Background
Methods
Survey development
Study design
Data analysis
Scale | Description and explanation/instructions in the questionnaire | Items |
---|---|---|
Relationship with your child | … Understanding of your child? | |
… Empathy for your child? | ||
… Time spent with your child? | ||
… Taking your child seriously? | ||
… Encouragement and support of your child? | ||
… Patience with your child? | ||
Child - Interaction |
In general (not merely based on the last visit), how satisfied are you with this pediatrician's: | … Treating your child as an individual? |
Relationship with your child | … is appropriate for my child's age. | |
Child - Information | How would you rate the information your child has received from this pediatrician? | … is appropriate for my child's development status. |
The information my child has received: | … is appropriate for my child's capacity and willingness to absorb the information. | |
Relationship with your child | · He/She informs my child of different choices of treatment. | |
Child – Decision making | How does this pediatrician involve your child in decision making and in processes such as examination and treatment? | · He/She informs my child of the advantages and disadvantages of the different choices of treatment. |
· He/She then asks my child which treatment the child prefers. | ||
· I am satisfied with the extent to which my child is involved in decision making. |
Scale | Description and explanation / instructions in the questionnaire | Items |
---|---|---|
Satisfaction with practice organization and facilities | … Wait time for a doctor's appointment? | |
… Wait time in the waiting room? | ||
… Consideration of your scheduling preferences? | ||
Practice organization | … Friendliness of practice staff? | |
Practice facilities |
In general (not merely based on the last visit), how satisfied are you with: | … Waiting room facilities? |
… Play and entertainment facilities for your child? | ||
Relationship with you | … Information received about your child's illness? | |
… Information about planned treatments for your child? | ||
… Information on the effects of prescribed medications for your child? | ||
… Information on what you can do to promote your child's recovery? | ||
… Comprehensibility / clarity of information? | ||
Parent - Information |
In general (not merely based on the last visit), how satisfied are you with this pediatrician in terms of: | … consideration of side effects of prescribed medications for your child ? |
Relationship with you | · He/She informs me of different options (e.g., for examination or treatment of my child). | |
· He/She informs me of advantages and disadvantages of different options. | ||
· He/She asks me which option I prefer for my child. | ||
Parent – Decision making | How does this pediatrician involve you in decisions related to the examination and treatment of your child? | · I am satisfied with the extent to which I am involved in decision making. |
Relationship with you | … Collaboration with other medical facilities? | |
… Thoroughness and diligence in examinations? | ||
Professional competence | … Readiness to refer your child to another physician in a timely manner? | |
How well do you trust this pediatrician? | ||
In general (not merely based on the last visit), how satisfied are you with the quality of care by this pediatrician? | ||
Global items | In general (not merely based on the last visit), how satisfied are you with this pediatrician's: | How satisfied are you with this pediatrician in general (not merely based on the last visit)? |
Results
Sample characteristics
Respondent | Mother | 94.3% |
---|---|---|
Father | 4.8% | |
other proxy (i.e. grandmother) | 0.3% | |
Age of respondents
| in years; M (SD) | 35.4 (6.6) |
