The Relational Aspects of Care Questionnaire: item reduction and scoring using inpatient and accident and emergency data in England

Figures & data

Table 1 Response option codes for approach 1 and approach 2

Item	Approach 1, item (coded response)	Approach 2, item (recoded response)
7. If you have needed attention, have you been able to get a member of medical or nursing staff to help you?	Yes, always (100)	Yes, always (100)
	Yes, sometimes (50)	Yes, sometimes (50)
	No, never (0)	No, never (0)
	I have not needed attention (–)	I have not needed attention (100)
8. Have staff responded quickly when you ask for help?	Yes, always (100)	Yes, always (100)
	Yes, to some extent (50)	Yes, to some extent (50)
	No (0)	No (0)
	I have not asked for help (–)	I have not asked for help (100)
	Do not know (–)	Do not know (–)
9. If you have raised any concerns with staff, have these been followed up?	Yes, definitely (100)	Yes, definitely (100)
	Yes, to some extent (50)	Yes, to some extent (50)
	No (0)	No (0)
	I have not raised any concerns (–)	I have not raised any concerns (100)
	Do not know (–)	Do not know (–)
12. Have your family or carers been informed by the staff about your condition?	Yes, definitely (100)	Yes, definitely (100)
	Yes, to some extent (50)	Yes, to some extent (50)
	No (0)	No (0)
	There has been no need to inform my family or carers (–)	There has been no need to inform my family or carers (100)
	There are no family or carers to be informed (–)	There is no family or carers to be informed (100)
13. Have you been involved as much as you want to be in decisions about your care and treatment?	Yes, definitely (100)	Yes, definitely (100)
	Yes, to some extent (50)	Yes, to some extent (50)
	No (0)	No (0)
	I have not been well enough to be involved in decisions about my care (–)	I have not been well enough to be involved in decisions about my care (100)
14. Have staff explained your condition and treatment in a way you can understand?	Yes, completely (100)	Yes, completely (100)
	Yes, to some extent (50)	Yes, to some extent (0)
	No (0)	No (0)
	I have not needed an explanation (–)	I have not needed an explanation (100)
15. Has a member of staff answered your questions in a way that you could easily understand?	Yes, completely (100)	Yes, completely (100)
	Yes, to some extent (50)	Yes, to some extent (50)
	No (0)	No (0)
	I have not had any questions (–)	I have not had any questions (100)
16. If you have had any anxieties or fears about your condition or treatment, has a member of staff discussed them with you?	Yes, completely (100)	Yes, completely (100)
	Yes, to some extent (50)	Yes, to some extent (50)
	No (0)	No (0)
	I have not had any anxieties or fears (–)	I have not had any anxieties or fears (1)
17. Has a member of staff told you about what danger signals regarding your condition or treatment to watch for?	Yes, completely (100)	Yes, completely (100)
	Yes, to some extent (50)	Yes, to some extent (50)
	No (0)	No (0)
	I have not needed this type of information (–)	I have not needed this type of information (100)

Figure 1 Steps of analysis and item removal.

Abbreviation: NHS, National Health Service.

Table 2 Characteristics (for cases with at least four responses)

Characteristics	n (%)
Sex
Male	1687 (43.4)
Female	2044 (52.6)
Missing	158 (4.1)
Age group (years)
18–30	329 (8.5)
31–40	235 (6.0)
41–50	332 (8.5)
51–60	402 (10.3)
61–70	492 (12.7)
71–80	700 (18.0)
81–90	793 (20.4)
≥91	238 (6.1)
Missing	368 (9.5)
Condition(s)
Deafness or severe hearing impairment	455 (11.7)
Blindness or partial sighted	195 (5.0)
A long-standing physical condition	716 (18.4)
A learning disability	52 (1.3)
A mental health condition	153 (3.9)
Dementia	96 (2.5)
Other long-standing condition	961 (24.7)
No long-standing condition	1767 (45.4)
Mode of administration
Tablet	3590 (92.3)
Kiosk	299 (7.7)
Ethnicity
English/Welsh/Scottish/Northern Irish/British	3540 (91.0)
Irish	14 (0.4)
Gypsy or Irish traveler	12 (0.3)
White and Black Caribbean	4 (0.1)
White and Black African	5 (0.1)
White and Asian	4 (0.1)
Indian	10 (0.3)
Pakistani	6 (0.2)
Bangladeshi	9 (0.2)
Chinese	7 (0.2)
African	9 (0.2)
Caribbean	6 (0.2)
Arab	3 (0.1)
Any other ethnic group	49 (1.3)
Missing	211 (5.4)

