Person-centredness in long-term care services for older adults: A systematic review of survey measures and measurement properties
Mark Wilberforce | University of Manchester
Background: ‘Person-centredness’ is internationally regarded as a central component of modern health and social care services. Despite attaining such prominent status, it is notoriously difficult to conceptualise and measure. Without good measurement, the scientific value of person-centredness is compromised, and providers are unable to evaluate the performance of their services with any confidence. No systematic review has so far been undertaken, and the few narrative reviews suffer from inadequate critical appraisal of methods.
Objectives: To identify, describe and critically appraise survey-based instruments that purport to measure person-centredness in the long-term care of older adults.
Methods: A systematic review of survey-based measures was undertaken. In addition to extracting details of measurement properties, the review critically appraised the methodological quality of the studies underpinning them. The COSMIN toolkit (COnsensus-based Standards for the selection of health Measurement Instruments) was used to synthesise the results.
Results: Eleven measures tested in 22 references were included. Six measures were designed for use in long-stay residential facilities, and four were for ambulatory clinic-based care. Only one measure was designed chiefly for evaluating home care services. The measures rarely incorporated service user or carer perspectives in devising the questionnaire items.
Overall, measures were tested only in relation to a narrow range of psychometric properties, and the rigour of these estimates were consistently undermined by poor methodological quality. Testing of hypotheses to support construct validity was of particularly low standard, whilst measurement error was rarely assessed. Furthermore, measures were too-often translated into new languages before rigorous properties had been established in the original tongue. Two measures were identified as having been the subject of the most rigorous testing.
Implications: Policy-makers are increasingly concerned that providers should attend to care experiences, as a crucial component of overall quality. Person-centredness is a helpful concept that places experiential features of care at the front-and-centre of service design. To evaluate care quality in this regard requires robust measures, but those reviewed in this study cannot be unequivocally recommended. Future research should pay greater attention to methodological rigour. The lack of service user and carer involvement in instrument design is poor practice (and ironically incompatible with person-centredness). Researchers may, in future, prefer to test a narrower-range of measurement properties in any single study, but do so to a higher standard.