Age of children
| in years; M (SD) | 4.7 (4.0) |
Age of children in groups
| Up to one year | 30,3% |
> 1 to up to 4 years | 28,6% | |
> 4 to up to 7 years | 19,7% | |
> 7 years | 21,4% | |
Knowing the pediatrician
| Years; M (SD) | 4.6 (3.9) |
Wait time
| in minutes; M (SD) | 20.2 (17.6) |
Patient-pediatrician contact time
| in minutes; M (SD) | 17.4 (14.8) |
Reasons for appointment*
| Routine check-up, vaccination | 36.2% |
Acute disease symptoms | 44.1% | |
Chronic disease symptoms | 11.3% | |
Emergency | 1.3% | |
Prescription, attest, referrals | 13.9% | |
other | 5.7% |
Item analyses
Variable | Subscale/Items | MV |
M
|
SD
| Skew-ness | Item -difficulty | Item-total corre-lation |
---|---|---|---|---|---|---|---|
Child - Interaction
| 2.2% | 87.1 | 16.85 | −1.19 | |||
CHINT1 | Understanding | 0.2% | 2.7 | 0.54 | −1.34 | 0.89 | 0.84 |
CHINT2 | Empathy | 0.2% | 2.6 | 0.59 | −1.39 | 0.87 | 0.83 |
CHINT3 | Time spent with child | 0.2% | 2.5 | 0.69 | −1.16 | 0.83 | 0.78 |
CHINT4 | Taking child seriously | 1.5% | 2.6 | 0.55 | −1.3 | 0.88 | 0.84 |
CHINT5 | Ecouragement & support | 0.9% | 2.5 | 0.61 | −1.11 | 0.85 | 0.83 |
CHINT6 | Patience | 0.4% | 2.6 | 0.55 | −1.23 | 0.88 | 0.81 |
CHINT7 | Treating child as an individual | 0.5% | 2.7 | 0.55 | −1.63 | 0.89 | 0.80 |
Child - Information | 16.6% | 86.3 | 17.52 | −1.05 | |||
CHINFO1 | Age appropriate | 15.4% | 2.6 | 0.57 | −1.05 | 0.86 | 0.85 |
CHINFO2 | Appropriate to child’s development stage | 15.4% | 2.6 | 0.55 | −1.02 | 0.87 | 0.87 |
CHINFO3 | Appropriate for child’s capacity | 14.9% | 2.6 | 0.57 | −1.05 | 0.86 | 0.82 |
Child – Decision-making | 46.2% | 66.3 | 29.63 | −0.60 | |||
ChDM1 | Offers choices about child’s health care to child | 42.9% | 2.1 | 0.91 | −0.62 | 0.68 | 0.84 |
ChDM2 | Discusses advantages and disadvantages of different choices of treatment with the child | 46.2% | 2.0 | 1 | −0.54 | 0.65 | 0.88 |
ChDM3 | Asks child about preferred choice of treatment | 46.0% | 1.9 | 1 | −0.49 | 0.64 | 0.89 |
ChDM4 | Appropriate involvement of the child in decision-making | 45.8% | 2.0 | 0.94 | −0.67 | 0.67 | 0.84 |
Subscale/Items | MV |
M
|
SD
| Skew-ness | Item Difficulty | Item-Total-Correlation | |
---|---|---|---|---|---|---|---|
Parent - Information | 10.3% | 80.9 | 19.22 | −0.85 | |||
ParInfo1 | Child’s illness | 2.2% | 2.5 | 0.63 | −1.08 | 0.84 | .77 |
ParInfo2 | Planned treatments | 4.3% | 2.5 | 0.6 | −0.96 | 0.84 | .77 |
ParInfo3 | Effect of medications | 3.4% | 2.3 | 0.74 | −0.84 | 0.78 | .81 |
ParInfo4 | What one can do to promote child‘s health | 3.0% | 2.4 | 0.72 | −1.02 | 0.8 | .79 |
ParInfo5 | Comprehensibility | 1.8% | 2.5 | 0.62 | −1.11 | 0.84 | .77 |
ParInfo6 | Consideration of side effects | 6.6% | 2.2 | 0.81 | −0.65 | 0.72 | .75 |
Parent – Decision-making | 6.5% | 70.3 | 28.40 | −0.71 | |||
ParDM1 | Offers choices of treatment for the child’s health care to parent | 5.0% | 2.1 | 0.88 | −0.66 | 0.7 | 0.85 |
ParDM2 | Discusses advantages and disadvantages about different choices of treatment with the parents | 5.3% | 2.1 | 0.96 | −0.7 | 0.69 | 0.84 |
ParDM3 | Asks for parents’ preferred choice of treatment | 5.0% | 2.0 | 0.97 | −0.66 | 0.68 | 0.88 |
ParDM4 | Appropriate involvement of parents in decision making | 5.1% | 2.2 | 0.91 | −0.91 | 0.73 | 0.84 |
Professional competence | 29.2% | 86.4 | 17.83 | −1.34 | |||
ProfComp1 | Collaboration with other medical faculties | 25.7% | 2.5 | 0.62 | −1.07 | 0.84 | 0.71 |
ProfComp2 | Thoroughness and diligence in examinations | 2.8% | 2.6 | 0.62 | −1.43 | 0.87 | 0.66 |
ProfComp3 | Readiness to refer the child | 22.5% | 2.6 | 0.63 | −1.62 | 0.87 | 0.73 |
Practice organization | 0.0% | 85.2 | 14.38 | −1.10 | |||
POrg1 | Wait time for doctor’s appointment | 0.7% | 2.6 | 0.56 | −1.49 | 0.88 | 0.55 |
