The Relational Aspects of Care Questionnaire: item reduction and scoring using inpatient and accident and emergency data in England

Abstract

PurposeThe Relational Aspects of Care Questionnaire (RAC-Q) is an electronic instrument which has been developed to assess staff’s interactions with patients when delivering relational care to inpatients and those accessing accident and emergency (A&E) services. The aim of this study was to reduce the number of questionnaire items and explore scoring methods for “not applicable” response options.Patients and methodsParticipants (n=3928) were inpatients or A&E attendees across six participating hospital trusts in England during 2015–2016. The instrument, consisting of 20 questionnaire items, was administered by trained hospital volunteers over a period of 10 months. Items were subjected to exploratory factor analysis to confirm unidimensionality, and the number of items was reduced using a range of a priori psychometric criteria. Two alternative approaches to scoring were undertaken, one treated “not applicable” responses as missing data, while the second adopted a problem score approach where “not applicable” was considered “no problem with care.”ResultsTwo short-form RAC-Qs with alternative scoring options were identified. The first (the RAC-Q-12) contained 12 items, while the second scoring option (the RAC-Q-14) contained 14 items. Scores from both short forms correlated highly with the full 20-item parent form score (RAC-Q-12, r=0.93 and RAC-Q-14, f=0.92), displayed high internal consistency (Cronbach’s α: RAC-Q-12=0.92 and RAC-Q-14=0.89) and had high levels of agreement (intraclass correlation coefficient [ICC]=0.97 for both scales).ConclusionThe RAC-Q is designed to offer near-real-time feedback on staff’s interactions with patients when delivering relational care. The new short-form RAC-Qs and their respective method of scoring are reflective of scores derived using the full 20-item parent form. The new short-form RAC-Qs may be incorporated into inpatient surveys to enable the comparison of ward or hospital performance. Using either the RAC-Q-12 or the RAC-Q-14 offers a method to reduce missing data and response fatigue.

COVID-NURSE: evaluation of a fundamental nursing care protocol compared with care as usual on experience of care for noninvasively ventilated patients in hospital with the SARS-CoV-2 virus—protocol for a cluster randomised controlled trial

“…Using published formulae by Hayes and Moulton, 16 we calculated our patient participant sample size based on an estimate of the minimum clinically important difference for the QPP of 0.2 and the typical within-unit standard deviation (0.6), supplied by the measure developers and an intraclass correlation coefficient (ICC) of 0.02. We have examined a number of potential scenarios, taking into account different cluster sizes and different between-cluster SD values informed by between-country differences on measures, estimated to provide 90% and 80% power.…”

Validation and Translation of the Relational Aspect of Care Questionnaire into the Malay Language (RAC-QM) to Evaluate the Compassionate Care Level of Healthcare Workers from the Patient’s Perspective

“…MOH received over five thousand official complaints each year, and at least a quarter of the complaints were related to poor service quality [ 8 ]. However, contrary to the common belief that the lack of compassionate care is due to healthcare worker’s (HCW) weakness and ignorance, evidence showed that patients’ characteristics and the care environment considerably affect patients’ perspectives on the compassionate care provided [ 9 , 10 , 11 , 12 ]. As long as these factors are not recognized, the quality of our image of healthcare will be jeopardized.…”

“…It measures the relational aspect of care across 22 themes [ 11 ]. The completion of the survey requires a mean time of 8.5 min, with a standard deviation of 9.9 min [ 12 ]. The original RAC-Q was administered digitally, and the responses were captured in near real time.…”

Sequential screening for depression in humanitarian emergencies: a validation study of the Patient Health Questionnaire among Syrian refugees

“…As the first step in screening, instruments capturing self-reported symptoms reduce the cost and time requirements of formal clinical diagnostic interviews [15]. The desirability of shorter screening procedures is threefold-first, brief screening instruments reduce the participant response burden; second, shorter instruments may be more readily used in resource-constrained settings because of administration and cost efficiencies; and third, shorter instruments may result in fewer missing responses and thus reductions in the risk of invalidation due to missingness [16]. Overall, ideal screening instruments in humanitarian crises are (1) self-reported or administered by trained non-medical health workers [2], and (2) responsiveness to change [17], with (3) demonstrated acceptable response rate, reliability, and validity in displaced populations [14], (4) and a minimal response burden [16].…”