PAMPA Patient Attitude, Motivation and Perception Assessment

Transcription

1 PAMPA Patient Attitude, Motivation and Perception Assessment

2 Contents Page Numbers Introduction 2 Development 3 Standardisation 5 Validation 6 Administration 7 References and publications 8 Appendix 10 1

3 Introduction One problem within forensic services is how to motivate patients to change and engage in therapy (Gudjonsson, Young & Yates, 2007). There is therefore a need for a comprehensive assessment to measure not only information about a patient s mental disorder and personality, but also factors such as their perceptions of their illness, staff and clinical setting which may hinder therapeutic success. This manual presents the PAMPA scales, developed to assess patients perception of their stay in hospital involving their needs, satisfaction and motivation: the Patient Attitude Questionnaire (PAQ), the Patient Motivation Inventory (PMI) and the Patient Perception Questionnaire (PPQ). The PAQ is designed to measure the extent to which a patient feels dissatisfied with their care, such as being unfairly treated or feeling discouraged (Gudjonsson, Young & Yates, 2007). This can lead to the patient building up resentment against the healthcare team, which may then lead to a lack of co-operation and will result in poorer health-related outcomes and engagement in their care. The PMI is designed to focus more directly on the internal motivation of the patient, particularly towards their engagement in therapy, and whether they have confidence that the healthcare setting will provide sufficient and adequate treatment aspects and care. The PPQ is designed to measure a patient s perceptions about their interest and engagement in treatments, whether they are ready to be discharged back into the community, and whether they can talk openly and honestly about their problems with healthcare staff. Together, the PAMPA scales will be useful within forensic services to identify perceptions and attitudes that may hinder motivation to change or engage in treatment, which then can be addressed by the multidisciplinary team and then assimilated into a patient s care plan or treatment. The scales can also be used to monitor changes over time, used to identify differences between clinical settings and can be used for research purposes, such as for identifying different motivational factors or patient dissatisfaction. Each of the PAMPA scales have been found to have satisfactory internal consistency indicating that they are conceptually meaningful scales with reasonably robust psychometric properties. 2

4 Development The Patient Attitude Questionnaire (PAQ) Each item of the PAQ was selected due to its conceptual relevance to two underlying constructs: 1) general dissatisfaction with care and 2) stress, which are measured on a sevenpoint frequency scale from 1 ( Never ) to 7 ( Always ). Although 15 items were originally factor analysed, two were eliminated after a scree test in order to retain the purity of the other factors, resulting in a 13-item questionnaire (see Table 1). Table 1. Factor loadings (varimax rotation) for the Patient Factor 1 Factor 2 Factor 3 Attitude Questionnaire (PAQ).* Dissatisfaction Stress Detachment 1. Does it occur to you that the staff are unkind and unfair to you? Do you feel discouraged on the unit? Do you get the feeling that staff don t care about you? Are you annoyed or irritable with others on the unit? Are you bored on the unit? Do you get uptight and stressed? Do you feel worn out and low on energy? Are you upset? Are you worried about things? Do you feel lazy and unmotivated? Do you feel lonely and distant from others? Are you awake when you want to fall asleep? Are you concerned that you can t keep up with all the things that you have to do? Percentage of total variance accounted for *Loadings of.40 or more in bold The Patient Motivation Inventory (PMI) The PMI consists of 16 items which are answered as either True or False by the patient. The items for the PMI were selected based on previous work regarding motivation in substance abuse treatment (Ryan et al., 1995), with concepts either relating to 1) internal motivation or 2) lack of confidence in the unit. Although 20 items were originally factor analysed, four were eliminated after a scree test in order to retain the purity of the other factors. Therefore, this is a 16-item questionnaire based on three factors: 1) internal motivation which compromises seven items, 2) lack of confidence in the unit which comprises six items and finally 3) feelings of failure which comprises three items (see Table 2). Table 2. Factor loadings (varimax rotation) for the Patient Factor 1 Factor 2 Factor 3 Motivation Inventory (PMI).* Internal No confidence Feeling of Motivation in unit failure 1. I am interested in getting help with my problems It will be important to work closely with others I accept the fact that I need help and support It is a relief to share my concerns with others I want treatment because it is important to me personally I want to share my concerns and feelings Getting treatment is the best way to help myself I am not sure that this unit will work for me I don t think being on this unit will help me solve my problems I only engage in treatment because I am pressured to do so I doubt being on this unit will help me stop getting into trouble in future I came to this unit because I had no choice I came to the unit because I wanted to I will feel like a failure if I do not get treatment I am responsible for this choice of treatment I feel bad about myself if I am not receiving help with my psychological problems Percentage of total variance accounted for *Loadings of.40 or more in bold 3

