title: Respectfulness from the patient perspective: comparison of primary healthcare evaluation instruments.
abstract: Respectfulness is one measurable and core element of healthcare responsiveness. The operational definition of respectfulness is "the extent to which health professionals and support staff meet users' expectations about interpersonal treatment, demonstrate respect for the dignity of patients and provide adequate privacy."
  
  
  OBJECTIVE
  To examine how well respectfulness is captured in validated instruments that evaluate primary healthcare from the patient's perspective, whether or not their developers had envisaged these as representing respectfulness.
  
  
  METHODS
  645 adults with at least one healthcare contact with their own regular doctor or clinic in the previous 12 months responded to six instruments, two subscales that mapped to respectfulness: the Interpersonal Processes of Care, version II (IPC-II, two subscales) and the Primary Care Assessment Survey (PCAS). Additionally, there were individual respectfulness items in subscales measuring other attributes in the Components of Primary Care Index (CPCI) and the first version of the EUROPEP (EUROPEP-I). Scores were normalized for descriptive comparison. Exploratory and confirmatory (structural equation modelling) factor analyses examined fit to operational definition.
  
  
  RESULTS
  Respectfulness scales correlate highly with one another and with interpersonal communication. All items load adequately on a single factor, presumed to be respectfulness, but the best model has three underlying factors corresponding to (1) physician's interpersonal treatment (eigenvalue=13.99), (2) interpersonal treatment by office staff (eigenvalue=2.13) and (3) respect for the dignity of the person (eigenvalue=1.16). Most items capture physician's interpersonal treatment (IPC-II Compassionate, Respectful Interpersonal Style, IPC-II Hurried Communication and PCAS Interpersonal Treatment). The IPC-II Interpersonal Style (Disrespectful Office Staff) captures treatment by staff, but only three items capture dignity.
  
  
  CONCLUSIONS
  Various items or subscales seem to measure respectfulness among currently available validated instruments. However, many of these items related to other constructs, such as interpersonal communication. Further studies should aim at developing more refined measures - especially for privacy and dignity - and assess the relevance of the broader concept of responsiveness.
authors.affiliation: Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC.
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Lévesque
authors.forename: Raynald
authors.initials: R
authors.lastname: Pineault
authors.forename: Jeannie L
authors.initials: JL
authors.lastname: Haggerty
authors.forename: Frederick
authors.initials: F
authors.lastname: Burge
authors.forename: Marie-Dominique
authors.initials: MD
authors.lastname: Beaulieu
authors.forename: David
authors.initials: D
authors.lastname: Gass
authors.forename: Darcy A
authors.initials: DA
authors.lastname: Santor
authors.forename: Christine
authors.initials: C
authors.lastname: Beaulieu