Family Practice Advance Access originally published online on November 4, 2004
Family Practice 2004 21(6):684-688; doi:10.1093/fampra/cmh617
Family Practice Vol. 21, No. 6 © Oxford University Press 2004, all rights reserved.
The association between maternal ratings of child health interviews and maternal and child characteristics
a University of Adelaide Department of Paediatrics, b Public Health Research Unit and c Women's and Children's Hospital Evaluation Unit, Women's and Children's Hospital, North Adelaide, South Australia
Email: maree.okeefe{at}adelaide.edu.au
Received 20 May 2004; Accepted 5 July 2004.
O'Keefe M, Baghurst P, Sawyer M and Roberton D. The association between maternal ratings of child health interviews and maternal and child characteristics. Family Practice 2004; 21: 686–690.
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Abstract |
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Background. Doctors develop the skills needed to interview parents and children in paediatric settings by practice and by receiving feedback during their medical training. Interviewed parents are ideally placed to provide evaluations of these skills. If parents, as consumers of health care services, are to be consulted, it is important to determine whether factors other than interview skills affect their evaluations.
Objectives. Our aim was to examine the relationship between maternal satisfaction ratings of student doctor interviews, and maternal and child characteristics.
Methods. Sixty mothers of children attending the paediatric medical out-patient clinic at the Women's and Children's Hospital, South Australia were allocated randomly to rate one of four video-taped final year student doctor interviews (15 mothers per interview). The level of skills displayed by the student doctor differed in each interview. Maternal satisfaction was measured using the Medical Interview Satisfaction Scale (MISS) and the Interpersonal Skills Rating Scale (IPS), and interview ratings were compared for a number of maternal and child characteristics.
Results. No significant associations were observed between maternal satisfaction ratings and any maternal or child characteristics other than lower satisfaction associated with previous experience of a real student doctor interview (P < 0.01). The interview seen by mothers predicted 53% (MISS) and 65% (IPS) of the variance in maternal satisfaction ratings. After controlling for the interview type, the maternal and child characteristics studied predicted 17% additional variance in MISS scores and 7% in IPS scores.
Conclusion. The quality of the interview skills demonstrated was the principle determinant of maternal satisfaction ratings.
Keywords. Patient satisfaction, physician–patient communication.
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Introduction |
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Most parents form an opinion of the skills of the doctor during a medical consultation concerning their child, and this opinion is likely to determine the extent to which they will follow the instructions and advice that are given. Doctors develop and refine their paediatric interview skills by conducting interviews as students and junior medical staff with parents presenting to health services with their children. Because these interviews are usually unwitnessed by clinical supervisors, it is difficult for these students and junior doctors to receive feedback regarding their skills development. The interviewed parents are ideally placed to provide this information but are rarely if ever asked their opinions, and little is known about any factors that may effect these parent evaluations.
We have demonstrated that maternal satisfaction ratings following a simulated student doctor paediatric interview were highest after an interview in which the student demonstrated high levels of patient-centredness and high levels of clinical competence.1 Similarly, maternal satisfaction ratings were lowest after an interview in which the student demonstrated low levels of patient-centredness and low levels of clinical competence. Levels of maternal satisfaction fell between these extremes for interviews in which the student displayed either high clinical competence and low patient-centredness, or, conversely, low clinical competence and high patient-centredness, with clinical competence having a greater effect on maternal ratings. Whilst a relationship between maternal ratings and the quality of the student doctor interview skills was demonstrated, other possible relationships between maternal ratings and individual maternal and child characteristics were not explored. If factors other than the quality of student doctor interview skills were significant determinants of maternal satisfaction ratings, these other factors need to be taken into account if maternal evaluations of medical interviews are to be sought to assist student and junior doctor learning. The aim of this study was to examine the relationship between maternal satisfaction ratings of student doctor interviews, and maternal and child characteristics. We hypothesized that certain key maternal and child characteristics may be related to maternal satisfaction with a student doctor interview. These key characteristics included maternal education and socio-economic status, the health condition of their child, whether mothers had children of a similar age to the child in the video-taped interview, and previous maternal experience of a real student doctor interview.
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Methods |
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Study location and participants
This study was conducted concurrently with a study of maternal ratings and student doctor interview qualities.1 Mothers of children attending the paediatric medical out-patient clinic at the Women's and Children's Hospital, South Australia, between March and December 2000 were invited to participate in the study. Mothers were contacted by letter and a subsequent telephone call prior to their scheduled appointment. Mothers were ineligible to participate in the study if the mother (or maternal carer) was not attending the appointment with the child, if the mother was not proficient in spoken and written English, if telephone contact was unsuccessful or if the child's appointment subsequently was cancelled. Mothers who agreed to participate were allocated randomly to view one of the four study video-tapes.