5 The Patient Perception Questionnaire The items for the PPQ were selected due to its conceptual relevance to concepts such as: 1) relevance to treatment engagement, 2) reluctance to be open/honest on the unit and 3) perceived readiness to be discharged, which are measured on a seven-point frequency scale from 1 ( Never ) to 7 ( Always ). Although 36 items were factor analysed, seven were eliminated after a scree test in order to retain the purity of the other factors. Therefore, this is a 29-item questionnaire (see Table 3). Table 3. Factor loadings (varimax rotation) for the Patient Factor 1 Factor 2 Factor 3 Perception Questionnaire (PMI).* Treatment Reluctance Readiness Engagement to open up for discharge 1. Do you find one to one sessions with your primary nurse as being helpful? 2. Do you see nursing as being helpful with your problems? 3. Do you think that you are being informed enough by staff about your progress on the unit? 4. Does your medication help with your illness? Do you think that you are adequately informed about your rights by the staff on the unit? 6. Do you think that the unit can help you with your problems? 7. Do you see group treatments as being helpful with your problems? 8. Is it in your best interests to open up and talk about your problems with staff? 9. Do you feel that staff on the unit understand you and your problems? 10. Do you see occupational therapy as being helpful with your problems? 11. Does being on the unit help with your problems? Do you think a patient s stay on the unit is therapeutic? 13. Do you see social work as being helpful with your problems? 14. Do you see psychological treatment as being helpful with your problems? 15. Do you think that filling in psychology quest questionnaires will get you into trouble? 16. Do you think that you would be punished if you told staff about your problems? 17. Do you think that there are too many restrictions for patients on the unit? 18. Do you think it is a waste of time being on the unit? 19. Do you think that you are given too much medication? 20. Do you feel that you are being punished here? Do you think that the nursing staff are too punitive (i.e. they punish the patients too much when things go wrong)? 22. Do you think the staff are too controlling in the way they treat you? 23. Is it in the patient s best interest not to tell staff about their problems? 24. Do you think it would be of great help to you if you had more leave away from the unit? 25. Do you think it would be a great help to you if you were to see your consultant more often? 26. Do you feel that you are now ready to be discharged into the community? 27. Could you be safely discharged back into the community now? 28. Do you think that being discharged from this unit will solve all your problems? 29. Do you have psychiatric (mental illness) problems? Percentage of total variance accounted for *Loadings of.40 or more in bold 4

6 Standardisation The PAMPA scales were first introduced in a paper by Gudjonsson, Young and Yates in The sample consisted of 116 mentally disordered offenders (predominately male) from three medium secure units and one open forensic ward. The mean age was 35.9 years (SD = 7.8) and they were from a wide range of ethnic backgrounds. Over half of the index offences of the patients (52%) involved physical violence, whilst others included robbery or theft (18%), sexual offences (10%), and other offences (e.g., arson, criminal damage, harassment) (20%). Mean and Standard Deviation Scores Table 4 displays the total mean scores and standard deviations (SD) for the four groups on each different factor on each questionnaire. Analysis of covariance was performed on the data in view of possible ethnic differences, for each questionnaire on each unit (fixed factor) with ethnicity as a covariate. A significant difference was only found on one of the nine factor scores (PPQ: reluctance to open up) with the ethnic minority patients scores reported as higher on this factor than the Caucasian patients scores. There was also a significant overall effect of this factor (F=4.65, df=4, p=.002; ethnic effect: F=5.625, df=1, p=.02; unit effect: F=2.921, df=3, p=.038). The effect size between the two ethnic groups for this factor (reluctance to open up) was medium (Cohen s D =.62). As there was generally an absence of ethnic effect, a one-way ANOVA was performed to compare differences between units on the factor scores for each test. Significant differences were found on all the PAQ factor scores, with the strongest relating to dissatisfaction (F=5.6, df=3, p<.001), then detachment (F=4.9, df=3, p<0.1), then stress (F=2.8, df=3, p<.05). On the PMI, Factor 2 (lack of confidence in the unit) differed significantly between the units (F=3.4, df=3, p<.05). Regarding the PPQ, Factors 2 (reluctance to open up) and 3 (readiness for discharge) differed significantly between the units (F=3.9, df =3, p<.05 and F=3.3, df= 3, p <.05), but none of the post-hoc Sheffe tests were significant between the individual units. Table 4. Mean and standard deviation scores on each factor for the three scales Mentally Disordered Offenders (N= ) Scales Mean SD PAQ Dissatisfaction Stress Detachment PMI Dissatisfaction No confidence in unit Feelings of failure PPQ Treatment engagement Reluctance to open up Readiness for discharge

