Background
Anthroposophic healthcare
Methods
Ethics statement
Phase 1: determining anthroposophic aspects
Literature study
Focus groups
Phase 2: validation of the CQ-index AH
Research population
Data collection
Measuring instruments
Statistical analyses
Phase 3: modelling and selection of new items
Results
Phase 1: anthroposophic quality aspects
Literature study
Focus groups
Phase 2: validation of the CQ-index AH
Response rate
NGP
| % of net sample | % of gross response | NIM
| % of net sample | ||
---|---|---|---|---|---|---|
Gross sample
| 6910 | 1000 | ||||
Not registered at GP | 100 | 20 | ||||
No visit in last 12 months | 75 | - | ||||
Younger than 18 | 2 | 1 | ||||
Net sample
| 6733 | 100% | 979 | 100% | ||
Non response with notification | 23 | 9 | ||||
Recently died | 4 | - | ||||
Non response without notification | 4322 | 625 | ||||
Gross response
| 2384 | 35,4% | 100% | 345 | 35,2% | |
Not completed questionnaires (digital) | 281 | 26 | ||||
Less than 50% of compulsory questions | 2 | - | ||||
Paper and digital | 2 | - | ||||
Only therapist questionnaire | 36 | - | ||||
Other | - | 4 | ||||
Net response
| 2063 | 30,6% | 86,4% | 315 | 32,2% |
Net sample | Net response | |
---|---|---|
Experience
| 6733 | 2063 |
% male |
38,9
|
34,8
|
% female |
61,1
|
65,2
|
Age, mean | 49,36 | 54,53 |
(SD) | (17,45) | (15,40) |
% under 45 years |
40,8
|
25,1
|
% 45 years and above |
59,2
|
74,9
|
Item-importance
| 979 | 315 |
% male |
38,1
|
35,9
|
% female |
61,9
|
64,1
|
Age, mean | 49,27 | 54,01 |
(SD) | (17,08) | (14,63) |
% under 45 years |
39,1
|
24,4
|
% 45 years and above |
60,9
|
75,6
|
Item analysis
Don’t know (%) | Not applicable (%) | Total missings (%) | High inter-item correlation [item] | Importance rating >3,0:+ or <2,5:- | Including in factor analyses: + or - | Factor loading (factor) analysis 1 | Item-total correlation | Additional theoretical reason for including or excluding | |
---|---|---|---|---|---|---|---|---|---|
Practice
| |||||||||
22. Ervoer u de inrichting van de wacht- spreek/behandelkamer als positief op uw welzijn? | 10,1 | 12,2 | - | - | Ex:- | ||||
(inside environment of practice building)
| |||||||||
GP’s interactional style
| |||||||||
43. Stelde uw huisarts u op uw gemak? | 2,2 | + | + | 0,746 | 0,711 | In:- | |||
(making comfortable)
| (1) | ||||||||
44. Had uw huisarts voldoende begrip voor uw klacht of aandoening? | 2,1 | + | + | 0,782 | 0,764 | In:- | |||
(showing understanding)
| (1) | ||||||||
45. Gaf uw huisarts u inzicht over de achtergrond en mogelijke oorzaken van uw klacht of aandoening? | 2,5 | [46] | + | + | 0,743 | 0,724 | In:- | ||
(providing insight in background and causes)
| (1) | ||||||||
46. Hielp uw huisarts u omgaan met de ongemakken en beperkingen die de klacht/aandoening met zich meebrengt? | 6,8 | 50,5 | 59,2 | [45,47] | + | 0,718 | 0,766 | Ex: item- reduction, inter-item correlation | |
(helping to cope with constraints)
| (1) | ||||||||
47. Had uw huisarts aandacht voor de eventuele gevolgen van uw klacht/aandoening voor uw sociale leven? | 3,5 | [46] | + | 0,756 | 0,777 | Ex: item- reduction, inter-item correlation | |||
(attention for social consequences)
| (1) | ||||||||
48. Bood uw huisarts u de zorg die u op dat moment nodig had? | 2,3 | + | + | 0,783 | 0,776 | In:- | |||
(providing needed care)
| (1) | ||||||||
49. Had uw huisarts een goede balans tussen betrokkenheid en professionele afstand? | 10,4 | 12,5 | + | + | 0,690 | 0,611 | In:- | ||
(balanced attitude)
| (1) | ||||||||
Treatment/intervention
| |||||||||
68. Bent u door uw huisarts goed geïnformeerd over de antroposofische behandelingsmogelijkheden? | 4,0 | + | 0,421 | 0,548 | In:- | ||||
(anthroposophic treatment options)
| (2) | ||||||||
69. Heeft uw huisarts u vrij gelaten in de keuze voor een reguliere en/of antroposofische behandeling? | 25,5 | 28,9 | [70] | + | + | 0,844 | 0,626 | In: Medical–ethical value | |
(free choice of treatment options)
| (3) | ||||||||
70. Heeft uw huisarts u vrij gelaten in de keuze voor chemische of natuurlijke medicatie? | 21,2 | 24,6 | [69] | + | + | 0,863 | 0,620 | Ex:- | |
(free choice of type of medication)
| (3) | ||||||||
71. Waren u en uw huisarts het eens over hoe uw klacht of aandoening te behandelen? | 9,7 | 12,7 | + | + | 0,611 | 0,631 | Ex: Item reduction, partly covered by existing item 31 | ||
(consensus about treatment)
| (1) | ||||||||
73. Richtte uw huisarts de behandeling (ook) op het ondersteunen van de eigen herstelkrachten van uw lichaam? | 24,6 | 27,8 | + | + | 0,625 | 0,655 | In:- | ||
(focus on physiological self-healing)
| (2) | ||||||||
Anthroposophic view
| |||||||||
74. Kon u door de antroposofische benadering beter begrijpen wat er met u aan de hand was? | 27,6 | 31,2 | [78] | - | Ex:- | ||||
