The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0): An overview and recent progress
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Techlllogy and Disability 14 (2002) 101-105 101
10S Press
i
The Quebec User Evaluation of Satisfaction
I
with Assistive Technology (QUEST 2.0): An
overview and recent progress
Louise Demers*, Rhoda Weiss-Lambrou and Bernadette Ska
Research Center of the Institut universitaire de geriatrie de Montreal, 4565 Queen Mary Road. IHontreal(Quebec),
H3W IW5, Canada
~
Abstract. The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) is a 12-item outcome measure
that assesses user satisfaction with two components, Device and Services. Psychometric properties have been tested with respect
to test-retest stability. alternate-form equivalence. internal consistency, factorial composition and nomological validity. Examples
of results obtained with the first version of the tool in outcome studies in Europe and North America support the importance and
relevance of the satisfaction measure.
1. Purpose 2. Conceptual basis
Due to a vacuum in theoretical knowledge, satisfac-
The Quebec User Evaluation of Satisfaction with tion determinants are vague in the field of assistive tech-
Assistive Technology (QUEST 2.0) was designed as nology. Similar conceptual limitations exist in other
an outcome measurementinstrument to evaluate a per- health domains [1-3]. Despite lack of standards, the
son's satisfaction with a wide range of assistive tech- rationale behind the QUEST was drawn from the state
nology (AT). It was intended as a clinical and research of the art in satisfaction assessment. The relations be-
instrument. As a clinical tool,..the rating scale pro- tween the variables involved in the experience of sat-
vides practitioners with a means of collecting satisfac- isfaction with AT are represented within a linear gen-
tion data to document the real-life benefitsof AT and to eral framework, inspired by Simon and Patrick [4]. In
justify the need for these devices. As a research tool, Fig. 1, expressed satisfaction is conceived as a reaction
to assistive technology provision. It may also trigger
it can be used to compare satisfaction data with other
a subsequent action or behaviour, for instance, the use
outcome measures such as clinical results, quality of or the abandonment of the AT. Satisfaction is defined
life, functional status, cost factors and comfort. It can
as a person's critical evaluation of several aspects of a
also serve to compare satisfactionresults obtained with
device. This evaluation is believed to be influenced by
different user groups, in differentsettings and in differ- one's expectations, perceptions, attitudes and personal
ent countries. Until now,the QUEST 2.0 has been used values. Accordingly, satisfaction is considered as a
mainly with adults but it may also be administered to multidimensional concept with two underlying dimen-
adolescents and elderly users of AT. sions respectively related to assistive technology, De-
vice and Services. As shown in Fig. 2, the Device di-
mension embraces 8 items related to salient character-
'Corresponding author: Tel.: +15143403540; Fax: +1514340 istics of the assistive technology whereas the Services
3548; E-mail: Louise.Demers@umontreal.ca. dimension encompasses 4 intercorrelated items.
ISSN 1055-4181/021$8.00 @2(J(J2 - [aS Press. All rights reserved
",,- ---..
[8]102 L. /J"/I"'/".' ,'t ill. / QUEST 2.0: .-\/1 """/T;,'\\'
...'
L. Delllas ,'t aLl QUEST 2.0: An overview and recent progres." 103
1 2 3 4 5
not satisfied not very satislied more or less satisfied quite satisfied very satisfied
at all
I. ASSISTIVE DEVICE
How satisfied are vou with,
I. the dimensions (size, height, length. width) of your asslstive device?
Comments:
I 2 3 4 5
'om
Ho
:lay 2. the weight of your assistive device?
2.0 Comments: I 2 3 4 5
Ises
If
late 3. the ease in adjusting (fixing, fastening) the parts of your assistive device? ':-
Comments:
ad- I 2 3 4 5
'me
ga
md 4. how safe and secure your assistive device is?
Comments: I 2 3 4 5
'ees
ing
red
lel-
.ub- SERVICES
How satisfied are you with,
lan,
9. the service delivery program (procedures, length of time) in which you obtained
your assistive device?
