Abstract
Background: Compassionate Healthcare In Action (CHIA) is a new questionnaire to measure patient experiences of compassionate care, with a particular focus on observable behaviours. It has been designed to address gaps in currently available metrics. It is generalisable across healthcare contexts and has been developed with patient and public involvement throughout. The present study sought to build on earlier development to evaluate the CHIA’s face validity, perform item reduction, establish dimensionality, validity and reliability.
Methods: Face validity was assessed via cognitive interviews with UK healthcare service users. Interviews used a Three-Step Test Method to understand how CHIA items were used, and which items were considered most/least important in measuring patient experiences of compassionate care (study 1). Cross-sectional survey data were analysed using inter-item correlations, item discrimination indexes, item and local dependency analyses and exploratory factor analysis. Statistical analyses were combined with cognitive interview data and panel reviewed to inform item reduction (study 2). A final cross-sectional survey corroborated single-factor dimensionality through confirmatory factor analysis alongside establishing reliability and validity (study 3).
Results: 21 cognitive interviews established face validity and identified items with stronger face validity (study 1). These results were combined with survey analyses (n=311). 7 items were removed resulting in a 14-item CHIA demonstrating a single factor structure (study 2). In study 3, further survey analysis (n=301) reinforced results showing a strong unidimensional structure, internal consistency, test-retest reliability and validity: content, face, convergent and discriminant.
Conclusions: The CHIA is a brief and generalisable metric that evaluates patient perceptions of compassionate care they receive. It has been robustly developed and has strong psychometric properties. The CHIA shows promise for supporting healthcare services to evaluate and improve their care. Further research could examine the CHIA in different contexts and populations.
Patient or Public Contribution: Lived experience consultants supported prior CHIA development papers. In this paper a lived experience consultant (experience of physical and mental healthcare services) was involved in reviewing methodology and materials, advising on and helping with recruitment, contributing to review panel discussions, reviewing and authoring this manuscript. Additionally, methods throughout sought to amplify the voices of diverse populations who could complete the CHIA.
Methods: Face validity was assessed via cognitive interviews with UK healthcare service users. Interviews used a Three-Step Test Method to understand how CHIA items were used, and which items were considered most/least important in measuring patient experiences of compassionate care (study 1). Cross-sectional survey data were analysed using inter-item correlations, item discrimination indexes, item and local dependency analyses and exploratory factor analysis. Statistical analyses were combined with cognitive interview data and panel reviewed to inform item reduction (study 2). A final cross-sectional survey corroborated single-factor dimensionality through confirmatory factor analysis alongside establishing reliability and validity (study 3).
Results: 21 cognitive interviews established face validity and identified items with stronger face validity (study 1). These results were combined with survey analyses (n=311). 7 items were removed resulting in a 14-item CHIA demonstrating a single factor structure (study 2). In study 3, further survey analysis (n=301) reinforced results showing a strong unidimensional structure, internal consistency, test-retest reliability and validity: content, face, convergent and discriminant.
Conclusions: The CHIA is a brief and generalisable metric that evaluates patient perceptions of compassionate care they receive. It has been robustly developed and has strong psychometric properties. The CHIA shows promise for supporting healthcare services to evaluate and improve their care. Further research could examine the CHIA in different contexts and populations.
Patient or Public Contribution: Lived experience consultants supported prior CHIA development papers. In this paper a lived experience consultant (experience of physical and mental healthcare services) was involved in reviewing methodology and materials, advising on and helping with recruitment, contributing to review panel discussions, reviewing and authoring this manuscript. Additionally, methods throughout sought to amplify the voices of diverse populations who could complete the CHIA.
| Original language | English |
|---|---|
| Number of pages | 19 |
| Journal | Health Expectations |
| DOIs | |
| Publication status | Published - 21 Jul 2026 |
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. The data that support the findings of this study are available on reasonable request from the corresponding author (with the exception of some participants who did not consent to this). The data are not publicly available due to ethical restrictions.Acknowledgements
Thank you to Kasia Kuczaj and Jacob Edwards for supporting the transcription and coding of the cognitive interviews and participation in the panel. Thank you to Dr Tom Jenkins and Professor Paul Chadwick for your discussions throughout and participation in the panel. Thankyou to staff from the University of Bath Mathematics Resources Centre(MASH), who have provided invaluable statistical consultation throughout the project. Also, we would like to acknowledge all the participants who gave their time. SA and EH worked on this project as part of their Doctorate in Clinical Psychology at the University of Bath(data for Studies 1 and 2). SA and EH were supported by Health Education England during their clinical training. SH worked on this project as part of her Masters degree at the University of Bath (data for Study 3). No specific funding was received for this project. LM was supported by the National Institute for Health and Care Research(NIHR) (Clinical Academic Fellowship NIHR301578) during part of the period of this work. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The project described in this paper did not receive specific funding from this or any other grant.Keywords
- care
- compassion
- measure
- metric
- questionnaire
- reliability
- validity
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