DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY
REVIEW
Measure of Processes of Care: a review of 20 years of research BARBARA J CUNNINGHAM
| PETER L ROSENBAUM
CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada. Correspondence to Peter Rosenbaum, CanChild Centre for Childhood Disability Research, Institute for Applied Health Sciences, McMaster University, 1400 Main Street West, Room 408 Hamilton, ON L8S 1C7, Canada. E-mail:
[email protected]
PUBLICATION DATA
Accepted for publication 11th October 2013. Published online 28th November 2013. ABBREVIATIONS
CSQ FCS FES FSS MPOC
Client Satisfaction Questionnaire Family-centred services Family Empowerment Scale Family Support Scale Measure of Processes of Care
AIM This article reviews literature on findings from the Measure of Processes of Care (MPOC) to assess family-centred services. METHOD Systematic searches for papers citing MPOC in both PubMed and Web of Science identified 107 articles. Fifty-five met the criterion for inclusion in this review in that they reported MPOC data. RESULTS Over the past 20 years MPOC has been used in settings additional to the children’s treatment centres for which it was designed; used in 11 countries and translated into 14 languages; and used to measure change in respondents’ perceptions over time. MPOC findings have also informed our understanding of the provision of family-centred services. Overall, parents report that service providers do a good job of providing respectful, comprehensive services in partnership with families, but that there remain limitations in the provision of general information, an area for improvement. Finally, MPOC has been shown to correlate with various other measures related to the provision of family-centred services. INTERPRETATION The MPOC ‘family’ of measures can be used to assess both families’ and service providers’ experiences and perceptions of the family-centredness of services received/ provided. Opportunities abound for further research enquiries.
Once a new measure is created, validated, and published it is easy to assume that the story is complete. There is, however, an afterlife to measures with respect to the ways in which they are used, their adaptations, whether they are translated (and, if so, whether they are validated to assess if they still ‘work’), and what is learned about the issues for which the measure was developed in the first place. The Measure of Processes of Care (MPOC) was developed as a clinical and research tool to measure parental perceptions of caregiving.1 It provides a self-report account of parents’ perceptions of the extent to which the health services they and their children receive are family centred. Several versions of MPOC are available for both parents and service providers. MPOC has been translated into 14 languages and is a trusted measure in many countries around the world. MPOC was designed to evaluate parents’ perceptions of the family-centredness of the services they and their children receive from developmental service providers and how those perceptions relate to parents’ satisfaction with services.1 The developers reasoned that parents who experienced more family-centred behaviours from their child’s service provider would experience less stress and greater satisfaction with their child’s services than parents who were served in a more traditional way.1 The original MPOC is a 56-item self-report measure that assesses ‘the extent to which’ services parents and © 2013 Mac Keith Press
children receive are family centred in five factorially determined domains: enabling and partnership; providing general information; providing specific information about the child; co-ordinated and comprehensive care; and respectful and supportive care.1 Reponses on the original MPOC-56 were made using a seven-point scale, of which three of the seven points were labelled as follows: 7 (to a great extent), 4 (sometimes), and 1 (never).2 MPOC-56 was developed in collaboration with close to 2000 parents from numerous children’s treatment centres across Ontario, Canada, in order to ensure that the concepts, content, format, and language of the measure were relevant, applicable, and accessible to potential users.1 MPOC-56 is psychometrically sound, with good reliability and good evidence of construct validity.1 It also correlates strongly with the Client Satisfaction Questionnaire (CSQ),3 a standard measure of satisfaction.1 A shorter, 20-item version (MPOC-20) developed in 2004 to improve the utility of the measure and increase its ability to discriminate programmes with different service delivery models.2 The psychometric properties of the shorter version were evaluated using existing data sets, and MPOC-20 was found to perform as well as MPOC-56 in terms of internal consistency, test–retest reliability, and construct validity.2 MPOC-20 was intended for use in programme evaluation and quality assurance activities; however, the more robust MPOC-56 is still recommended for research purposes.2 DOI: 10.1111/dmcn.12347
445
MPOC – Service Provider (MPOC-SP) was developed as an analogue of MPOC-56 to include service providers as well as parents in the evaluation of the provision of family-centred services (FCS).4 This measure served the important purpose of providing a self-assessment tool for professionals to evaluate their practices with respect to family-centredness, rather than their attitudes and beliefs, as could be done with other tools.4 Other adaptations of the original MPOC include MPOC-Adult (A),5 MPOC-28,6 and MPOC-8 South Africa (8 SA).7 The specific purposes of this review are twofold: (1) to review how MPOC tools have been used in research, and what researchers have learned about the measures, and (2) to summarize what researchers have learned and reported about FCS using this family of measures. In this paper, we discuss findings related to MPOC-56, MPOC-20, and MPOC-SP, but do not discuss findings related to MPOC-8(SA), MPOC-28, or MPOC-A as these were each used in only one study found in our search; however, detailed descriptions of all versions of MPOC are available in Appendix SI (online supporting information).