Comments: I 2 3 4 5
10. the repairs and servicing (maintenance) provided for your assistive device?
'ea- Comments:
I 2 3 4 5
ity,
lew
At
48 Fig. 3. Examples from the QUEST 2.0.
us-
lot- agreement for the 12 items were obtained from a study ers and consumers to review and critique the prelim-
ups of the original 24-item instrument [8]. In this study, inary versions of the instrument [5]. This led to the
~ek 85 users of wheelchairs and lower limb prosthesis were developmentof an experimental 24-item version, ready
md administered the test twice, with a 7 to lO-day inter- for field trials. A number of researchers and clinicians
the val between measures. Weighted kappa ranged from (n = 12) from the United States, The Netherlands,
in- .51 to .74 and averaged around .61. Internal consis- and Canada volunteered to test the newly developed
md tency estimates were calculated from the same sample outcome measure and completed a questionnaire on its
ec- of subjects and Alpha values of .80, .76 and.82 were content, administration procedures, and usefulness [7].
ere found [9]. At the test level, the findings revealed that the QUEST
Ilts was sampled adequately in terms of embracing all im-
. of portant facets of satisfaction with AT.At the item level,
5. Validity however,it was shown that changes needed to be made
to item wording and to the administration procedures
, for During the early development of the QUEST, con- to ensure optimal content validity. These results, com-
:-lew
tent validity was tested by asking a panel of stakehold- bined with those of a reliability study, were used in
. -.., '.~- .'~. -., ,-....104 L. nell/a'\" "Il/I. / QUEST ':,0: .4" m'en';""' and I'/'cl.'lIl progn',H
an item analysis [9] and led to the development of the and Iwarsson (15] used the Danish version of the origi-
shorter single rating scale QUEST2.0 1111. nal QUEST as part of their outcome study on powered
Factorial analyses of the QUEST 2.0 were per- wheelchair used by the elderly. Data from III sub-
formed in two studies using the Principal Axis Factor- jects showed that the vast majority considered the AT
ing method. The first study [9) involved 150 Canadian to be important and that they were satisfied with it as a
subjects using mobility devices. Results suggested a whole. However, a substantial proportion of users were
bidimensional structure of satisfaction with AT, De- not satisfied with some of the technical characteristics.
vice and Services, accounting for 40% of the common such as power and speed.
variance. A cross-validation study [121 was conducted In North America, Benedict et a!. [16] used the tool
with 243 Dutch subjects using a wide range of home to examine whether use of AT by young children was
technologies. The findings broadly supported the divi- related to caregiver satisfaction (n = 37). They found
sion into Device and Service components, in spite of that high ranked satisfaction scores were more likely
contrasting assistive technology and services delivery for children using the device as intended than for those
systems. underutilizing the device. Weiss-lambrou et a!. (17]
In a recent study [10], the expected relationship be- assessed user satisfaction ,lVith modular-type seating
tween the QUEST 2.0 and another outcome measure device integrated in a powered wheelchair (n = 23).
of assistive technology was empirically tested. Par- The results revealed that the item comfort was the most
ticipants (n = 81) who were administered the instru- important consumer criterion yet it was evaluated as
ment also completed the Psychosocial Impact of Assi- the least satisfying. The QUEST was one of four mea-
tive Devices Scale (PIADS) [13]. This measure cap- sures chosen by Bursick et a!. [18] to assess wheelchair
tures the concepts of Competence, Adaptability, and seating and positioning outcomes in the elderly nursing
Self-Esteem, all subsumed as fundamental dimensions home population. This randomized controlled study
under quality oflife. Both measures rely on the individ- included an intervention group (n = 12) receiving a
uals' subjective experiences but have different stand- new wheelchair, cushions and a custom seat back and
points for evaluation. Positive correlations were found a comparison group (n = 12). Overall, the subjects in
between the QUEST 2.0 and the three PIADS dimen- the custom fitted wheelchairs and seating systems were
sions. They were fair to moderate for Device and to- more satisfied (3.72 compared with 3.14) with their AT.
