Purpose: The Relational Aspects of Care (RAC) questionnaire is an electronic instrument which has been developed to assess staff interactions with patients when delivering relational care to inpatients and those accessing Accident and Emergency (A&E) services. This analysis aimed to reduce the number of questionnaire items and explore scoring methods for ‘not applicable’ response options.
Patients and methods: Participants (n=3928) were inpatients or A&E attendees across six participating hospital trusts in England during 2015-2016. The instrument, consisting of 20 questionnaire items, was administered by trained hospital volunteers over a period of ten months. Items were subjected to exploratory factor analysis to confirm unidimensionality and the number of items were reduced using a range of psychometric apriori criteria. Two alternative approaches to scoring were undertaken, one treated ‘not applicable’ responses as missing data while the second adopted a problem score approach where ‘not applicable’ was considered ‘no problem with care’.
Results: Two short form questionnaires with alternate scoring options were identified. The first (the RAC-12) contained 12 items, while the second problem score approach short form (the RAC-14) contained 14 items Scores from both short forms correlated highly with the full 20 item parent form score (RAC-12, rho=0.93 and RAC-14, rho=0.92), displayed high internal consistency (Cronbach’s α, RAC-12= 0.92 and RAC-14=0.89) and had high levels of agreement (ICC=0.97 for both scales).
Conclusion: The RAC is designed to offer near real-time feedback on staff interactions with patients when delivering relational care. The new RAC short form questionnaires and their respective method of scoring are reflective of scores derived using the full 20 item parent form.The new short form questionnaires may be incorporated into inpatient surveys to enable the comparison of ward or hospital performance. Use of a RAC short form offers a method which to reduce missing data and responder fatigue.
