SEQUenCE: a service user-centred quality of care instrument for mental health services

Int J Qual Health Care. 2015 Aug;27(4):284-90. doi: 10.1093/intqhc/mzv043. Epub 2015 Jun 16.

Abstract

Objective: To develop a quality of care instrument that is grounded in the service user perspective and validate it in a mental health service.

Design: The instrument (SEQUenCE (SErvice user QUality of CarE)) was developed through analysis of focus group data and clinical practice guidelines, and refined through field-testing and psychometric analyses.

Setting: All participants were attending an independent mental health service in Ireland.

Participants: Participants had a diagnosis of bipolar affective disorder (BPAD) or a psychotic disorder.

Interventions: Twenty-nine service users participated in six focus group interviews. Seventy-one service users participated in field-testing: 10 judged the face validity of an initial 61-item instrument; 28 completed a revised 52-item instrument from which 12 items were removed following test-retest and convergent validity analyses; 33 completed the resulting 40-item instrument.

Main outcome measures: Test-retest reliability, internal consistency and convergent validity of the instrument.

Results: The final instrument showed acceptable test-retest reliability at 5-7 days (r = 0.65; P < 0.001), good convergent validity with the Verona Service Satisfaction Scale (r = 0.84, P < 0.001) and good internal consistency (Cronbach's alpha = 0.87).

Conclusions: SEQUenCE is a valid, reliable scale that is grounded in the service user perspective and suitable for routine use. It may serve as a useful tool in individual care planning, service evaluation and research. The instrument was developed and validated with service users with a diagnosis of either BPAD or a psychotic disorder; it does not yet have established external validity for other diagnostic groups.

Keywords: health services research; healthcare quality improvement; mental health; patient satisfaction; patient-centred care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Bipolar Disorder / therapy
  • Female
  • Focus Groups
  • Humans
  • Ireland
  • Male
  • Mental Health Services / standards*
  • Middle Aged
  • Patient Satisfaction*
  • Psychotic Disorders / therapy
  • Quality of Health Care / standards*
  • Reproducibility of Results
  • Surveys and Questionnaires
  • Young Adult