Developing and testing scales for home support service continuity (HSSC): cross-sectional studies in Canada and UK

Ensuring the continuity of home support services has become increasingly important due to challenges arising from ageing demographics and healthcare staffing shortages. However, there is a lack of validated measurements specifically designed for assessing service continuity in this context. The primary objective of this study is to develop and validate scales that capture the multidimensional nature of home support service continuity (HSSC), incorporating informational continuity, management continuity and relational continuity as its underlying components. Subsequently, these scales are employed to measure the overall level of continuity experienced within home support services and investigate its association with service quality.

This study used a cross-sectional survey design with convenience sampling. Direct caregivers in the UK were recruited through the Prolific UK online platform, while direct caregivers in British Columbia, Canada were recruited through local health authorities and home support agencies. A total of 550 direct caregivers completed the online survey following the approved ethics protocol. Structural equation modelling was employed to evaluate HSSC and it underlying components. Furthermore, the study investigated the influence of HSSC on service quality within these two samples.

The quantitative tests confirmed that HSSC comprises three first-order continuity components. These components showed significant loadings on HSSC in the Canadian sample (N=367) (λ_{informational}=0.81, λ_management=0.93, λ_relational=0.38) at p<0.01 level. This finding was further supported in the UK sample (N=183) (λ_{informational}=0.87, λ_management=0.90, λ_relational=0.93) at p<0.01 level. In both samples, the overall HSSC showed a positive correlation with service quality (path coefficient for the Canadian sample: b_{HSSC_employee perceived service quality (EPSQ)}=0.22, p<0.01; the UK sample: b_{HSSC_EPSQ}=0.70, p<0.01).

The results support the conceptualisation of HSSC as a second-order latent construct. The newly developed and validated scales for the three first-order constructs identify specific items that could be targeted to improve HSSC and service quality.