Sammendrag
The primary aim of this thesis is to address the knowledge gap concerning user satisfaction with Child and Adolescent Mental Health Services (CAMHS) from the perspectives of young people and their parents. The objectives are threefold: (1) establish the construct validity of the Experience of Service Questionnaire (ESQ) (Paper I), assess the predictors of user satisfaction (Paper II), and explore the impact of user satisfaction on clinical outcomes (Paper III). By utilizing registry data collected from ordinary CAMHS in Norway (Papers I to III) and the United Kingdom (UK) (Paper I), and employing rigorous data analysis and statistical modelling, this thesis delves into the complexities of user satisfaction, uncovering insights into the factors that shape user satisfaction with CAMHS. In Paper I, a bifactor model was found to be the best fit for the English and Norwegian versions of the ESQ, revealing a General Satisfaction (GS) factor along with two subordinate factors: Satisfaction with Care (SWC), and Satisfaction with Environment (SWE). However, the Norwegian version for young people retained a unidimensional model. Paper II explored the specific predictors for young people and parents, revealing the distinct influences of these predictors on satisfaction levels. Paper III found that discrepancies in user satisfaction between young people and their parents were linked to poorer outcomes for young people, with both young people and parent-reported satisfaction found to be predictors of these outcomes. In particular, the interaction between young people and parent satisfaction emerged as a significant predictor of young people’s reported outcomes and explained a substantial proportion (10%) of the outcome variance. The collected findings of this thesis are consolidated in the form of a proposed conceptual model for user satisfaction in CAMHS. This model highlights the interconnection between satisfaction factors and emphasizes the necessity of personalized, effective care that addresses the distinct needs of young people and their parents in CAMHS settings. Overall, this thesis highlights the importance of prioritizing user satisfaction to improve clinical outcomes and enhance mental health services for children and adolescents.
Formålet med denne avhandlingen er å øke kunnskapen om brukertilfredshet i Barne- og Ungdomspsykiatriske tjenester (BUP) fra ungdom og foreldres perspektiv. Hovedmålene med forskningen er å etablere konstruktvaliditeten til brukertilfredshetsmålet Experience of Service Questionnaire (ESQ) (Paper I), analysere hvilke faktorer som predikerer brukertilfredshet (Paper II) og utforske hvilken innvirkning brukertilfredshet har på behandlingsresultat (Paper III). Problemstillingene ble undersøkt ved å analysere registerdata fra ordinær klinisk praksis i BUP i Norge (Paper I-III) og Storbritannia (Paper I). I første artikkel fant vi at en bifaktormodell best forklarte den underliggende faktorstrukturen til den engelske og norske versjonen av ESQ, med en generell tilfredshetsfaktor (GS), samt to underliggende faktorer: for tilfredshet med omsorg (SWC) og tilfredshet med miljøet (SWE). For den norske ungdomsversjonen av ESQ ble en unidimensjonal modell beholdt. I den andre artikkelen avdekket vi spesifikke prediktorer for ungdom og foreldres brukertilfredshet. I den siste artikkelen fant vi at uoverensstemmelser i brukertilfredshet mellom ungdom og foreldre var knyttet til dårligere behandlingsresultat. Spesielt viste det seg at interaksjonen mellom ungdom og foreldres tilfredshet var en betydelig prediktor for ungdomsrapporterte behandlingsresultater, der hele 10% variansen ble forklart av interaksjonseffekten. Basert på disse resultatene foreslås en konseptuell modell for brukertilfredshet i BUP. Modellen fremhever sammenhengen mellom tilfredshetsfaktorer og understreker nødvendigheten av skreddersydd behandling til familier som har behov for et tilbud i BUP. Samlet sett understreker denne avhandlingen viktigheten av å prioritere brukertilfredshet for å forbedre kliniske resultater og styrke psykiske helsetjenester for barn og ungdom.
Har del(er)
Paper I: Arnesen, Y., Handegård, B.-H., Mathiassen, B., Lillevoll, K., Martinussen, M., da Costa Silva, L., … Edbrook-Childs, J. User satisfaction with Child and Adolescent Mental Health Services: Factor structure of the Experience of Service Questionnaire (ESQ) in Norway and the UK. (Submitted manuscript).
Paper II: Arnesen, Y., Lillevoll, K.R. & Mathiassen, B. (2023). User satisfaction in child and adolescent mental health service: Comparison of background, clinical and service predictors for adolescent and parent satisfaction. Health Expectations, 26(6), 2608–2619. Also available in Munin at https://hdl.handle.net/10037/31715.
Paper III: Mathiassen, B. & Arnesen, Y. (2024). User satisfaction with child and adolescent mental health services: the association between user satisfaction and clinical outcomes. BMC Psychiatry, 24, 279. Also available in Munin at https://hdl.handle.net/10037/34188.