Introduction
Methods
Study design and participants
The questionnaire
Measures
SDM-Q-9
Translation of the questionnaire
Content coding of decisions
CPSpost
Statistical analyses
Results
Sample characteristics
Variables |
n
| % | Proportional difference (%) | |
---|---|---|---|---|
Gender | ||||
Female | 290 | 54 | 53.1 | 0.9 |
Male | 247 | 46 | 46.9 | − 0.9 |
Age (years) | ||||
18–24 | 50 | 9.3 | 10.0 | − 0.7 |
25–34 | 89 | 16.6 | 15.2 | 1.4 |
35–44 | 92 | 17.1 | 19.5 | − 2.4 |
45–54 | 64 | 11.9 | 16.0 | − 4.1 |
55–64 | 89 | 16.6 | 16.8 | − 0.2 |
65–74 | 126 | 23.5 | 13.0 | 10.5 |
75 + | 27 | 5 | 9.5 | − 4.5 |
Highest level of education | ||||
Primary school | 83 | 15.5 | 23.8 | − 8.3 |
Secondary school | 281 | 52.3 | 55.0 | − 2.7 |
College/university | 173 | 32.2 | 21.2 | 11.0 |
Place of residence | ||||
Capital | 110 | 20.5 | 17.9 | 2.6 |
Other town | 305 | 56.8 | 52.6 | 4.2 |
Village | 122 | 22.7 | 29.5 | − 6.8 |
Regiona | ||||
Northern Hungary | 69 | 12.8 | 11.7 | 1.1 |
Northern Great Plain | 68 | 12.7 | 14.9 | − 2.2 |
Southern Great Plain | 62 | 11.5 | 13.0 | − 1.5 |
Central Hungary | 183 | 34.1 | 30.4 | 3.7 |
Central Transdanubia | 58 | 10.8 | 10.8 | 0.0 |
Western Transdanubia | 39 | 7.3 | 10.1 | − 2.8 |
Southern Transdanubia | 58 | 10.8 | 9.2 | 1.6 |
Minimum European Health Module | ||||
Self-perceived health | ||||
Very good | 35 | 6.5 | 19 | − 12.5 |
Good | 229 | 42.6 | 42 | 0.6 |
Fair | 213 | 39.7 | 28 | 11.7 |
Bad | 56 | 10.4 | 8 | 2.4 |
Very bad | 4 | 0.7 | 3 | − 2.3 |
Chronic morbiditya,b | ||||
Yes | 335 | 62.4 | 45 | 17.4 |
No | 140 | 26.1 | 55 | − 28.9 |
Activity limitations (GALI)a,c | ||||
Not limited at all | 240 | 44.7 | 70.8 | − 26.1 |
Limited but not severely | 220 | 41.0 | 20.0 | 21.0 |
Severely limited | 48 | 8.9 | 9.2 | − 0.3 |
Content coding of the two open-ended questions of SDM-Q-9
SDM-Q-9 question | n (%) |
---|---|
Reason for the visit (complaint/problem/illness)a | |
Musculoskeletal | 97 (18.1%) |
Cardiovascular | 80 (14.9%) |
Infection | 63 (11.7%) |
Gastrointestinal | 48 (8.9%) |
Metabolic (incl. diabetes) | 41 (7.6%) |
Neurological | 35 (6.5%) |
Urinary (incl. kidney diseases) | 20 (3.7%) |
Dermatological | 18 (3.4%) |
Gynaecological | 18 (3.4%) |
Pulmonary | 17 (3.2%) |
Endocrinological | 17 (3.2%) |
Ophtalmological | 16 (3.0%) |
Oncological | 14 (2.6%) |
Psychiatric | 14 (2.6%) |
Reproductive | 13 (2.4%) |
Traumatological | 13 (2.4%) |
Prevention | 10 (1.9%) |
Allergological/immunological | 6 (1.1%) |
Otolaryngological | 6 (1.1%) |
Occupational | 3 (0.6%) |
Unspecifiedb | 37 (6.9%) |
Type of decision madec | |
Treatment | 424 (79.0%) |
Diagnosis or screening test | 77 (14.3%) |
Referral | 45 (8.4%) |