Procedures
Four video-taped interviews developed from actual student doctor interviews with parents were used in this study.1 In one video-tape, high clinical competence and high patient-centredness was demonstrated. In another, low clinical competence and low patient-centredness was demonstrated. The remaining two video-tapes showed either high clinical competence and low patient-centredness, or low clinical competence and high patient-centredness. The four video-tapes, whilst differing in the details of student dialogue, had almost identical maternal dialogue and clinical content, and concerned a child aged 18 months who was acutely unwell with a viral illness. A male actor played the role of the student doctor. The actor's attire, facial expressions and voice were identical in each video-tape to ensure the verbal content of the interviews was the only variable being assessed. A technical assistant played the role of the ‘mother’ whose voice only was heard. The development of these video-tapes, together with the independent assessment of clinical competence and patient-centredness, has been described in detail previously.1
The video-taped interviews were screened on a television monitor in the out-patient clinic waiting area. They were preceded by a pre-recorded orientation video-tape which encouraged participating mothers to imagine themselves as the ‘mother’ in the video-taped interview. Each interview ran for 7 min, with the questionnaire completed by mothers after each interview taking 
15 min.
Measures
Maternal satisfaction was measured using the Medical Interview Satisfaction Scale (MISS), a 29-item, 7-point response scale,2 and the Interpersonal Skills Rating Scale (IPS), a 13-item 7-point response scale.3 These two scales were selected because they focused on aspects of interview skills that were particularly relevant to student doctors. Minor adjustments were made to each scale to ensure the questions were relevant to the situation portrayed in each video-tape. On both scales, maternal responses were summed, and higher scores indicated higher satisfaction.
Mothers also completed a self-report questionnaire of maternal and child characteristics (Table 1). The age of the child attending the out-patient appointment and the age of the youngest child in the household were categorized into one of three groups: (i) 0–2 years (the approximate age of the child in the video-taped interviews); (ii) 3–8 years; and (iii) 9–18 years. The health condition of the child attending the out-patient appointment (based on maternal self-report) was categorized according to the body system primarily affected. Developmental conditions included all conditions associated primarily with development or behaviour. If more than one body system was involved, the health condition was categorized as complex. Information on family structure was sought by asking mothers to indicate whether the child lived with two natural parents, a natural mother and a defacto or step-father, a single mother, or in some ‘other’ family structure such as with a step-mother, foster mother or grandmother. Maternal socio-economic status was categorized according to stated maternal occupation.4 For mothers who stated their occupation as ‘home duties’, maternal occupation was categorized according to paternal occupation. For five single-parent mothers, maternal education was used to determine maternal socio-economic status. Maternal education was categorized according to the highest level of completed schooling. Mothers who completed primary school and commenced but did not complete high school, for example, were categorized as primary.
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Statistical analyses
Comparisons of MISS and IPS scores according to maternal and child characteristics were made using analysis of variance (ANOVA). To examine the effects of maternal and child characteristics on maternal satisfaction, multiple regression analyses were undertaken with MISS and IPS scores as the dependent variables, and with the maternal and child characteristics described in the previous section as the explanatory variables together with the type of video seen. The stepwise regression procedure provided in Genstat5 was used for this analysis, with a minimum residual mean square used as the stopping criterion.
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Results |
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Enrolment
Letters were sent to 125 consecutive eligible mothers with subsequent telephone contact. Sixty-nine mothers agreed to participate (55%), and 56 declined (45%). Nine mothers who agreed to participate did not attend on the day of the video-tape screening, or arrived too late to complete the study requirements, leaving 60 participating mothers. The distribution of mothers in relation to each maternal and child characteristic is shown in Table 1. There were no significant differences between the children of participating and non-participating mothers regarding gender or age. Mothers viewed the video-tapes on the day of their appointment in the clinic so the number of mothers able to attend any particular screening varied. Most mothers watched their allocated video-tape alone (38 mothers), 16 watched their allocated video-tape with one other mother, and six mothers watched their video-tape in a group of three mothers. No discussion was permitted between the mothers regarding the video-tape content if more than one mother was present.
Maternal satisfaction
There were no significant associations noted between maternal satisfaction ratings and any of the maternal and child characteristics studied other than lower maternal satisfaction associated with previous experience of a real student doctor interview (P < 0.01) (Table 2). Although not reaching statistical significance, there was a trend observed where satisfaction scores were higher for mothers of children with certain medical conditions such as gastrointestinal diseases, and lower for mothers of children with others such as neurological diseases.
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In the regression analyses, the interview rated by mothers predicted 53% (MISS) and 65% (IPS) of the percentage variance in maternal satisfaction (Table 3). Family structure predicted a further 12% (MISS) and maternal education predicted a further 6% (IPS); all other increments were <3%. In total, the regression model predicted 71% (MISS) and 73% (IPS) of the variance in maternal satisfaction. Mothers in two natural parent families recorded lower satisfaction with the interviews in comparison with the other mothers, as did mothers who commenced but did not complete their secondary schooling. Previous experience of a student doctor interview predicted only 2% (MISS) and 0.6% (IPS) of the variance in maternal satisfaction ratings.
