Mariela Loreto Lara-Cabrera

Objectives This study aimed to examine the structural validity and internal consistency of the eight-item Client Satisfaction Questionnaire (CSQ-8) among parents of children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD), attending and evaluating a psychoeducational programme. Based on previous research, we hypothesised that the CSQ-8 would demonstrate a unidimensional factor structure and high internal consistency in this population. Design A cross-sectional study was conducted, using analytical methods appropriate for ordinal data. Structural validity was evaluated using exploratory and confirmatory factor analyses based on polychoric correlations and internal consistency was assessed using ordinal alpha and McDonald’s omega. Setting Participants were recruited from four outpatient clinics within Norwegian Child and Adolescent Mental Health Services. Participants Of the 239 parents who participated in the psychoeducational programme, 178 responded and 157 parents completed all items of the CSQ-8 questionnaire. Data were collected between May 2019 and February 2020. Results Item responses indicated generally high levels of parent satisfaction (mean total score 26.2 out of possible 32, SD 3.51), with distributions skewed towards the upper response categories. Polychoric correlations showed moderate to strong inter-item associations. Parallel analysis, supported by scree plot inspection, and factor loadings ranging from 0.73 to 0.90 supported a unidimensional factor structure. Confirmatory factor analysis indicated good model fit for the one-factor model. Internal consistency was excellent, with both ordinal α and McDonald’s ω equal to 0.94. Conclusions The findings provide preliminary evidence supporting the structural validity and internal consistency of the CSQ-8 among Norwegian parents of children newly diagnosed with ADHD who participated in a psychoeducational programme. Further research is needed to evaluate other measurement properties before broader conclusions can be drawn about the validity and reliability of the instrument.

Background: Patient satisfaction has been a widely used construct when measuring the patient perspective and a vital component of both patient-centered care and quality assurance. Nevertheless, several concerns regarding patient satisfaction have been raised in the literature. These include lack of definitional consensus and measurement standardization, consistently high satisfaction scores, and ceiling effects. Another concern is that striving for high satisfaction may incentivize pleasing the patient rather than delivering the highest-quality care. Objective: This critical review clarifies the concept of patient satisfaction, primarily by distinguishing it from related concepts such as patient experience and patient-centered care. The primary goal is to explore issues surrounding patient satisfaction and investigate its relationship with the underexamined concept of patient dissatisfaction. The discussion focuses on underlying problems and potential pathways toward improved usage and understanding of the patient satisfaction construct. Methods: Given the conceptual nature of these topics, which are not easily addressed by a single research question, we chose an unsystematic critical review for its flexibility in addressing theoretical and methodological issues. Discussion: Depending on the context and objective of its measurement, investigating and minimizing patient dissatisfaction may be more appropriate and may resolve many of the concerns raised by critics of patient satisfaction. This contrasts with current practices, which primarily focus on investigating and maximizing satisfaction. Thus, a complementary focus on patient dissatisfaction may offer utility for quality improvement. Finally, the article presents unresolved conceptual issues, along with suggestions for future research. Conclusion: Patient dissatisfaction has remained a largely overlooked blind spot in patient satisfaction research and assessment. Resolving conceptual issues surrounding patient satisfaction and dissatisfaction and developing improved methods to identify pernicious dissatisfaction may render satisfaction scores more meaningful, thereby enhancing future quality-assurance evaluations.

