Abstract
Background
Satisfaction with services represents a key component of the user’s perspective, and user satisfaction surveys are the most commonly used approach to evaluate the aforementioned perspective. The aim of this discursive paper is to provide a critical overview of user satisfaction surveys in addiction treatment and harm reduction services, with a particular focus on opioid maintenance treatment as a representative case.
Methods
We carried out a selective critical review and analysis of the literature on user satisfaction surveys in addiction treatment and harm reduction services.
Results
Most studies that have reported results of satisfaction surveys have found that the great majority of users (virtually all, in many cases) are highly satisfied with the services received. However, when these results are compared to the findings of studies that use different methodologies to explore the patient’s perspective, the results are not as consistent as might be expected. It is not uncommon to find that “highly satisfied” patients report significant problems when mixed-methods studies are conducted. To understand this apparent contradiction, we explored two distinct (though not mutually exclusive) lines of reasoning, one of which concerns conceptual aspects and the other, methodological questions.
Conclusion
User satisfaction surveys, as currently designed and carried out in addiction treatment and harm reduction services, do not significantly help to improve service quality. Therefore, most of the enthusiasm and naiveté with which satisfaction surveys are currently performed and interpreted – and rarely acted on in the case of nonoptimal results – should be avoided. A truly participatory approach to program evaluation is urgently needed to reshape and transform patient satisfaction surveys.
Acknowledgments
This article is both dedicated, in memoriam, and profoundly indebted to Imma. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. However, the article-processing charge was defrayed by a grant from the Banco de Instrumentos del Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). An early draft of some of the ideas incorporated in this article was presented at the Encuentro FIPSE sobre Investigación de la Perspectiva Social del VIH/SIDA (FIPSE Research Meeting on Social Perspectives on HIV/AIDS) (Valencia, Spain, November 26–28, 2006), and appeared in Tratado SET de trastornos adictivos (SET Handbook of Addictive Disorders).Citation135
Author contributions
Joan Trujols and Ioseba Iraurgi conceived of and designed the present study, counting on advice from Eugenia Oviedo-Joekes and Joan Guàrdia-Olmos. Joan Trujols wrote the initial draft and led the writing of subsequent versions. All authors commented on and significantly contributed to the successive drafts. All authors read and approved the final version submitted for publication.
Disclosure
The authors state that they have been involved in the design, implementation, analysis, and/or reporting of satisfaction survey studies, whether or not cited in the current manuscript. Joan Trujols also declares to be a member of the team of researchers who adapted the Verona Service Satisfaction scale for methadone treatment programs; this adaptation is, in any case, in the public domain. Authors do not consider these facts to constitute actual or potential conflicts of interest with respect to the submitted manuscript but include the information for completeness and transparency. The views expressed are those of the authors and do not necessarily represent nor reflect those of the organizations or institutions in which they work. The authors report no other conflicts of interest in this work.