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

Authors Kelly L, Sizmur S, Käsbauer S, King J, Cooper R, Jenkinson C, Graham C

Received 16 November 2017

Accepted for publication 28 March 2018

Published 19 June 2018 Volume 2018:9 Pages 173—181

DOI https://doi.org/10.2147/PROM.S157213

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Andrew Yee

Peer reviewer comments 3

Editor who approved publication: Dr Robert Howland


Laura Kelly,1 Steve Sizmur,2 Susanne Käsbauer,2 Jenny King,2 Robyn Cooper,2 Crispin Jenkinson,1 Chris Graham2

1Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; 2Research Division, Picker Institute Europe, Oxford, UK

Purpose: The 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 methods: Participants (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.”
Results: Two 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, r=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).
Conclusion: The 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.

Keywords: real-time feedback, patient experience, surveys, hospital care, emergency care

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