Background: Specialized mental health services are facing high demand, potentially leading to lower-quality care. One solution may be to prepare patients for attending treatment. Digital pretherapy psychoeducation may be particularly relevant. However, the effectiveness of such an intervention depends on user engagement and satisfaction, and usability is therefore one of the most important factors. Objective: This article has 2 objectives. Study 1 describes the development of StartHelp, a co-created digital pretherapy psychoeducation program for patients on waiting lists before their first consultation in outpatient specialized mental health services. Study 2 explores the usability of StartHelp, aiming to identify potential issues and assess whether the intervention is suitable for further evaluation in a randomized controlled trial. Methods: Guided by co-creation principles, we developed StartHelp in accordance with the Guidance for Reporting Involvement of Patients and the Public (GRIPP2) checklist. To assess the app’s usability, we recruited 10 patients from specialized mental health care to complete tasks during individual think-aloud interviews. Afterward, they completed questionnaires, including open-ended questions, an item assessing perceived video quality, 2 versions of the System Usability Scale (SUS), the 4-item Client Satisfaction Questionnaire (CSQ-4), and a modified version of the CSQ-4 (CSQ-Video). The StartHelp project group discussed the results, and solutions to the identified issues were proposed and implemented. Results: Study 1 involved the development of StartHelp over 24 months. The app comprises 27 tasks, including 24 videos and links to 14 websites containing in-depth information. Study 2 involved usability testing with 5 men and 5 women. SUS scores for StartHelp’s videos indicated good usability, with a mean of 83.7. By contrast, SUS scores related to navigating StartHelp’s overarching architecture were barely acceptable, with a mean of 63.6. For the CSQ-4, the sample mean was 12.3, indicating moderate satisfaction. Mean scores on the CSQ-Video (10.9) indicated satisfaction in the lower moderate range. However, patients perceived the videos as high quality and rated them as nonoffensive. The qualitative findings supported the quantitative results. The usability tests revealed 1 major issue and several minor issues. The primary issue concerned navigation of the overarching technological infrastructure on which StartHelp was developed, rather than StartHelp itself. To address these issues and impracticalities related to interacting with the overarching technological infrastructure, we made minor changes to the StartHelp app. Conclusions: Through a collaborative co-creation process, we developed StartHelp, a digital pretherapy psychoeducation program. Usability testing indicated that the content itself was highly usable, with video-related SUS scores suggesting good usability, whereas navigation of the overarching technological infrastructure received lower scores. Although patients rated the clinical material as high quality and nonoffensive, satisfaction scores were lower than anticipated. Nevertheless, StartHelp was deemed ready for further testing in a clinical trial.

Introduction: Psychoeducational group programs have shown promising results for people with attention-deficit/hyperactive disorders (ADHD). This pilot study aimed to investigate the impact of a new co-produced psychoeducational group intervention on quality of life (QoL), ADHD-related symptoms, and patient satisfaction. Method: This pragmatic pilot randomized controlled trial (RCT) had two parallel arms. Outpatients were recruited in two community mental health centers (CMHCs) in the Central Norway Regional Health Authority. Patients eligible for inclusion were diagnosed with ADHD. The psychoeducation group (PG) received a 10-session psychoeducational group program as a supplement to treatment as usual (TAU), while the control group (CG) received TAU only. The program was developed in collaboration between user representatives and health professionals. While the primary aim of this pilot study was to assess the preliminary impact of the intervention, we conducted exploratory between-group comparisons to identify potential effects on patient-centered outcomes. The primary outcome was QoL measured with the Adult ADHD Quality of Life Scale (AAQoL). Secondary outcomes were ADHD symptom severity (Adult Self-Report Scale, 6-Item) and patient satisfaction (Satisfaction with Information on ADHD and Treatment Scale). We collected data at baseline, pre-, and post-intervention (T0, T1, and T2 respectively). Results: Of 49 patients, 27 were allocated to the PG and 22 to the CG. Between-group comparisons using linear mixed models indicated a statistically significant improvement in QoL (mean difference = 6.90; p = 0.04; 95% CI [0.20–13.60]; Cohen’s d = 0.49). Outpatients in the PG reported significantly higher satisfaction with information as compared to the CG (mean difference = 2.14; p = 0.02; 95% CI [0.33–3.95]; Cohen’s d = 0.78). However, there were no significant differences in ADHD symptoms between the groups. Conclusion: This psychoeducational group intervention significantly improved QoL and patient satisfaction but not symptom burden in adult patients with ADHD. Future studies should explore the long-term effects of psychoeducational group programs and examine ways to optimize treatment outcomes. Trial registration: ClinicalTrials.gov NCT03337425, 06/11/2017.

