SEQUenCE: a service user-centred quality of care instrument for mental health services

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Abstract
Objective To develop a quality of care instrument that is grounded in the service user perspective and validate it in a mental health service. Design The instrument (SEQUenCE (SErvice user QUality of CarE)) was developed through analysis of focus group data and clinical practice guidelines, and refined through field-testing and psychometric analyses. Setting All participants were attending an independent mental health service in Ireland. Participants Participants had a diagnosis of bipolar affective disorder (BPAD) or a psychotic disorder. Intervention(s) Twenty-nine service users participated in six focus group interviews. Seventy-one service users participated in field-testing: 10 judged the face validity of an initial 61-item instrument; 28 completed a revised 52-item instrument from which 12 items were removed following test–retest and convergent validity analyses; 33 completed the resulting 40-item instrument. Main outcome measures Test–retest reliability, internal consistency and convergent validity of the instrument. Results The final instrument showed acceptable test–retest reliability at 5–7 days (r = 0.65; P < 0.001), good convergent validity with the Verona Service Satisfaction Scale (r = 0.84, P < 0.001) and good internal consistency (Cronbach's alpha = 0.87). Conclusions SEQUenCE is a valid, reliable scale that is grounded in the service user perspective and suitable for routine use. It may serve as a useful tool in individual care planning, service evaluation and research. The instrument was developed and validated with service users with a diagnosis of either BPAD or a psychotic disorder; it does not yet have established external validity for other diagnostic groups.

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