| Abstract |
Background: Social capital is a term used to reflect the belief that social context and social relations have important consequences on people’s everyday life. It has many different conceptualizations but most authors agree that it refers to civic participation, density of social networks, information channels, shared values, trust, mutual support, and reciprocity among people. Its central idea is that social interactions and engagement in community activities are investments that promote individual and collective well‐being. Social capital is important because it brings a new emphasis in understanding health outcomes and incorporates contextual perspectives in medical diagnos
es and assessments. Patient satisfaction has emerged as a powerful determinant and outcome of health care quality: satisfied patients have better compliance with their therapy, cooperation with the health staff, health outcomes and quality of life. Financial reasons intervene as well: in a competitive environment, satisfied patients tend both to re‐use the same hospital/services and to recommend it to others. Patient satisfaction is influenced by major sociodemographic characteristics (sex, age, education, e.t.c.) but it as not been associated with social capital yet.
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Aim: The main aim of the thesis is to examine the effect social capital may have on patient satisfaction ratings in oncology settings. Secondary objectives are to validate the Social Capital Questionnaire (SCQ) and the Comprehensive Assessment of Satisfaction ith Care (CASC) in Greece.
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Description of the questionnaires: SCQ was developed in Australia by Onyx & Bullen (2000). It has 36 questions in eight factors to measure different social capital dimensions, including: Participation in the Local Community, Social Agency or Proactivity in a Social Context, Feelings of Trust & Safety, Neighborhood Connections, Family & Friends Connections, Tolerance to Diversity, Value of Life, and Work Connections. Higher scores on a 4‐point Likert‐type scale indicate more social capital.
υπηρεσιών υγείας από τις υπηρεσίες υγείας
CASC was developed by Brédart et al. (1998, 1999). It comprises 60 questions that evaluate both inpatient and outpatient dimensions of cancer care i.e. medical, nursing, and administrative. The rating of the responses is in a 5‐point Likert scale. 1 represents the worst experience of care while a rating of 5 reveals excellent satisfaction.
Translation Process: For both scales, we followed the translation guidelines of the European Social Survey. The translation process was divided into four phases. First, three translators made independent parallel translations of the English version of the questionnaires. In the second stage, the translators and one reviewer agreed on a final version. Third, although it is not part of the ESS guidelines, a back‐translation from Greek to English by an independent translator was also performed. In the fourth phase, using all the information from the first three phases and after thorough discussions with translators and reviewers, the doctoral student, acting as adjudicator, approved the final version of the two scales.
Psychometric and cognitive validation of the Social Capital Questionnaire: The validation of SCQ was conducted in two phases: First, cognitive validation interviews with 25 adults in Athens were performed by concurrent interviewing. They explored people’s understandings in complex and multi‐dimensional terms relevant to social capital such as multiculturalism, trust, community, active participation e.t.c. They also revealed issues of multiple questions within one for Greek people’s attitudes towards the immrs
igant. At the second stage, the psychometric properties of the Greek version of the Social Capital Questionnaire (SCQ‐G) were evaluated in a sample of 521 adults drawn from th
ree different urban areas in Greece (Athens, Korinthos, Iraklio‐Crete). Exploratory factor analysis followed by multi‐trait scaling yielded six factors: Participation in the Local Community, Feelings of Safety, Family/Friends Connections, Value of Life and Social Agency, Tolerance of Diversity, and Work Connections. Variations in the factor solution suggest that social capital does not share the same structure in different countries. Cronbach’s alpha for the entire SCQ‐G was .83 and between .68 and .77 for the factors. The Family and Friends Connections factor did not perform well, with a Cronbach’s alpha of .33.
Πανεπιστήμιο Κρήτης Τμήμα Ιατρικής Τομέας Κοινωνικής Ιατρικής xii
ΜελέτηTwo limitations of the study must be recognized: The sample consisted only of people from urban settings and criterion validity, how two different scales that measure the same concept relate to each other, was not tested.
Sample of oncology patients: 84 cancer inpatients in a department of Medical oncology in Athens for a period of ten weeks met the inclusion criteria: they are 18–79 years old, they are communicative and mentally healthy (with no extensive brain metastases and no previous psychiatric history), able to understand and speak Greek, stay at least two nights in the hospital. Of them, 32 (38%) refused to participate leading to a 62% response rate. Interview‐based administration was chosen in order to yield more reliable results in terms of time of assessment, response rate and data omission. Ethical approval was granted by the hospital’s ethical committee.
Validation of CASC: Multitrait scaling analyses along with construct, item and scale discriminant validity and reliability tests were carried out to establish the Greek version of the C
ASC. Scales on Doctors’ technical skills, Care organisation and General Satisfaction came to support the European structure. Doctors’ scales, in general, had the anticipated structures. Most of the variations were noticed in the Nurses’ scales leading to a revised item‐scale formation and may reflect dissimilar importance patients attribute to various aspects of nursing care in different countries. Chronbach’s alpha was .97 for the entire cale and over .85 for all subscales in the Greek sample.
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Social capital and patient satisfaction: In order to explore whether patient satisfaction is influenced by individual‐level social capital, we performed correlational analyses, as well as simple and multiple linear regressions (including sex, age and educati
on) among social capital factors and 13 dimensions of oncology care. In multivariate analyses most of the dimensions of cancer care were related to and affected by total Social Capital score and the factor Value of Life and Social Agency with th
e exception of Doctors Availability. Feelings of Safety and Tolerance to Diversity both affect some dimensions of patient satisfaction in oncology settings. Community participation does not affect any dimension of cancer care in current analyses.
Although it is the first time that such a relational analysis is performed, our results agree with current literature in that social capital factors do not equally affect health outcomes. The main research question of the thesis is confirmed. Social capital and other cognitive sociological factors may affect patient satisfaction in oncology care. When social capital score rises, patient satisfaction is increasing. Social capital creates the necessary social conditions, in terms of trust, reciprocity and cohesion, to satisfy atient
ps’ expectations with their care. A limitation is that the study design was cross‐sectional and it does not permit final conclusions. Nevertheless, the direction of causality investigated here is certainly he most plausible.
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Conclusions: Our findings support the view that SCQ is a practical, valid and reliable tool to measure individual‐level social capital in Greece. They highlight the need to develop culturally and concept‐specific measures of the term using techniques from both cognitive and psychometric paradigms. Social capital measurement tools should be validate
d in each cultural or national setting in which they are applied. Greek version of CASC can be used to assess patient satisfaction in oncology settings. Cross‐cultural validation of the existing tools is necessary to enable comparison between different countries and settings. Interview‐based administration should be
considered when validating patient satisfaction instruments. The present study was conducted to investigate the extent to which cancer care is associated with and thus dependent on social preconditions derived from the social capital. Our results suggest that social capital and other cognitive sociological factors may affect, to some extent, patient satisfaction with cancer care.
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Μελέτη συσχέτισης του κοινωνικού κεφαλαίου με την ικανοποίηση των χρηστών
