title: Casting light on the concept of patient satisfaction by studying the construct validity and the sensitivity of a questionnaire.
abstract: OBJECTIVE
  This study aims to explore the construct validity and the sensitivity of a patient satisfaction questionnaire for the purpose of gaining a better understanding of the concept, and of issues surrounding its measurements.
  
  
  METHODS
  Several statistical analyses were used to study the reliability, construct validity, and the sensitivity of a patient satisfaction questionnaire.
  
  
  RESULTS
  The study supported the construct validity, high internal consistency, and homogeneity of the instrument. Two factors were found; one consisted of negatively worded items and the other of positively worded items. The negatively worded items contributed more than the positively worded items to the sensitivity of the instrument. Items were identified that contribute little or nothing to the construct validity and/or the sensitivity of the questionnaire.
  
  
  CONCLUSIONS
  The effect of wording on the variability and sensitivity of the instrument can be explained both as a consequence of response set bias and with regard to the theories against which two phenomena were being measured - patient satisfaction and patient dissatisfaction. The development of two kinds of instruments is proposed: those that measure patient dissatisfaction and are sensitive to minute changes in nursing care and those that measure both concepts and capture what patients find important in their care.
  
  
  CONCLUSIONS
  The paper demonstrates how an analysis of the construct validity and the sensitivity of patient satisfaction instrument, can enhance understanding of the concept. It contributes to the debate about whether patient satisfaction and dissatisfaction are opposite ends of the same continuum or two different phenomena that require two different definitions.
authors.affiliation: Department of Nursing, The University of Iceland, Reykjavik, Iceland. pb@hi_is
authors.forename: Páll
authors.initials: P
authors.lastname: Biering
authors.forename: Heather
authors.initials: H
authors.lastname: Becker
authors.forename: Amy
authors.initials: A
authors.lastname: Calvin
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Grobe
mesh_terms: D003627:Data Interpretation, Statistical; D006761:Hospitals; D006801:Humans; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires / Q000592:standards*; D013781:Texas