validate a concise scale for measuring outpatient satisfaction suitable across specialties and cultures. Design & setting. Item generation adopted a concept-driven approach, and 10 candidate items were administered together with a battery of validation items and scales in a cross-sectional survey at a government-aided Chinese medicine specialized outpatient department in Hong Kong. Participants. About 344 consenting patients or their accompanying caregivers were recruited upon their first visit at the clinic and interviewed one month thereafter. Results. The overall response rate wa s 79%. After deleting one item (physician's manner and attitude) for its redundancy suggested by interitem correlations, exploratory factor analysis yielded two factors, General Service and Case Physician, explaining 75% of variance of the remaining nine items. The internal consistency coefficients of the whole scale and the two subscales were higher than 0.90. Criterion-related validity was supported by high correlations with three anchor items, overall satisfaction, intended future reutilization, and recommendation to others (r = 0.38-0.85). Significant correlations with compliance and negative affects provided preliminary evidence for construct validity. Conclusion. The psychometric properties of the resulting 9-item scale supported its usefulness in measuring outpatient satisfaction. Further validation studies in various specialties and countries are suggested to make future cross-cultural comparisons possible. © 2006 Oxford University Press.link_to_subscribed_fulltex

Incorporating family therapy into asthma group intervention: A randomized waitlist-controlled trial

Asthma psychoeducational programs have been found to be effective in terms of symptom-related outcome. They are mostly illness-focused, and pay minimal attention to systemic/familial factors. This study evaluated a novel asthma psychoeducation program that adopted a parallel group design and incorporated family therapy. A randomized waitlist-controlled crossover clinical trial design was adopted. Children with stable asthma and their parents were recruited from a pediatric chest clinic. Outcome measures included, for the patients: exhaled nitric oxide (eNO), spirometry, and adjustment to asthma; and for the parents: perceived efficacy in asthma management, Hospital Anxiety and Depression Scale anxiety subscale, Body Mind Spirit Well-being Inventory emotion subscale, and Short Form 12 health-related quality of life scale. Forty-six patients participated in the study. Attrition rates were 13.0% and 26.0% for the active and control groups, respectively. Repeated-measures ANOVA revealed a significant decrease in airway inflammation, as indicated by eNO levels, and an increase in patient's adjustment to asthma and parents' perceived efficacy in asthma management. Serial trend analysis revealed that most psychosocial measures continued to progress steadily after intervention. Significant improvements in both symptom-related measures and mental health and relationship measures were observed. The findings supported the value of incorporating family therapy into asthma psychoeducation programs. 2008 © FPI, Inc.link_to_subscribed_fulltex

Evaluating an integrated parallel group intervention for Chinese asthma children and their parents

Conference Theme: Bridging Disciplinary Boundarie

Short communication: The effect of a one-hour Eastern stress management session on salivary cortisol

The Eastern stress management techniques derived from the Body-Mind-Spirit (BMS) model by Chan (2001) have been applied to interventions for a variety of clienteles and the effectiveness has been supported by positive psychological outcomes. This study aims to complement these studies by evaluating the efficacy of a one-hour Eastern stress management session in reducing salivary cortisol levels in working adults in Hong Kong. Pre- and post-test salivary cortisol levels were measured and a significant drop after the session when compared with local normative data was evident. The efficacy of the stress management session, limitations of this study suggestions for further research are discussed. Copyright © 2006 John Wiley & Sons, Ltd.link_to_subscribed_fulltex

The Dynamics Of Rocking Isolation

The uplifting and rocking of slender, free-standing structures when subjected to ground shaking may limit appreciably the seismic moments and shears that develop at their base. This high-performance seismic behavior is inherent in the design of ancient temples that consist of slender, free-standing columns which support freely heavy epistyles together with the even heavier frieze atop. While the ample seismic performance of rocking isolation has been documented with the through-the-centuries survival of several free-standing ancient temples; and careful post-earthquake observations in Japan during the 1940’s suggested that the increasing size of slender free-standing tombstones enhances their seismic stability; it was Housner (Bull Seismol Soc Am 53(2):404–417, 1963) who more than half century ago elucidated a size-frequency scale effect and explained that there is a safety margin between uplifting and overturning and as the size of the column or the frequency of the excitation increases, this safety margin increases appreciably to the extent that large free-standing columns enjoy ample seismic stability. This article revisits the important implications of this post-uplift dynamic stability and explains that the enhanced seismic stability originates from the difficulty of mobilizing the rotational inertia of the free-standing column. As the size of the column increases the seismic resistance (rotational inertia) increases with the square of the column size; whereas, the seismic demand (overturning moment) increases linearly with size. The same result applies to the articulated rocking frame given that its dynamic rocking response is identical to the rocking response of a solitary free-standing column with the same slenderness; yet larger size. The article concludes that the concept of rocking isolation by intentionally designing a hinging mechanism that its seismic resistance originates primarily from the mobilization of the rotational inertia of its members is a unique seismic protection strategy for large, slender structures not just at the limit-state but also at the operational state