Quality of psychiatric care: validation of an instrument for measuring inpatient opinion

Objectives. To validate a brief self-completed questionnaire for routinely assessing patients' opinions on the quality of care in inpatient psychiatric wards (Rome Opinion Questionnaire for Psychiatric Wards). Design. A preliminary version was assessed for face and content validity by eight psychiatrists and two patient focus groups. The final version was evaluated for acceptability, factor structure, internal consistency, and test-retest reliability. Setting. An inpatient psychiatric ward in a general hospital in Rome. Study participants. The questionnaire was administered to all consecutive inpatients admitted over a 6-month period (n = 169). Test-retest reliability was evaluated by administering the questionnaire for a second time to 27 inpatients. Main outcome measures. Face and content validity: psychiatrists and focus groups' opinions on relevance, importance, and clarity; acceptability: inpatients' opinions on user-friendliness; factor analysis: principal component analysis; internal consistency: Cronbach's alpha; test-retest reliability: Cohen's weighted kappa coefficient, intraclass correlation coefficient. Results. After evaluating face and content validity, the questionnaire was reduced to 10 items. Inpatients found the questionnaire to be acceptable. Factor analysis revealed that three factors-professional qualities of staff, information received, and physical environment-explained 67.2% of total variance. Cronbach's alpha was 0.82 for the questionnaire and 0.61, 0.71, and 0.35 for the three factors, respectively. Test-retest reliability was good; weighted kappa higher than 0.9 for three items and 0.6-0.9 for seven items. The intraclass correlation coefficient was 0.80. Conclusions. The questionnaire seems to be adequate for evaluating patients' opinions on care in inpatient psychiatric wards. Because of its user-friendliness, it may be particularly suitable for routine use.