POrg2 | Wait time in waiting room | 0.5% | 2.1 | 0.78 | −0.59 | 0.7 | 0.45 |
POrg3 | Consideration of scheduling preferences | 0.4% | 2.7 | 0.51 | −1.58 | 0.9 | 0.56 |
POrg4 | Friendliness of staff | 0.4% | 2.7 | 0.49 | −1.93 | 0.92 | 0.43 |
Practice facilities | 0.0% | 73.9 | 23.38 | −0.53 | |||
PFacil1 | Waiting room facilities | 0.3% | 2.2 | 0.75 | −0.63 | 0.74 | 0.78 |
PFacil2 | Play and entertainment facilities | 0.6% | 2.2 | 0.74 | −0.59 | 0.73 | 0.78 |
Scoring and reliability of the subscales
Interaction | Information | Decision making | |
---|---|---|---|
"Chld-Scales" | |||
Number of items | 7 | 3 | 4 |
Responders (n) | 957 | 816 | 503 |
Missing values (%) | 2.2 | 16.6 | 48.6 |
Subscale minimum/maximum | 0/21 | 0/9 | 0/12 |
Subscale mean, raw | 18.3 | 7.8 | 8.0 |
Subscales transformed (min/max) | 0/100 | 0/100 | 0/100 |
Subscale mean, transformed | 87.1 | 86.3 | 66.4 |
Floor effect (%) | 0 | 0.1 | 3.0 |
Ceiling effect (%) | 47.8 | 45.7 | 12.8 |
Skewness | −1.18 | −1.14 | -.34 |
Inter-item correlation (min/max) | 0.71 (0.65 - 0.83) | 0.81 (0.78 – 0.84) | 0.8 (0.74 – 0.84) |
Cronbach‘s alpha | 0.95 | 0.93 | 0.94 |
Information | Decision making | Professional competence | Practice organization | Practice facilites | |
---|---|---|---|---|---|
"Parent"-Scales
| |||||
Number of items | 6 | 4 | 3 | 4 | 2 |
Responder (n) | 878 | 915 | 693 | 966 | 973 |
Missing values (%) | 10.3 | 6.5 | 29.2 | 1.3 | 0.6 |
Subscale minimum/maximum | 0/18 | 0/12 | 0/9 | 0/12 | 0/6 |
Subscale mean, raw | 14.6 | 8.4 | 7.8 | 10.2 | 4.4 |
Subscales transformed (min/max) | 0/100 | 0/100 | 0/100 | 0/100 | 0/100 |
Subscale mean, transformed | 80.9 | 70.3 | 86.4 | 85.2 | 73.9 |
Floor effect (%) | 0.2 | 3.4 | 0.2 | 0.2 | 0.8 |
Ceiling effect (%) | 28.7 | 29.0 | 36.4 | 27.2 | 34.1 |
Skewness | -.75 | -.66 | -.64 | −1.1 | -.53 |
Inter-item correlation (min/max) | 0.67 (0.57 – 0.79) | 0.79 (0.75 – 0.83 | 0.63 (0.50 – 0.69) | 0.39 (0.27 – 0.50) | 0.78 |
Cronbach‘s alpha | 0.92 | 0.94 | 0.84 | 0.72 | 0.88 |
Construct validity
Stability of the measurement model – older and younger children
Model | Chi2 | Df | p-value | CFI | RMSEA | SRMR | |
---|---|---|---|---|---|---|---|
"Child"-Scales
| |||||||
Model 0 | Unconstrained basic model | 424 | 148 | <0.000 | 0.96 | 0.62 | 0.040 |
Model 1 | Constrained regression weights, covariances, and error terms | 508 | 176 | <0.000 | 0.95 | 0.063 | 0.050 |
Model 1 vs. Model 0 | 84 | 28 | <0.000 | ||||
Model 2 | Constrained regression weights and covariances | 447 | 162 | <0.000 | 0.96 | 0.063 | 0.040 |
Model 2 vs. Model 0 | 23 | 14 | 0.06 | ||||
Model 3 | Constrained regression weights | 434 | 159 | <0.000 | 0.96 | 0.063 | 0.040 |
Model 3 vs. Model 0 | 10 | 11 | 0.53 | ||||
"Parent“-Scales
| |||||||
Model 0 | Unconstrained basic model | 692 | 282 | <0.000 | 0.95 | 0.049 | 0.049 |
Model 1 | Constrained regression weights, covariances, and error terms | 820 | 326 | <0.000 | 0.94 | 0.05 | 0.064 |
Model 1 vs. Model 0 | 128 | 44 | <0.000 | ||||
Model 2 | Constrained regression weights and covariances | 763 | 306 | <0.000 | 0.94 | 0.049 | 0.06 |
Model 2 vs. Model 0 | 71 | 24 | |||||
Model 3 | Constrained regression weights | 720 | 296 | <0.000 | 0.95 | 0.048 | 0.051 |
Model 3 vs. Model 0 | 28 | 14 | 0.014 |
Correlation between subscales and global items
ZAP Subscales | Trust in doctor | Treatment quality | Satisfaction with doctor |
---|---|---|---|
Child-Interaction | 0.56 | 0.60 | 0.62 |
Child-Information | 0.49 | 0.50 | 0.45 |
Child-Decision making | 0.52 | 0.59 | 0.54 |
Parent-Information | 0.65 | 0.68 | 0.66 |
Parent- Decision making | 0.50 | 0.58 | 0.53 |
Professional competence | 0.62 | 0.65 | 0.62 |
Practice organization | 0.45 | 0.42 | 0.44 |
Practice facilities | 0.32 | 0.37 | 0.37 |