title: Demand-oriented care: the development and validation of a measuring instrument.
abstract: OBJECTIVE
  Demand-oriented care has recently become a key topic in the area of care provision, fitting into the modern pursuit for patient autonomy. This paper introduces a measuring instrument to assess demand-orientation in mental health care.
  
  
  METHODS
  A concept mapping procedure was used to understand the concept of demand-orientation. The resulting items were introduced to a validating sample of 204 patients of three mental health facilities. After factor analysis, a 19-item General-Demand Orientated Care Questionnaire (DOC-G), and a supplementary questionnaire (DOC-S) containing 6 sections remained. This questionnaire was submitted to confirmatory analysis in a random sample (n = 304) of psychiatric patients.
  
  
  RESULTS
  Respondents were predominantly female (57.6%), of Dutch ethnic origin (84.1%), and outpatients (71.4%). The analyses confirmed the 4-factor structure of the questionnaire. Both internal and external validity of the instrument proved to be sufficient. The questionnaire discriminated in the experience of demand-orientation of care between patients who did and those who did not have a treatment plan put up; between those who did and those who did not have a crisis plan, and between those who had a lifetime prevalence of undergoing compulsory treatment, and those who had not.
  
  
  CONCLUSIONS
  We conclude that the DOC is a useful instrument to measure demand-orientation in a population of psychiatric patients. It is useful to measure changes in care quality. The supplementary questionnaires make it possible to evaluate chosen projects or subprojects quickly.
authors.affiliation: Julius Centre for Health Sciences and Primary Health Care, University Medical Centre Utrecht, Hp Str 6.131, PO Box 85500, Utrecht, GA 3508, The Netherlands. g.h.deweert@umcutrecht.nl
authors.forename: Gerdien H
authors.initials: GH
authors.lastname: de Weert-van Oene
authors.forename: Victor J A
authors.initials: VJ
authors.lastname: Buwalda
authors.forename: Johan M
authors.initials: JM
authors.lastname: Havenaar
authors.forename: Wilma
authors.initials: W
authors.lastname: Swildens
authors.forename: Albert
authors.initials: A
authors.lastname: van Keijzerswaard
authors.forename: Augustinus J P
authors.initials: AJ
authors.lastname: Schrijvers
mesh_terms: D000328:Adult; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000592:standards* / Q000706:statistics & numerical data; D009426:Netherlands; D011795:Surveys and Questionnaires