Background: The implementation of peer-led programs provided by individuals with lived experience of mental disorders has been increasingly acknowledged as a key component in improving the quality of mental health services. When considering research on eating disorders, peer-led online programs may be an alternative approach to enhancing participants’ well-being. Furthermore, increasing evidence suggests that mindful self-compassion (MSC) may be a helpful approach to strengthening self-compassion as a prevention program for eating disorders. However, the feasibility and acceptability of online group-based peer-led MSC programs remain unexplored in this context. Methods: In this pilot study, using a single-arm pre-post pilot design, lived experience experts delivered and managed the program themselves and collected the data. Participatory action research principles informed the study’s quantitative design. Adults with symptoms of eating disorders were invited to participate. The primary outcome was to assess the feasibility and acceptability of the MSC program, measured by the dropout rate, attendance rate, and client satisfaction. As a secondary outcome, the program’s preliminary efficacy on self-compassion and psychological well-being was investigated. Results: Twenty-five people contacted the user organization, and all agreed to participate. However, 18 participants (78%) responded to the questionnaires at both measurement points. Two participants dropped out. The attendance rate was excellent, with 35% of the participants achieving 100% attendance, 39% completing seven of the eight group sessions (87.5% attendance), and 26% of the participants achieving 75% attendance. The participants reported to be very satisfied with the MSC program, with a total mean score of 14.4 (SD = 1.42, 95% CI [13.7, 15.1]) out of a maximum of 16 points. The participants also showed significant improvement in self-compassion and psychological well-being. Conclusions: The findings indicate that the program was both feasible and acceptable for adults with eating disorder symptoms. Additionally, participants reported significant improvements in self-compassion and psychological well-being. However, as this was the first study to examine such a program in this context, these preliminary findings warrant further research. Nonetheless, these findings suggest that peer-led online MSC programs may offer an accessible, community-rooted, and person-centered addition to ED services, particularly for individuals underserved by traditional models.

Stress is a potential risk factor for other serious health concerns. Studies show an association between Attention‐Deficit/Hyperactivity Disorder (ADHD) and stress due to impairments in emotional regulation and executive functioning that are typical of the disorder. The Perceived Stress Scale (PSS) is among the most widely used measures of perceived stress, and its four‐item version (PSS‐4) lacks validation in Norwegian contexts. This study aims to evaluate the construct validity of the PSS‐4 in an adult ADHD sample, to facilitate effective and valid measurements of perceived stress in this population. A total of 423 adults with ADHD were recruited through a Norwegian user involvement organization. Confirmatory factor analysis with a two‐ and a one‐factor model was applied. Gradually, more restricted models were evaluated in terms of model fit and compared with each other to test measurement invariance across sexes. Pearson correlations were calculated for the association with related constructs. Our results favored the two‐factor model, which demonstrated a good fit, over the one‐factor model. Our results indicated that the PSS‐4 posits measurement invariance across sexes at the configural, metric, and scalar levels. All correlations aligned with expected directions and strengths. These results indicate that the Norwegian PSS‐4 posits good construct and structural validity, and measurement invariance across sexes in this population. In sum, our results support the use of the PSS‐4 as a short and valid measure of perceived stress among adults with ADHD.