tal QUEST (Pearson correlation coefficient [rp] .34 to Use of and satisfaction of upper limb myoelectric pros-
.45) and fair with Services (r p .27 to .30). This ar- theses were studied by Routhier et a!. [19] with a sam-
gues that satisfaction with a device is associated, to a ple of 10 subjects. Although general satisfaction was
certain extent, with lifestyle, behavior, and experiential high (80%), specific concerns were raised with respect
factors. to heat, weight, service delivery procedures, durability
of mechanisms and battery, follow-up services, profes-
sional services, dimensions and loss of tactile sensa-
6. Results of application in outcome studies tion. Stickel et a1. [20] conducted interviews with 40
users and nonusers of electronic aids to daily living.
The following are exemplesof studies in Europe that Simplicity of use and safety were rated as the most
used the first version of the QUEST as an outcome satisfactory items whereas cost, follow-up services and
measure of satisfaction with AT. In the Netherlands, device compatibility were commonly reported to be
Wessels et a1. [14] implemented a 3-month follow-up low.
study with 375 users of toilet adaptations, shower seats Results from the application of the QUEST 2.0 are
and chairs, wheelchairs, adapted beds, stairslifts, home beginning to be published. Vincent and Demers (21]
adaptations and adaptedbeds. Althoughthe majority of administered the test to 43 community-dwelling sub-
the respondents reported they were very satisfied with jects using twin or double electrical beds. The major-
their devices, a substantialproportion(199'0)expressed ity of users are very satisfied with their bed, with item
specific concerns andoveralldissatisfaction. The items scores averaging close to 4.00. Comfort and ease of
that clients were least satisfied with were related to use were considered the most important items. Inter-
services issues, such as Service Delivery, Follow-up estingly, users of double beds were more satisfied with
Services, or Professional Services, whereas the items the item dimension than were users of twin beds. Sev-
that clients were most satisfiedwith included Durabil- eral concerns were raised about the noise of the engine,
ity, Effectiveness, Comfort and Dimensions. Brandt the maximal and minimal heights, the tilting angles and
.. ----- ~-I
1
L. Del1lt'r,f et Ill, I QUEST ~.(): :\11oven'iell' and ream progress !O5
the overall resistance of the beds. The QUEST 2.0 has [4] S.E. Simon and A. Patrick. Understanding and assessing con-
been released recently and more outcome studies are sumer satisfaction in rehabilitation, Jollmal 4 Rehabilitation
Outcomes Measurement 1(1997). 1-14.
expected to be published in the coming years.
[5] L. Demers et aI., Development of the Quebec User Evaluation
of Satisfaction with Assistive Technology (QUEST), Assistive
Technology 8 (1996), 3-13.
7. Discussion [6] M.J. Scherer, Li,'ing in tl1,' slIIte ofstuck-HolI' teelmolog." im-
pactthe !i\'es of people with disabilities, 2nd ed.. Cambridge:
Brookline. 1996.
The QUEST 2.0 is a pioneer scale for satisfaction [7] L. Demers et al., An international content validation of the
measurement. It was developed in response to the last Quebec User Evaluation of Satisfaction with assistive Tech-
decade's wake-up call for outcome measurements in nology (QUEST), Occupational Therapy International 6(3)
(1999),159-175.
the field of rehabilitation assistive technology. As a
[8] L. Demers et al., Stability and reproducibility of the Que-
generic assessment, it covers both Device and Services bec User Evaluation of Satisfaction with assistive Technology
components of AT. Thus, the items may be applied to a (QUEST), Journal of Rehabilitation Olllcomes Measurement
wide range of devices. On the other hand, some poten- 3(4) (1999), 42-52.
