A Rasch analysis of patients' opinions of primary health care professionals' ethical behaviour with respect to communication issues.
BACKGROUND
Patients' opinions are crucial in assessing the effectiveness of the ethical theories which underlie the care relationship between patients and primary health care professionals.


OBJECTIVE
To study the ethical behaviour of primary health care professionals with respect to communication issues according to patients' opinions.


METHODS
Cross-sectional study using a self-administered questionnaire in patients from a network of 15 urban primary health centres. Participants were patients attended at the centres when the study was conducted. We used a Rasch analysis to verify the structure of the 17 questionnaire items, and to calculate interval level measures for patients and items. We analysed differences according to patient subgroups using analysis of variance tests and differences between the endorsement of each item.


RESULTS
We analysed 1013 (70.34%) of questionnaires. Data fit to the Rasch model was achieved after collapsing two categories and eliminating five items. Items with the lowest degree of endorsement were related to the management of differences in conflictive situations between patients and health care professionals. We found significant differences (P < 0.001) in patients' opinions according to the degree of confidence in professionals and their educational level.


CONCLUSIONS
Patients opined that empathy and traditional communication skills were respected by family physicians and nurses. However, opinions on endorsement were lower when patients disagreed with health care professionals. The differences found between patient subgroups demonstrated the importance of trust and confidence between patients and professionals.
Transverse Group for Research in Primary Care, IDIBAPS, Barcelona, School of Medicine and Health Sciences, Universitat Internacional de Catalunya. Sant Cugat del Vallés, gonzalezdepaz@hotmail.com.
Luis
L
González-de Paz
Transverse Group for Research in Primary Care, IDIBAPS, Barcelona.
Belchin
B
Kostov
Department of Basic Psychology and Methodology. University of Murcia, Murcia.
Jose A
JA
López-Pina
Institut Català de la Salut. Àmbit d'Atenció Primària Barcelona Ciutat. Barcelona and.
Pilar
P
Solans-Julián
School of Medicine and Health Sciences, Universitat Internacional de Catalunya. Sant Cugat del Vallés.
M Dolors
MD
Navarro-Rubio
Transverse Group for Research in Primary Care, IDIBAPS, Barcelona, University of Barcelona School of Medicine (Hospital Clinic), Barcelona, Spain.
Antoni
A
Sisó-Almirall
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003430:Cross-Sectional Studies; D034462:Dissent and Disputes; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010817:Physician-Patient Relations / Q000941:ethics*; D010820:Physicians / Q000941:ethics*; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D035502:Trust; D055815:Young Adult
Ethics; ethical conduct; patients; primary health care; professional–patient relationship.