BACKGROUND Specialized mental health services are facing high demand, potentially leading to lower-quality care. One solution may be to prepare patients for attending treatment. Digital pretherapy psychoeducation may be particularly relevant. However, the effectiveness of such an intervention depends on user engagement and satisfaction, and usability is therefore one of the most important factors. OBJECTIVE This article has 2 objectives. Study 1 describes the development of StartHelp, a co-created digital pretherapy psychoeducation program for patients on waiting lists before their first consultation in outpatient specialized mental health services. Study 2 explores the usability of StartHelp, aiming to identify potential issues and assess whether the intervention is suitable for further evaluation in a randomized controlled trial. METHODS Guided by co-creation principles, we developed StartHelp in accordance with the Guidance for Reporting Involvement of Patients and the Public (GRIPP2) checklist. To assess the app’s usability, we recruited 10 patients from specialized mental health care to complete tasks during individual think-aloud interviews. Afterward, they completed questionnaires, including open-ended questions, an item assessing perceived video quality, 2 versions of the System Usability Scale (SUS), the 4-item Client Satisfaction Questionnaire (CSQ-4), and a modified version of the CSQ-4 (CSQ-Video). The StartHelp project group discussed the results, and solutions to the identified issues were proposed and implemented. RESULTS Study 1 involved the development of StartHelp over 24 months. The app comprises 27 tasks, including 24 videos and links to 14 websites containing in-depth information. Study 2 involved usability testing with 5 men and 5 women. SUS scores for StartHelp’s videos indicated good usability, with a mean of 83.7. By contrast, SUS scores related to navigating StartHelp’s overarching architecture were barely acceptable, with a mean of 63.6. For the CSQ-4, the sample mean was 12.3, indicating moderate satisfaction. Mean scores on the CSQ-Video (10.9) indicated satisfaction in the lower moderate range. However, patients perceived the videos as high quality and rated them as nonoffensive. The qualitative findings supported the quantitative results. The usability tests revealed 1 major issue and several minor issues. The primary issue concerned navigation of the overarching technological infrastructure on which StartHelp was developed, rather than StartHelp itself. To address these issues and impracticalities related to interacting with the overarching technological infrastructure, we made minor changes to the StartHelp app. CONCLUSIONS Through a collaborative co-creation process, we developed StartHelp, a digital pretherapy psychoeducation program. Usability testing indicated that the content itself was highly usable, with video-related SUS scores suggesting good usability, whereas navigation of the overarching technological infrastructure received lower scores. Although patients rated the clinical material as high quality and nonoffensive, satisfaction scores were lower than anticipated. Nevertheless, StartHelp was deemed ready for further testing in a clinical trial.

Background: This study aimed to explore the internal consistency and factor validity of the 13-item self-report questionnaire Parent-Patient Activation Measure (P-PAM) in a sample of parents of children with Attention-deficit/hyperactivity disorder. Methods: In a cross-sectional study, 239 parents were recruited from four outpatient clinics of the Child and Adolescent Mental Health Services and completed the P-PAM along with demographic variables. The factor structure of the P-PAM was examined through exploratory factor analysis, and internal consistency was estimated with the use of both Cronbach’s alpha and McDonald’s omega. A confirmatory factor analysis was used to estimate and test individual parameters. Results: The fit indices suggest an acceptable two-factor model of P-PAM and show high internal consistency and reliability for both factors, indicating that the scale measures two concepts. Conclusions: Our findings provide evidence for an acceptable factor structure and a high reliability of P-PAM as a measure of parent activation, suggesting that the theoretical factors reflect the construct of parent activation as intuitively compiled into an inner cognitive factor and an outer behavioral factor, which are related.

Purpose: Research on the psychological well-being of caregivers of children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) suggests that the well-being of parents and caregivers has been negatively affected by the COVID-19 pandemic. Although the psychological well-being of caregivers is a major concern, few validated well-being measures exist for caregivers of children diagnosed with ADHD. Therefore, a valid self-report scale is needed to assess well-being during the pandemic. The brief Five-Item World Health Organization Well-Being Index (WHO-5) has previously been used in studies on caregivers. However, its validity in this population remains unknown. This study aimed to evaluate the reliability and construct validity of the WHO-5 with caregivers of children with ADHD. Methods: A cross-sectional anonymous online survey was conducted in Norway. The study recruited caregivers from a community sample during the COVID-19 pandemic. This was carried out to investigate the construct validity by exploring the relationship between well-being, quality of life, social support, self-reported psychological distress, and perceived stress. Results: The findings of unidimensionality and high internal consistency, together with the results from the hypothesis testing, demonstrate the reliability and construct validity of the Norwegian version of the WHO-5 in this population. Conclusions: This study provides the first empirical evidence of the validity and reliability of the WHO-5 from a sample of Norwegian caregivers of children diagnosed with ADHD, with excellent reliability and construct validity. The scale can be used to systematize the measurement of well-being in caregivers because of its brevity and good psychometric properties, making it a valuable resource in research settings and assisting healthcare professionals in their crucial work of caring for caregivers.