Lifestyle | 43 (8.0%) |
Monitoring/follow-up | 13 (2.4%) |
Descriptive statistics of the nine items of SDM-Q-9
Items | Ceiling effect (n, %) | Floor effect (n, %) | Difficultyb (mean, SD) | Discrimination (corrected item-total correlation) | Internal consistency (Cronbach’s α if the item deleted |
---|---|---|---|---|---|
Total sample (n = 537)a | |||||
Item 1 | 189 (35.2%) | 81 (15.1%) | 3.25 (1.78) | 0.470 | 0.933 |
Item 2 | 140 (26.1%) | 84 (15.6%) | 2.97 (1.73) | 0.715 | 0.917 |
Item 3 | 186 (34.6%) | 65 (12.1%) | 3.36 (1.68) | 0.740 | 0.915 |
Item 4 | 210 (39.1%) | 59 (11.0%) | 3.44 (1.68) | 0.820 | 0.910 |
Item 5 | 243 (45.3%) | 38 (7.1%) | 3.69 (1.55) | 0.751 | 0.915 |
Item 6 | 159 (29.6%) | 88 (16.4%) | 2.99 (1.79) | 0.794 | 0.912 |
Item 7 | 159 (29.6%) | 83 (15.5%) | 3.03 (1.78) | 0.847 | 0.908 |
Item 8 | 167 (31.1%) | 81 (15.1%) | 3.11 (1.77) | 0.783 | 0.913 |
Item 9 | 252 (46.9%) | 32 (6.0%) | 3.82 (1.46) | 0.656 | 0.921 |
Scale | 66 (12.3%) | 12 (2.2%) | 3.29 (1.34) | – | 0.925 |
Primary care sample (n = 211) | |||||
Item 1 | 62 (29.4%) | 35 (16.6%) | 3.10 (1.78) | 0.432 | 0.938 |
Item 2 | 51 (24.2%) | 34 (16.1%) | 2.88 (1.72) | 0.684 | 0.922 |
Item 3 | 61 (28.9%) | 29 (13.7%) | 3.24 (1.68) | 0.774 | 0.917 |
Item 4 | 69 (32.7%) | 31 (14.7%) | 3.22 (1.75) | 0.845 | 0.912 |
Item 5 | 85 (40.3%) | 18 (8.5%) | 3.55 (1.60) | 0.773 | 0.917 |
Item 6 | 60 (28.4%) | 36 (17.1%) | 2.93 (1.79) | 0.796 | 0.915 |
Item 7 | 55 (26.1%) | 36 (17.1%) | 2.93 (1.80) | 0.850 | 0.911 |
Item 8 | 61 (28.9%) | 31 (14.7%) | 3.07 (1.76) | 0.783 | 0.916 |
Item 9 | 84 (39.8%) | 15 (7.1%) | 3.61 (1.51) | 0.706 | 0.921 |
Scale | 20 (9.5%) | 8 (3.8%) | 3.17 (1.36) | – | 0.927 |
Specialised care sample (n = 320) | |||||
Item 1 | 127 (39.7%) | 43 (13.4%) | 3.38 (1.76) | 0.482 | 0.929 |
Item 2 | 88 (27.5%) | 47 (14.7%) | 3.05 (1.72) | 0.732 | 0.912 |
Item 3 | 124 (38.8%) | 35 (10.9%) | 3.44 (1.68) | 0.717 | 0.913 |
Item 4 | 141 (44.1%) | 27 (8.4%) | 3.60 (1.62) | 0.799 | 0.908 |
Item 5 | 157 (49.1%) | 19 (5.9%) | 3.81 (1.50) | 0.728 | 0.913 |
Item 6 | 99 (30.9%) | 50 (15.6%) | 3.05 (1.79) | 0.790 | 0.908 |
Item 7 | 103 (32.2%) | 46 (14.4%) | 3.10 (1.78) | 0.847 | 0.904 |
Item 8 | 106 (33.1%) | 48 (15.0%) | 3.16 (1.77) | 0.785 | 0.908 |
Item 9 | 165 (51.6%) | 16 (5.0%) | 3.97 (1.39) | 0.621 | 0.919 |
Scale | 46 (14.4%) | 3 (0.9%) | 3.39 (1.31) | – | 0.922 |
Primary vs. specialised | Fisher’s exact test p = 0.1072 | Fisher’s exact test p = 0.0303 | Student’s t test = − 1.91 (df = 529), p = 0.0564 | – | Feldt’s test χ2 = 0.22 (df = 1), p = 0.6382 |
Item difficulty, discrimination and internal consistency
Construct validity
Exploratory factor analysis (EFA)