7 Validation In the original study (Gudjonsson et al. 2007), all three subscales of the PAQ, PMI and PPQ were psychometrically robust and had satisfactory internal consistency (Cronbach s alpha), apart from Factor 3 of the PMI. In a study conducted in a large medium-secure unit (River House), Beazley and Gudjonsson (2011) found that the Cronbach s alpha for the three PMI subscales were 0.79, 0.75 and 0.65 for Internal Motivation, Lack of Confidence in the Unit, and A Feeling of Failure, respectively. This was consistent with the results found in the original validation study. The Cronbach s alpha was highest for the Total Score (0.83), which suggests that the Total score of the PMI is the one best utilised. In this study, the Total Motivation score correlated significantly with positive ward atmosphere and negatively with feelings of depression. The total mean PMI score was (SD = 3.7). Gudjonsson, Savona, Green and Terry (2011) used the PMI and PPQ in a study investigating the recovery model in River House. The Cronbach s alpha of the three PPQ subscales (Treatment engagement, Reluctance to open up, and Readiness for discharge) were 0.89, 0.81 and 0.76, respectively, confirming previous findings. The Cronbach s alpha of the Total score on the PMI was The total mean score for the PMI in this study was 10.9 (SD = 3.7), which is almost identical to that found in the Beazley and Gudjonsson (2011) study. The total PMI and the PPQ Treatment engagement subscale scores correlated significantly (0.39 and 0.70, respectively) with the Recovery Journal Questionnaire (Green, Batson, & Gudjonsson, 2011), providing evidence for the validation of these scales as predictors of therapeutic recovery. 6

8 Administration A copy of each of the PAMPA scales can be found in the Appendix. The scales may be administered either individually or in a group setting. Instructions are provided at the top of each scale as follows: Please read each of the following questions carefully and circle the response which best describes how you feel: For the PAQ and PPQ, the respondent is required to select and circle a number from 1 to 7. For the PMI the respondent is required to circle True or False for each statement. In cases of literacy problems, the items may be read out and explained to the respondent. If respondents wish to change their response, they should be asked to place an X through the original response and then circle the correct response. Scoring For the PAQ, scores are obtained by summing the responses for the following items: Dissatisfaction items 1, 2, 4, 9 and 10 Stress items 3, 5, 6, 7 and 12 Detachment items 8, 11 and 13 For the PMI, scores are obtained by awarding a score of 1 for each of the following items: Internal Motivation items 2, 5, 6, 9, 10, 11 and 12 marked true Lack of confidence in the unit item 1 marked false and items 8, 13, 14, 15 and 16 marked true A feeling of failure items 3, 4, and 7 marked true For the PPQ, first reverse the score obtained for item 1 (e.g. a response of 7 scores 1, a response of 6 scores 2 etc.). Then sum the responses for the following: Treatment engagement items 2, 4, 7 8, 9, 10, 11, 13, 15, 23, 24, 27, 28 and 29 Reluctance to open up items 6, 12, 15, and 26 Readiness for discharge items1, 3, 5 and 25 Interpretation Higher scores are indicative of greater dissatisfaction of the patient towards their healthcare setting (PAQ), greater motivation (PMI) and a more positive perception regarding their future progress (PPQ). 7

