title: SEQUenCE: a service user-centred quality of care instrument for mental health services.
abstract: OBJECTIVE
  To develop a quality of care instrument that is grounded in the service user perspective and validate it in a mental health service.
  
  
  METHODS
  The instrument (SEQUenCE (SErvice user QUality of CarE)) was developed through analysis of focus group data and clinical practice guidelines, and refined through field-testing and psychometric analyses.
  
  
  METHODS
  All participants were attending an independent mental health service in Ireland.
  
  
  METHODS
  Participants had a diagnosis of bipolar affective disorder (BPAD) or a psychotic disorder.
  
  
  METHODS
  Twenty-nine service users participated in six focus group interviews. Seventy-one service users participated in field-testing: 10 judged the face validity of an initial 61-item instrument; 28 completed a revised 52-item instrument from which 12 items were removed following test-retest and convergent validity analyses; 33 completed the resulting 40-item instrument.
  
  
  METHODS
  Test-retest reliability, internal consistency and convergent validity of the instrument.
  
  
  RESULTS
  The final instrument showed acceptable test-retest reliability at 5-7 days (r = 0.65; P < 0.001), good convergent validity with the Verona Service Satisfaction Scale (r = 0.84, P < 0.001) and good internal consistency (Cronbach's alpha = 0.87).
  
  
  CONCLUSIONS
  SEQUenCE is a valid, reliable scale that is grounded in the service user perspective and suitable for routine use. It may serve as a useful tool in individual care planning, service evaluation and research. The instrument was developed and validated with service users with a diagnosis of either BPAD or a psychotic disorder; it does not yet have established external validity for other diagnostic groups.
authors.affiliation: Department of Psychiatry, St Patrick's University Hospital, Trinity College Dublin, Dublin, Ireland.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Hester
authors.affiliation: Department of Psychiatry, St Patrick's University Hospital, Trinity College Dublin, Dublin, Ireland.
authors.forename: Lorna Jane
authors.initials: LJ
authors.lastname: O'Doherty
authors.affiliation: Department of Psychiatry, St Patrick's University Hospital, Trinity College Dublin, Dublin, Ireland.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Schnittger
authors.affiliation: Department of Psychiatry, St Patrick's University Hospital, Trinity College Dublin, Dublin, Ireland.
authors.forename: Niamh
authors.initials: N
authors.lastname: Skelly
authors.affiliation: Department of Psychiatry, St Patrick's University Hospital, Trinity College Dublin, Dublin, Ireland.
authors.forename: Muireann
authors.initials: M
authors.lastname: O'Donnell
authors.affiliation: Department of Psychiatry, St Patrick's University Hospital, Trinity College Dublin, Dublin, Ireland.
authors.forename: Lisa
authors.initials: L
authors.lastname: Butterly
authors.affiliation: Department of Psychiatry, St Patrick's University Hospital, Trinity College Dublin, Dublin, Ireland.
authors.forename: Robert
authors.initials: R
authors.lastname: Browne
authors.affiliation: Consumer Council, St Patrick's University Hospital, Dublin, Ireland.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Frorath
authors.affiliation: Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Craig
authors.initials: C
authors.lastname: Morgan
authors.affiliation: Department of Psychiatry, St Patrick's University Hospital, Trinity College Dublin, Dublin, Ireland Trinity College Institute of Neuroscience, St Patrick's University Hospital, Trinity College Dublin, Dublin, Ireland.
authors.forename: Declan M
authors.initials: DM
authors.lastname: McLoughlin
authors.affiliation: Department of Psychiatry, St Patrick's University Hospital, Trinity College Dublin, Dublin, Ireland.
authors.forename: Paul
authors.initials: P
authors.lastname: Fearon
mesh_terms: D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000628:therapy; D005260:Female; D017144:Focus Groups; D006801:Humans; D007494:Ireland; D008297:Male; D008605:Mental Health Services / Q000592:standards*; D008875:Middle Aged; D017060:Patient Satisfaction; D011618:Psychotic Disorders / Q000628:therapy; D011787:Quality of Health Care / Q000592:standards*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: health services research; healthcare quality improvement; mental health; patient satisfaction; patient-centred care