title: Measuring nonspecific factors in treatment: item banks that assess the healthcare experience and attitudes from the patient's perspective.
abstract: Nonspecific factors that accompany healthcare treatments, such as patients' attitudes and expectations, are important parts of the experience of care and can influence outcomes. However, no precise, concise, and generalizable instruments to measure these factors exist. We report on the development and calibration of new item banks, titled the Healing Encounters and Attitudes Lists (HEAL), that assess nonspecific factors across a broad range of treatments and conditions.
  
  
  
  The instrument development methodology of the Patient-Reported Outcomes Measurement Information System (PROMIS(®)) was used. Patient focus groups and clinician interviews informed our HEAL conceptual model. Literature searches of eight databases yielded over 500 instruments and resulted in an initial item pool of several thousand items. After qualitative item analysis, including cognitive interviewing, 296 items were included in field testing. The calibration sample included 1657 respondents, 1400 obtained through an Internet panel and 257 from conventional and integrative medicine clinics. Following exploratory and confirmatory factor analyses, the HEAL item banks were calibrated using item response theory.
  
  
  
  The final HEAL item banks were Patient-Provider Connection (57 items), Healthcare Environment (25 items), Treatment Expectancy (27 items), Positive Outlook (27 items), and Spirituality (26 items). Short forms were also developed from each item bank. A six-item short form, Attitudes toward Complementary and Alternative Medicine (CAM), was also created.
  
  
  
  HEAL item banks provided substantial information across a broad range of each construct. HEAL item banks showed initial evidence of predictive and concurrent validity, suggesting that they are suitable for measuring nonspecific factors in treatment.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. grecocm@upmc.edu.|University of Pittsburgh Center for Integrative Medicine, 580 South Aiken Avenue, Suite 310, Pittsburgh, PA, 15232, USA. grecocm@upmc.edu.
authors.forename: Carol M
authors.initials: CM
authors.lastname: Greco
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Lan
authors.initials: L
authors.lastname: Yu
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Johnston
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Nathan E
authors.initials: NE
authors.lastname: Dodds
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Natalia E
authors.initials: NE
authors.lastname: Morone
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.|University of Pittsburgh Center for Integrative Medicine, 580 South Aiken Avenue, Suite 310, Pittsburgh, PA, 15232, USA.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Glick
authors.affiliation: Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Schneider
authors.affiliation: Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Klem
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.|University of Pittsburgh Center for Integrative Medicine, 580 South Aiken Avenue, Suite 310, Pittsburgh, PA, 15232, USA.
authors.forename: Christine E
authors.initials: CE
authors.lastname: McFarland
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Lawrence
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Colditz
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Maihoefer
authors.affiliation: Samueli Institute, Alexandria, VA, USA.
authors.forename: Wayne B
authors.initials: WB
authors.lastname: Jonas
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.|University of Pittsburgh Center for Integrative Medicine, 580 South Aiken Avenue, Suite 310, Pittsburgh, PA, 15232, USA.
authors.forename: Neal D
authors.initials: ND
authors.lastname: Ryan
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Pilkonis
mesh_terms: D000529:Complementary Therapies; D019992:Databases as Topic; D006801:Humans; D008962:Models, Theoretical; D000071066:Patient Reported Outcome Measures; D011594:Psychometrics / Q000295:instrumentation*
keywords: Attitude toward complementary medicine; Nonspecific contextual factors in treatment; PROMIS instrument development methodology; Patient experience of care; Patient-reported measures; Patient–provider relationship; Perceptions of the Healthcare Environment; Placebo measurement; Positive Outlook; Spirituality; Treatment expectations