9 References Beazley, P., & Gudjonsson, G. H. (2011). Motivating inpatients to engage with treatment: The mediating role of depression and ward atmosphere. Nordic Journal of Psychiatry, 65, Green, T., Batson, A., & Gudjonsson, G. H. (2011). The Recovery Journal Questionnarie (RJQ). The development and initial validation of a service-led measure for recovery of mentally disordered offenders. The Journal of Forensic Psychiatry and Psychology, 22, Gudjonsson, G. H., Savona, C., Green, T., & Terry, R. (2011). The recovery approach to the care of mentally disordered patients. Does it predict treatment engagement and positive social behaviour beyond quality of life? Personality and Individual Differences, 51, Gudjonsson, G. H., Young, S., & Yates, M. (2007). Motivating mentally disordered offenders to change. Instruments for measuring patients perception and motivation. The Journal of Forensic Psychiatry and Psychology, 18, 74. 8

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11 Appendix 10

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13 PAQ Patient Attitude Questionnaire Name: Date: Please read each of the following questions carefully and circle the response which best describes how you feel Never Sometimes Always 1, Do you feel discouraged on the Unit? 2. Are you annoyed or irritable with others on the Unit? 3. Do you feel worn out and low on energy? 4. Are you bored on the Unit? 5. Do you get uptight and stressed? 6. Are you worried about things? 7. Are you upset? 8. Are you awake when you want to fall asleep? 9. Do you get the feeling that staff don t care about you? 10. Does it occur to you that the staff are unkind or unfair to you? 11. Are you concerned that you can t keep up with all the things you have to do? 12. Do you feel lazy and unmotivated? 13. Do you feel lonely and distant from others? 12

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15 PMI Patient Motivation Inventory Name: Date: Please read each of the following questions carefully and circle the response which best describes how you feel: 1, I came to the Ward/Unit because I wanted to. True False 2. I want treatment because it is important to me personally. True False 3. I feel bad about myself if I am not receiving help with my psychological/psychiatric problems. True False 4. I will feel like a failure if I do not get treatment. True False 5. Getting treatment is the best way to help myself. True False 6. I am interested in getting help with my problems. True False 7. I am responsible for this choice of treatment. True False 8. I only engage in treatment because I am pressured to do so. True False 9. I want to share my concerns and feelings. True False 10. It will be important to work closely with others. True False 11. It is a relief to share my concerns with others. True False 12. I accept the fact that I need help and support. True False 13. I am not sure this Unit will work for me. True False 14. I doubt being on the Unit will help me to stop getting into trouble in the future. True False 15. I don t think being on this Unit will help me solve my problems. True False 16. I came to this Unit because I had no choice. True False 14

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17 PPQ Patient Perception Questionnaire Name: Date: Please read each of the following questions carefully and circle the response which best describes how you feel: Not at all Very much so 1, Do you have psychiatric (mental illness) problems? 2. Does being on the Unit/Ward help with your problems? 3. Could you be safely discharged back into the community now? 4. Do you think a patient s stay on the Unit is therapeutic? 5. Do you feel that you are now ready to be discharged into the community? 6. Do you feel that you are being punished here? 7. Is it in your best interests to open up and talk about your problems with staff? 8. Does your medication help with your illness? 9. Do you see occupational therapy as being helpful with your problems? 10. Do you see psychological treatment as being helpful with your problems? 11. Do you see social work as being helpful with your problems? 12. Do you think that you would be punished if you told staff about your problems? 13. Do you see nursing as being helpful with your problems? 14. Do you find one to one sessions with your primary nurse as being helpful? 1/2 16

18 Never Sometimes Always 15. Do you think it would be of great help to you if you were to see your Consultant more often? 16. Do you think it would be of great help to you if you had more leave away from the Unit/Ward? 17. Do you think it is a waste of time being on the Unit/Ward? 18. Do you think that filling in psychology questionnaires will get you into trouble? 19. Do you think there are too many restrictions for patients on the Unit/Ward? 20. Do you think that the nursing staff are too punitive (i.e. they punish the patients too much when things go wrong)? 21. Do you think that you are given too much medication? 22. Do you think that staff are too controlling in the way that they treat you? 23. Do you feel that staff on the Unit understand you and your problems? 24. Do you think that the Unit can help you with your problems? 25. Do you think that being discharged from this Unit will solve all your problems? 26. Is it the patient s best interest not to tell staff about their problems? 27. Do you think that you are being informed enough by staff about your progress on the ward? 28. Do you think that you are adequately informed about your rights by the staff on the Unit/Ward? 29. Do you see group treatment as being helpful with your problems? 2/2 17

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