Further Development and Validation of a Measure of Compassionate Healthcare in Action

Compassionate Healthcare In Action (CHIA) is a new questionnaire to measure patient experiences of compassionate care, with a particular focus on observable behaviours. It has been designed to address gaps in currently available metrics. It is generalisable across healthcare contexts and has been developed with patient and public involvement throughout. The present study sought to build on earlier development to evaluate the CHIA's face validity, perform item reduction, establish dimensionality, validity and reliability.

Face validity was assessed via cognitive interviews with UK healthcare service users. Interviews used a Three-Step Test Method to understand how CHIA items were used, and which items were considered most/least important in measuring patient experiences of compassionate care (Study 1). Cross-sectional survey data were analysed using inter-item correlations, item discrimination indexes, item and local dependency analyses and exploratory factor analysis. Statistical analyses were combined with cognitive interview data and panel reviewed to inform item reduction (Study 2). A final cross-sectional survey corroborated single-factor dimensionality through confirmatory factor analysis alongside establishing reliability and validity (Study 3).

21 cognitive interviews established face validity and identified items with stronger face validity (Study 1). These results were combined with survey analyses (n = 311). Seven items were removed resulting in a 14-item CHIA demonstrating a single factor structure (Study 2). In Study 3, further survey analysis (n = 301) reinforced results showing a strong unidimensional structure, internal consistency, test-retest reliability and validity: content, face, convergent and discriminant.

The CHIA is a brief and generalisable metric that evaluates patient perceptions of compassionate care they receive. It has been robustly developed and has strong psychometric properties. The CHIA shows promise for supporting healthcare services to evaluate and improve their care. Further research could examine the CHIA in different contexts and populations.

Lived experience consultants supported prior CHIA development papers. In this paper a lived experience consultant (experience of physical and mental healthcare services) was involved in reviewing methodology and materials, advising on and helping with recruitment, contributing to review panel discussions, reviewing and authoring this manuscript. Additionally, methods throughout sought to amplify the voices of diverse populations who could complete the CHIA.