Table 3 Items removed during the study for approaches 1 and 2

Questionnaire item	Item removed
	Approach 1	Approach 2
1. Have staff introduced themselves before treating or caring for you?		✓
2. Have staff taken the opportunity to learn about you as a person?		✓
3. Have staff made you feel at ease by being friendly and warm in conversations?
4. Have staff showed you care and compassion?
5. Have staff listened to what you have to say?
6. During your time in hospital, have you had enough contact with staff?
7. If you have needed attention, have you been able to get a member of medical or nursing staff to help you?	✓
8. Have staff responded quickly when you ask for help?	✓
9. If you have raised any concerns with staff, have these been followed up?	✓
10. Do staff appear confident and able to perform their tasks when caring for you?
11. Have you had enough time to discuss your health or medical problem with a doctor or nurse?
12. Have your family or carers been informed by the staff about your condition?	✓	✓
13. Have you been involved as much as you want to be in decisions about your care and treatment?
14. Have staff explained your condition and treatment in a way you can understand?	✓
15. Has a member of staff answered your questions in a way that you could easily understand?	✓
16. If you have had any anxieties or fears about your condition or treatment, has a member of staff discussed them with you?	✓
17. Has a member of staff told you about what danger signals regarding your condition or treatment to watch for?	✓	✓
18. During your time in hospital, have staff made you feel safe?		✓
19. Have you received as much support as you have needed from staff?
20. Overall, do you feel you have been treated with respect and dignity while in hospital?		✓

Table 4 Scale descriptive statistics

Scale	Mean	n*	SD	Standard error of the mean	Cronbach’s a	Spearman’s correlation	ICC
Approach 1
RAC-Q, 20 items	83.43	609	20.15	0.82	0.94	0.93, p<0.001	0.97 (0.97)**
RAC-Q-12	85.60	609	19.96	0.81	0.92
Approach 2
RAC-Q, 20 items	88.91	2967	14.25	0.26	0.90	0.92, p<0.001	0.97 (0.97)**
RAC-Q-14	90.11	2967	14.61	0.27	0.89

Notes:

* Cases where scored responses were obtained for all RAC-Q and respective short-form items.

** Exact agreement.

Abbreviations: ICC, intraclass correlation coefficient; RAC-Q, Relational Aspects of Care Questionnaire.

Table 5 Differences between sex, mode of completion (Mann–Whitney U-test of significance) and hospital trusts (Kruskal–Wallis k-independent samples test)

Characteristics		RAC-Q-12 items			RAC-Q-14 items
		n	Mean (SD)	p	n	Mean (SD)	p
Sex	Male	1413	90.19 (13.44)	0.016	1460	91.17 (13.37)	<0.001
	Female	1664	88.37 (15.86)		1742	88.63 (16.18)
Mode of completion Trust	Tablet	2844	89.27 (14.36)	0.044	2959	89.86 (14.54)	0.18
	Kiosk	243	88.41 (19.40)		256	88.60 (19.82)
	Site A	431	88.82 (12.73)	<0.001	442	89.88 (13.07)	<0.001
	Site B	357	83.72 (18.30)		357	83.98 (18.92)
	Site C	579	91.62 (13.52)		628	91.61 (13.71)
	Site D	444	88.55 (13.84)		465	89.08 (14.33)
	Site E	653	86.84 (17.49)		676	87.61 (17.46)
	Site F	623	93.30 (10.63)		647	93.78 (10.88)

Notes: Data collection took place in six hospital trusts within England. Sites A-F represent these distinct locations.

Abbreviation: RAC-Q, Relational Aspects of Care Questionnaire.