[9] L. Demers et al" Item analysis of the Quebec User Evaluation
tial items, relevant to a specific pieces of technology or
of Satisfaction with assistive Tec~ology (QUEST), Assistive
delivery systems may be absent. Speed, for instance, Technology 12(2) (2000), 96-105.
is subsumed within the item effectiveness although it [10] L. Demers et al., Reliability, validity, and applicability of the
may be considered an important aspect of a powered Quebec User Evaluation of Satisfaction with assistive Tech-
wheelchair's performance. Users of the tool are invited nology (QUEST 2.0) for adults with Multiple Sclerosis, Dis-
ability and Rehabilitation 24 (2002), 21-30.
to add a few items of their own, using the 5-point sat- [II] L. Demers et al., Quebec User Evaluation of Satisfaction
isfaction rating scale and a similar format. However, with assistive Technology QUEST 2.0 - An outcome measure
such data cannot be included in the Device, Service and for assistive technology devices, Webster (NY): Institute for
Matching Person and Technology, 2000.
total QUEST scores; they should be added at the end
[12] L. Demers et al., Key dimensions of client satisfaction with as-
of the questionnaire and analysed separately. sistive technology: A cross-validation of a Canadian measure
Most studies about the psychometric properties of in the Netherlands, Scandinavian Journal of Rehabilitation
the tool have been conducted by the team of developers Medicine 33 (2001), 1-5.
[13] H. Day and 1. Jutai, Measuring the Psychosocial Impact of
themselves. Nevertheless, the scales and subscales ap-
Assistive Devices: The PIADS, Canadian Journal of Reha-
pear to be adequate with respect to test-retest stability, bilitation 9 (1996), 159-168.
alternate-form equivalence, and internal consistency. [14] R.D, Wessels et al" A Dutch version of QUEST (D-QUEST)
More reliability tests for the 4-item Services subscale applied as a routine follow-up within the service delivery pro-
however need to be conducted. Construct validity has cess, in: Improving the quality of life for the European Citizen,
I. Placiencia Porrero and E, Ballabio, eds, Amsterdam: IOS
been studied through factorial composition and nomo- Press, 420-424, 1998.
logical relatedness (expected correlation between mea- [15] A. Brandt and S. Iwarsson, Do certain groups of older people
sures of related concepts). Although not extensive, va- benefit the most from the use of powered wheelchairs? in:
Resna Proceedings 2001, J. Winters, ed., Arlington: Resna
lidity results are convergent and support the adequacy
Press, 2001, pp. 212-214,
of the satisfaction measure. Severed outcome studies [16] Benedict et al., Assistive devices as an early childhood in-
were conducted using the first version of the tool. The tervention: Evaluating outcomes. Technology and Disability
QUEST 2.0 has better measurement properties and is 11(1/2) (1999), 79-90.
[17] R. Weiss-Lambrou et al., Wheelchair seating aids: How satis-
an important improvement to the previous version. It
fied are consumers? Assistive Technology 11 (1999),43-53.
allows both item and test levels results and should be- [18] T. Bursick et al., Wheelchair seating and positioning outcomes
come a valuable tool to enhance most studies concerned in the elderly nursing home population, in: Resna Proceedings
with consumer satisfaction. 2000, J. Winters, ed., Arlington: Resna Press, 2000, pp. 316-
318.
[19] F. Routhier et al., Clinical results of an investigation of pae-
diatric limb myoelectric prosthesis fitting at the Quebec Re-
References habilitation Institute, Prosthetics and Orthotics International
25(2) (2001), 119-131.
[I] S. Bond and L.H. Thomas, Me.asuring patients' satisfaction [20] S. Stickel et al., Toward a comprehensive evaluation of the im-
with nursing care, Journal of Advanced Nursing 17 (1992), pact of electronic aids to daily living: Evaluation of Consumer
52-63. satisfaction, Disability and Rehabilitation (in press).
[2] R.A. Carr-Hill, The measurement of patient satisfaction, Jour- [21] C. Vincent and L. Demers, Les lits electriques 11domicile?
nal of Public Health Medicine 14 (1992), 236-249. Pouvons-nous dormir sur nos deux ore illes, Occupational
[3] H. Vuori, Patient satisfaction - Does it matter? Qualit)' Assur- Therapy Now 4(2) (2002), 11-14.
ance In Health Care 3 (1991). 183-189.
~-- - --.---..You can also read
