The measurement of quality of care in public sector psychiatric services based on consumer expectations.

In this study the expectations of consumers of public sector psychiatric care in South Africa were identified, and formulated in the form of 13 standards, each with a set of criteria. During this phase input from the literature was incorporated, and expectations were validated with different groups of consumers, so that rural/urban, ethnicity and regional differences were taken into account. Based on the comprehensive set of standards and criteria, four instruments were developed to measure attainment of these standards. These included a questionnaire to consumers and one to the Director of Mental Health. It also included two schedules to be filled in by observers during site visits to hospital units and clinics. The observer teams included community members and consumers. The content validity of the instruments was established by setting out the items measuring each criterium, and validating that with a group of experts. The instruments were then tested in one province. The inter-rater reliability of the site visit schedules was calculated as 0.94, and the coding of the Director questionnaire by different coders was also tested. The average performance on all criteria was calculated, using items from all four data collection instruments. In the process items were revised, coding instructions developed, and criteria adjusted.