A critical analysis of user satisfaction surveys in addiction services: opioid maintenance treatment as a representative case study.
BACKGROUND
Satisfaction with services represents a key component of the user's perspective, and user satisfaction surveys are the most commonly used approach to evaluate the aforementioned perspective. The aim of this discursive paper is to provide a critical overview of user satisfaction surveys in addiction treatment and harm reduction services, with a particular focus on opioid maintenance treatment as a representative case.


METHODS
We carried out a selective critical review and analysis of the literature on user satisfaction surveys in addiction treatment and harm reduction services.


RESULTS
Most studies that have reported results of satisfaction surveys have found that the great majority of users (virtually all, in many cases) are highly satisfied with the services received. However, when these results are compared to the findings of studies that use different methodologies to explore the patient's perspective, the results are not as consistent as might be expected. It is not uncommon to find that "highly satisfied" patients report significant problems when mixed-methods studies are conducted. To understand this apparent contradiction, we explored two distinct (though not mutually exclusive) lines of reasoning, one of which concerns conceptual aspects and the other, methodological questions.


CONCLUSIONS
User satisfaction surveys, as currently designed and carried out in addiction treatment and harm reduction services, do not significantly help to improve service quality. Therefore, most of the enthusiasm and naiveté with which satisfaction surveys are currently performed and interpreted - and rarely acted on in the case of nonoptimal results - should be avoided. A truly participatory approach to program evaluation is urgently needed to reshape and transform patient satisfaction surveys.
Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Bilbao, Spain ; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Bilbao, Spain.
Joan
J
Trujols
DeustoPsych - Unidad de Investigación, Desarrollo e Innovación en Psicología y Salud, Universidad de Deusto, Bilbao, Spain.
Ioseba
I
Iraurgi
School of Population and Public Health, University of British Columbia, Vancouver, Canada ; Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, Canada.
Eugenia
E
Oviedo-Joekes
Departament de Metodologia de les Ciències del Comportament, Facultat de Psicologia, Institut de Recerca en Cervell, Cognició i Conducta (IR3C), Universitat de Barcelona, Barcelona, Spain.
Joan
J
Guàrdia-Olmos
harm reduction services; patient satisfaction; patient-centered evaluation; service user perspective; substance abuse treatment services; user involvement