The validity and reliability of self-reported satisfaction with healthcare as a measure of quality: A systematic literature review

Purpose: The aim of this paper is to systematize the evidence on the validity and reliability of subjective measurements of satisfaction with healthcare.

Data sources: In this qualitative systematic literature review, we searched for relevant publications in PubMed and JSTOR databases.

Study selection: The key inclusion criteria included (i) original research articles in peer-reviewed journals, (ii) year of publication from 2008 onward and (iii) English language publications.

Data extraction: We applied directed qualitative content analysis to the publications included in the review.

Results of data synthesis: Overall, 1167 publications are found and screened. Of these, 39 publications that focus on the psychometric properties of the measurement of patient satisfaction are included. The majority of the studies validate the already existing instruments adapted to different contexts; the rest describe psychometric properties of self-developed tools. Psychometric properties are assessed by means of reliability and validity assessment. Reliability assessment is performed via Cronbach alpha and test-retest reliability. Overall, 94.9% of studies find that the satisfaction measures are reliable. Validation is performed by a variety of different methods, among which the most applicable are face validity and factor analysis. Overall, 71.8% of studies find that the satisfaction measures are valid.

Conclusion: Because of the complexity of the studies, we cannot make strong recommendations on the application of self-reported satisfaction measures. We recommend the following key strategies: (i) developing of a unified standard toward satisfaction measurement and (ii) identifying a combination of tools to routinely measure satisfaction. We also suggest to further research the issue of subjectivity reduction.