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Discussion |
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Maternal satisfaction ratings were predicted principally by the quality of interview skills displayed by the student. The design used in this study permitted comparison of multiple maternal ratings of the same interviews. This design, together with the control exercised over so many interview variables and the extensive independent assessment of the interview variables, was a particular strength of this work. In most studies of the relationship between patient characteristics and evaluations of medical interviews, patient evaluations are compared across different interviews conducted by different doctors.6,7
Previous maternal experience of a student doctor interview was the only variable to be associated with significant differences in maternal satisfaction ratings. Mothers interviewed previously by a real student doctor recorded lower levels of satisfaction following a video-taped interview. It is possible that this observation was due to the use of simulated interviews. Mothers previously interviewed by a real student may have expected the video-tape recreation to resemble this previous experience in terms of the warmth and intimacy of an actual conversation with another person. These mothers may have based their evaluations in part on these expectations when viewing the video-tape interviews. Video-tape interview recreations cannot replicate faithfully all aspects of an actual interview; however, mothers have indicated previously that the interview recreations used in this study were very realistic.1 An alternative explanation is that some mothers may not have enjoyed their previous encounter with a student and this was reflected in their video-tape ratings. There is also the possibility that this is a chance finding because a number of comparisons were made; however, the association was observed with both the MISS and IPS scores.
In studies of adult patient satisfaction with medical consultations (without the control of interviewer and interview content employed in this study), higher satisfaction has been associated with more healthy patients, and higher socio-economic status patients were more satisfied with their care.6,8,9 These differences were not, however, the major predictors of patient satisfaction. When the associations between patient satisfaction, doctor communication and patient demographic variables were considered, the most significant predictor of patient satisfaction was the communication skills of the doctor.6,10 Individual patient characteristics predicted only 5% of the variation in patient satisfaction ratings.10 Similar information has not been available for child health consultations.
Mothers were enrolled for this study because they are usually the primary caregivers of young children and are overwhelmingly represented in the out-patient clinic population. Enrolling mothers only in this study permitted control of parent gender in the concurrent study of the association between maternal ratings and student doctor interview qualities.1 This study design, however, precluded any exploration of the relationship between parent gender and parent satisfaction ratings. Exploring any association between maternal expectations and satisfaction also was beyond the scope of this study. The role of maternal expectations deserves further consideration, particularly in light of the relationship we observed between previous student doctor interview experience and maternal satisfaction. In addition, because non-English-speaking mothers were excluded from this study, the results cannot be generalized to non-English-speaking mothers without further study.
Although other studies of patient evaluations of medical interviews have used a range of methods, similar levels of non-participation are also reported.2,7 Whilst there were no significant differences between participating and non-participating mothers in relation to child age and gender, insufficient information was available about the other maternal and child characteristics for non-participating mothers to determine whether the participating mothers were a truly representative group. It seems unlikely, however, that the non-participation rate would have compromised the key findings of this study.
Conclusions
Student doctor interview skills were the principal determinants of maternal satisfaction irrespective of the different maternal and child characteristics studied. This study should counter concerns of students or teachers that maternal ratings may be significantly influenced by individual maternal characteristics. Providing mothers with the opportunity to rate the interview skills of junior or student doctors during their paediatric clinical terms would increase greatly our capacity to provide individual feedback. In addition to enriching our child health learning programmes, the inclusion of maternal ratings would demonstrate a commitment to consumer involvement in the training of future doctors.
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Declaration |
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Funding: The development of the videotaped interviews used in this study was supported by a University of Adelaide, Faculty of Health Sciences B3 Grant.
Ethical approval: The study was approved by the Research Ethics Committee of the Women's and Children's Hospital, Adelaide.
Conflicts of interest: None.
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Acknowledgments |
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MO was principal investigator for this study. PB advised on study design and conducted the statistical analyses. MS and DR participated in development of the study methods. All authors contributed to the preparation of the manuscript.
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References |
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1 O'Keefe M, Roberton D, Sawyer M, Baghurst P. Medical student interviewing: a randomised trial of patient-centredness and clinical competence. Fam Pract 2003; 20: 213–219.
2 Kinnersley P, Stott N, Peters T, Harvey I, Hackett P. A comparison of methods for measuring patient satisfaction with consultations in primary care. Fam Pract 1996; 13: 41–51.
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7 Haddad S, Potvin L, Roberge D, Pineault R, Remondin M. Patient perceptions of quality following a visit to a doctor in a primary care unit. Fam Pract 2000; 17: 21–29.[Medline]
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10 Tucker J, Kelley V. The influence of patient sociodemographic characteristics on patient satisfaction. Mil Med 2000; 165: 72–76.[ISI][Medline]
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