Table 2. Cognitive testing issues identified in items in the Hospital Consumer Assessment of Health Providers and Systems survey, Odisha, India, 2020.
| Survey domain and item | Full item text | Cognitive testing issue |
|
|---|---|---|---|
| Brief description | Typea | ||
| Interpersonal care from nurses | |||
| Courtesy and respect | During this hospital stay, how often did nurses treat you with courtesy and respect? | No issues raised | NA |
| Listen carefully | During this hospital stay, how often did nurses listen carefully to you? | Listening carefully may not be seen as distinct from being treated with respect | Construct |
| Explain | During this hospital stay, how often did nurses explain things in a way you could understand? | Patient must define “how often,” as the concept often lacks a point of reference | Construct |
| Interpersonal care from doctors | |||
| Courtesy and respect | During this hospital stay, how often did doctors treat you with courtesy and respect? | No issues raised | NA |
| Listen carefully | During this hospital stay, how often did doctors listen carefully to you? | Doctors are often not responsible for listening to patients | Relevance |
| Explain | During this hospital stay, how often did doctors explain things in a way you could understand? | Doctors are often not responsible for explaining care to patients | Relevance |
| Hospital environment | |||
| Room clean | During this hospital stay, how often were your room or ward and bathroom kept clean? | Families, not providers, are often responsible for cleanliness | Relevance |
| Quiet | During this hospital stay, how often was the area around your room/ward quiet at night? | Lack of clarity on the concept quiet. In open hospital wards, it may not be possible to maintain quiet | Construct and relevance |
| General experience | |||
| Bathroom help | How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted? | Families, not providers, are often responsible for bedpans | Relevance |
| Talk about pain | During this hospital stay, how often did hospital staff talk with you about how much pain you had? | Patient must define “how often,” as the concept often lacks a point of reference | Construct |
| Talk about pain treatment | During this hospital stay, how often did hospital staff talk with you about how to treat your pain? | Patient must define “how often,” as the concept often lacks a point of reference | Construct |
| Explain medication purpose | Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? | Lack of clarity on what constitutes new medicine. External purchase of medication most common and doctors rarely provides the medicine | Information and relevance |
| Explain side-effects of medication | Before giving you any new medicine, how often did hospital staff describe possible side-effects in a way you could understand? | Lack of clarity on what constitutes new medicine. External purchase of medication most common and doctors rarely provides the medicine | Information and relevance |
| After discharge | |||
| Assessment of post-discharge | During this hospital stay, did doctors, nurses or other hospital staff talk with you about whether you would have the help you needed when you left the hospital? | Understood as: when you go home will you get the help that you need | Construct |
| Receipt of discharge guidance | During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital? | Written guidance may be irrelevant if patients are illiterate | Relevance |
| Understanding of care | |||
| Taking preferences seriously | During this hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left. | The doctors may not concern themselves with care after discharge, as it is not within the scope of the doctor’s professional role | Relevance |
| Understand responsibilities | When I left the hospital, I had a good understanding of the things I was responsible for in managing my health. | Lack of clarity on what the patient is told versus what the patient understands | Construct |
| Understand purpose of medications | When I left the hospital, I clearly understood the purpose for taking each of my medications? | No issues raised | NA |
NA: not applicable
a Construct issues were raised when the item was understood differently than its intended construct. Information issues were raised when there was unclear or inadequate information for a patient to answer the question reliably. Relevance issues were when there was something about the question that raised concern, e.g. relevance in the Odisha inpatient setting.