Items | Total sample (n = 537)a | Primary care (n = 211) | Specialised care (n = 320) | |||
---|---|---|---|---|---|---|
Factor loadings | Communalities (h2) | Factor loadings | Communalities (h2) | Factor loadings | Communalities (h2) | |
Item 1 | 0.540 | 0.292 | 0.497 | 0.247 | 0.554 | 0.307 |
Item 2 | 0.766 | 0.588 | 0.739 | 0.546 | 0.782 | 0.611 |
Item 3 | 0.802 | 0.643 | 0.827 | 0.683 | 0.784 | 0.615 |
Item 4 | 0.872 | 0.760 | 0.891 | 0.793 | 0.855 | 0.732 |
Item 5 | 0.813 | 0.661 | 0.826 | 0.683 | 0.797 | 0.635 |
Item 6 | 0.851 | 0.725 | 0.854 | 0.730 | 0.849 | 0.721 |
Item 7 | 0.895 | 0.801 | 0.901 | 0.812 | 0.893 | 0.797 |
Item 8 | 0.845 | 0.714 | 0.848 | 0.719 | 0.846 | 0.716 |
Item 9 | 0.730 | 0.533 | 0.775 | 0.600 | 0.698 | 0.487 |
KMO | 0.910 | 0.907 | 0.898 | |||
Bartlett’s test | χ2 = 3560.87 (df = 36), p < 0.0001 | χ2 = 1476.26 (df = 36), p < 0.0001 | χ2 = 2067.34 (df = 36), p < 0.0001 |
Confirmatory factor analysis
No. | Model | Estimator |
df
|
χ
2
| CFI | RMSEA | SRMR |
---|---|---|---|---|---|---|---|
Total sample (n = 537) | |||||||
1 | One-factor model including all items | ML | 27 | 387.39* | 0.899 | 0.158 |
0.052
|
SB | 204.53* |
0.916
| 0.111 | N/A | |||
2 | One-factor model excluding item 1 | ML | 20 | 260.28* |
0.928
| 0.150 |
0.039
|
SB | 129.89* |
0.943
| 0.101 | N/A | |||
3 | One-factor model excluding item 9 | ML | 20 | 324.06* |
0.905
| 0.168 |
0.053
|
SB | 168.87* |
0.923
| 0.118 | N/A | |||
4 | One-factor model excluding items 1 and 9 | ML | 14 | 195.81* |
0.939
| 0.156 |
0.035
|
SB | 94.79* |
0.954
| 0.104 | N/A | |||
Primary care (n = 211) | |||||||
1 | One-factor model including all items | ML | 27 | 168.44* |
0.904
| 0.158 |
0.054
|
SB | 82.67* |
0.932
| 0.099 | N/A | |||
2 | One-factor model excluding item 1 | ML | 20 | 119.11* |
0.929
| 0.153 |
0.038
|
SB | 56.07* |
0.953
| 0.092 | N/A | |||
3 | One-factor model excluding item 9 | ML | 20 | 147.03* |
0.903
| 0.174 |
0.058
|
SB | 75.06* |
0.929
| 0.114 | N/A | |||
4 | One-factor model excluding items 1 and 9 | ML | 14 | 97.29* |
0.932
| 0.168 |
0.038
|
SB | 47.64* |
0.954
| 0.107 | N/A | |||
Specialised care (n = 320) | |||||||
1 | One-factor model including all items | ML | 27 | 266.40* | 0.884 | 0.166 |
0.056
|
SB | 152.49* |
0.904
| 0.121 | N/A | |||
2 | One-factor model excluding item 1 | ML | 20 | 181.28* |
0.916
| 0.159 |
0.046
|
SB | 96.08* |
0.934
| 0.109 | N/A | |||
3 | One-factor model excluding item 9 | ML | 20 | 208.03* | 0.899 | 0.171 |
0.055
|
SB | 113.01* |
0.920
| 0.121 | N/A | |||
4 | One-factor model excluding items 1 and 9 | ML | 14 | 123.74* |
0.936
| 0.157 |
0.039
|
SB | 60.24* |
0.955
| 0.102 | N/A |