Greek Home Care Satisfaction Questionnaire

Authors

Purpose

The primary objective of this instrument is to provide a validated, context-specific metric for evaluating user satisfaction with municipal Home care services in Greece. Prior to its development, the effectiveness of these widespread, state-funded programs had never been formally assessed using a standardized tool. Existing international questionnaires were deemed inadequate because they were calibrated for different healthcare architectures—such as systems requiring out-of-pocket payments, insurance contributions, or differing configurations of healthcare personnel.

For researchers and clinical administrators, this scale fills a critical gap by offering a localized evaluation mechanism that aligns with the specific operational realities of Greek social care. By capturing the nuances of a free-at-point-of-use, multi-disciplinary care model, the tool allows policymakers to audit service quality, identify areas for operational improvement, and ensure that the vulnerable elderly and disabled populations are receiving care that genuinely enhances their quality of life.

Construct

The psychological construct of 'Home care satisfaction' is conceptualized here as a multidimensional evaluation of service encounters. Theoretically, it posits that a patient's overall satisfaction is a composite, weighted appraisal of various specific service attributes and interactions. The construct encompasses several critical domains of the caregiving experience, including the perceived effectiveness and safety of the care, the respect and attention demonstrated by staff, the patient's active participation in care planning, logistical access, socialization benefits, and the technical competence of the care team.

By breaking down the overarching concept of satisfaction into these granular, actionable dimensions, the construct aligns with modern service quality theories. It acknowledges that satisfaction is not merely a reflection of clinical outcomes, but is deeply intertwined with the interpersonal, organizational, and emotional facets of the caregiving relationship. This comprehensive framework ensures that both the tangible (e.g., technical nursing skills) and intangible (e.g., emotional support and companionship) elements of Home care are systematically measured.

Validity

The validation process for this instrument was rigorous, beginning with a strong emphasis on content validity. The researchers utilized a multi-stage qualitative approach, conducting cognitive interviews with 15 program enrollees and 15 staff members to ensure the items were culturally resonant, unambiguous, and comprehensively covered the satisfaction construct. A subsequent pretesting phase with an additional 20 elderly and disabled individuals further refined the item pool, eliminating irrelevant questions and clarifying phrasing, which is a gold-standard practice in questionnaire design.

Construct validity was evaluated through Exploratory factor analysis. Crucially, the researchers employed polychoric correlation matrices rather than standard Pearson matrices. Because the 5-point Likert scale generates ordinal data, Pearson correlations can underestimate the strength of relationships and distort factor structures. By assuming that the ordinal responses reflect an underlying continuous, normally distributed latent variable, the polychoric approach provides a much more accurate and statistically sound representation of the scale's true dimensionality.

Reliability

To establish internal consistency, the researchers evaluated the scale using both traditional and advanced psychometric techniques. Recognizing the limitations of standard reliability metrics when applied to skewed, ordinal response formats, they calculated an ordinal standardized item alpha coefficient alongside the conventional Cronbach's alpha.

This dual approach is highly instructive for psychometric evaluation. While standard Cronbach's alpha is ubiquitous, it often underestimates true reliability when data violate the assumption of continuous, interval-level measurement. By inserting Polychoric correlations into the alpha formula, the researchers derived an ordinal alpha that more accurately reflects the internal consistency of the items, ensuring that the subscales reliably capture their intended specific domains of Patient satisfaction without being artificially deflated by the ordinal nature of the Likert scale.

Factor Analysis

The factor structure was investigated using an Exploratory factor analysis (EFA) on a sample of 319 enrollees. To determine the suitability of the data for structure detection, the researchers utilized the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and Bartlett's test of sphericity. The extraction was performed using the unweighted least squares method, which was deliberately chosen for its robustness with smaller sample sizes and its ability to handle non-positive definite correlation matrices—a common hurdle when estimating polychoric matrices pairwise.

Following extraction, a varimax rotation was applied to achieve a simple, interpretable factor structure. Items were retained on a factor if they demonstrated a primary loading of greater than 0.50, with cross-loadings differing by at least 0.20. This strict loading criterion ensures that each item is a strong, unambiguous indicator of its respective latent factor, minimizing conceptual overlap and resulting in distinct, theoretically meaningful subscales.

Instrument

Scoring & Interpretation Guidelines

Greek Home Care Satisfaction Questionnaire Items

Sample

The validation sample consisted of 319 elderly and disabled individuals (aged 65 to 90 years) enrolled in five randomly selected municipal Home care programs in Thessaloniki, Greece. Participants were required to have been in the program for a minimum of two months and were screened to exclude those with severe cognitive impairments (e.g., advanced Alzheimer's disease or severe stroke) that would preclude reliable self-reporting.