(provinding insight in situation)
| |||||||||
75. Werd u door uw huisarts aangesproken in uw eigen verantwoordelijkheid voor de keuzes die u maakt met betrekking tot uw gezondheid? | 15,7 | 19,4 | + | + | 0,749 | 0,586 | In:- | ||
(patients’ own responsibility)
| (2) | ||||||||
76. Motiveerde de aanvullende benadering u om zelf actief aan uw gezondheidstoestand bij te dragen? | 17,6 | 21,3 | + | + | 0,829 | 0,706 | In:- | ||
(patients’ active contribution)
| (2) | ||||||||
77. Ondersteunde de arts u hierbij op voor u belangrijke momenten? | 5,7 | 39,7 | 48,6 | + | 0,729 | 0,710 | Ex: item reduction, combination with 76 | ||
(support of GP)
| (2) | ||||||||
78. Kon u door de antroposofische benadering uw klacht/aandoening betekenis geven binnen de samenhang van uw leven en functioneren? | 11,2 | 36,8 | 51,2 | [74,79] | - | In: theoretical importance content AH | |||
(giving meaning with daily life)
| |||||||||
79. Ondersteunde de antroposofische benadering u in uw persoonlijke ontwikkeling als mens? | 11,0 | 38,4 | 52,3 | [78] | - | Ex:- | |||
(support on personal growth)
| |||||||||
80. Bood de antroposofische benadering u handvatten (of inspiratie) om uw klachten/aandoening een spirituele betekenis te geven? | 10,5 | 40,5 | 54,1 | - | - | Ex:- | |||
(spiritual meaning)
| |||||||||
Perceived treatment effect
| |||||||||
83. Waren er bijwerkingen van de behandeling? | 21,4 | 25,7 | + | 0,436 | 0,141 | In: theoretical and scientific importance: separate item. | |||
(prevalence of side effects)
| (3) | ||||||||
84.Beïnvloedde de behandeling de kwaliteit van uw leven op een positieve manier? | 24,0 | 28,2 | 8 | + | 0,663 | 0,567 | In:- | ||
(influence on quality of life)
| (1) | ||||||||
Separate items with other answer catagories
| |||||||||
(no factor analyses)
| |||||||||
67. Wat is de belangrijkste klacht of aandoening waarvoor u de afgelopen 12 maanden in behandeling bent geweest? | Ex: item reduction, not compulsory for respondent | ||||||||
(main complaint/illness, open item)
| |||||||||
72. Hoe bent u behandeld? | 16,2 | In: comparison between AH and conventional care | |||||||
(way of treatment)
| |||||||||
81. Heeft de antroposofische benadering u verwachtingen gegeven ten aanzien van het verbeteren van uw gezondheid? | 34,7 | 3,3 | In: scientific importance | ||||||
(expectations of AH treatment)
| |||||||||
82. Binnen welke termijn heeft u positief effect van de behandeling ervaren? | 9,7 | 5,1 | Ex: joined with 67 | ||||||
85. Zo ja, kunt u aangeven waarom? | In: joined with 84 | ||||||||
(If so, please explain why? open item)
|
Items | Importance rating |
---|---|
Practice
| |
22. (inside environment of practice building)
| 2,5 |
GP’s interactional style
| |
43. (making comfortable)
| 3,1 |
44. (showing understanding)
| 3,4 |
45. (providing insight in background and causes)
| 3,4 |
46. (helping to cope with constraints)
| 3,0 |
47. (attention for social consequences)
| 2,8 |
48. (providing needed care)
| 3,4 |
49. (balanced attitude)
| 3,2 |
Treatment/intervention
| |
68. (anthroposophic treatment options)
| 2,9 |
69. (free choice of treatment options)
| 3,1 |
70. (free choice of type of medication)
| 3.1 |
71. (consensus about treatment)
| 3,1 |
73. (focus on physiological self-healing)
| 3.2 |
Anthroposophic view
| |
74. (providing insight in situation)
| 3,0 |
75. (patients’ own responsibility)
| 3,0 |
76. (patients’ active contribution)
| 3,1 |
77. (support of GP)
| 2,9 |
78. (giving meaning within daily life)
| 2,9 |
79. (support on personal growth)
| 2,7 |
80. (spiritual meaning)
| 2,1 |
Perceived treatment effect
| |
83. (prevalence of side effects)
| 2,7 |
84. (influence on quality of life)
| 3,1 |
Separate items with other answer catagories:
no importance analysis
|
-
|
Factor analyses
Scale construction
Scale | Items | Mean scale score | Conbach’s alpha |
---|---|---|---|
InteractionalStyleGP
| 43. Making comfortable | 3.6 | 0.810 |
44. Showing understanding | |||
45. Providing insight in background and causes | |||
48. Providing needed care | |||
49. Balanced attitude | |||
AnthroposophicTreatment
| 68. AH treatment options | 3.1 | 0.832 |
69. Free choice of treatment options | |||
73. Focus on physiological self-healing | |||
75. Patients’ own responsibility | |||
76. Patients’ active contribution | |||
78. Giving meaning within daily life | |||
84. Influence on quality of life |
Psychometric quality
Interactional style GP | Anthroposophic treatment | |
---|---|---|
Existing scales GP | ||
Accessibility
| .32* | .24* |
Reception
| .38* | .26* |
SocialHandlingGP
| .70* | .36* |
CommunicationGP
| .75* | .41* |
TailoredCareGP
| .76* | .56* |
InteractionalStyleGP
| 1 | .50* |