METHOD AND SUMMARY OF SEARCH FINDINGS To retrieve articles that had used MPOC, the term MPOC in a title or abstract was searched in the PubMed database. A citation search was also carried out using the Web of Science database for the original MPOC-56 article1 and MPOC-20 article.2 One hundred and seven articles were identified using the above-mentioned search criteria. Those articles were reviewed and sorted as follows: papers containing MPOC data (n=55); papers writing about FCS citing the MPOC as a way to assess but without MPOC data (n=7); papers that only referred to MPOC (n=13); papers with no reference to the MPOC, but that discussed FCS (n=21); and papers that were unrelated to FCS or MPOC, but discussed service provision in general (n=11). Since we wanted to review all of the published experiences with MPOC, we did not complete a formal quality evaluation of the papers as we planned to include all articles that contained MPOC data. Therefore, our inclusion criterion was that an article had to contain data from one of the MPOC measures, while our exclusion criterion was papers that only discussed MPOC or FCS, but did not report actual data from an MPOC measure. The 55 papers containing MPOC data were extracted from the original list and were further examined. Table I provides specific details on how those papers were sorted. Eleven countries were represented across the 55 articles (Table II). MPOC has been used in various settings, including children’s treatment or rehabilitation centres, children’s hospitals, large urban hospitals, university hospitals, and one community development programme (Australia). Numerous disabilities and conditions of children were targeted, including type 1 diabetes, physical disabilities, cerebral 446 Developmental Medicine & Child Neurology 2014, 56: 445–452
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What this paper adds MPOC measures have been shown to be valid in many settings additional to the treatment centres for which they were originally developed. MPOC measures are valid across countries, languages, and cultures. MPOC can be used to evaluate change in family-centredness.
palsy, cancer, and acquired brain injury, as well as general developmental disorders typically treated by developmental therapists. MPOC was usually used to evaluate services provided to parents of preschool or school-aged children; however, parents of children from as young as 2 months to as old as 26 years of age were included in some studies. MPOC-SP has been completed by numerous professionals, including physiotherapists, speech–language pathologists, occupational therapists, recreation therapists, physicians, nurses, social workers, psychologists, neurosurgeons, audiologists, managers, and case managers. In the articles examined for this project, MPOC-56 was used in English, Dutch, and Swedish; MPOC-20 was used in English, Dutch, Finnish, Norwegian, Traditional Chinese and Icelandic; and MPOC-SP was used in English, Dutch, Finnish, and Traditional Chinese. Among the adaptations of the original version of MPOC, MPOC-A was used in English; MPOC-8(SA) was used in six African languages; and MPOC-28 was translated into Swedish. In addition to the eight languages we found that were used in MPOC research, CanChild Centre for Childhood Disability Research reports that MPOC is available in ten other languages including, for MPOC-20, Arabic, Danish, French, German, Hebrew, Italian, Japanese, Latvian, Portuguese, and Spanish8 for MPOC-56, Hebrew and Japanese;8 and, for MPOC-SP, Arabic, Danish, Hebrew, Italian, Japanese, and Portuguese,9 in addition to the seven referred to above, but no published research articles were found in these languages.
RESULTS How research has expanded our understanding of MPOC measures When MPOC-56, MPOC-20, and MPOC-SP were originally created, they were known to be psychometrically strong measures that were developed based on what parents felt was important in terms of service provision for their children;1,2 however, several questions still remained. First, the measures were developed and validated almost entirely with parents of children with long-term, mainly
Table I: Papers reporting MPOC data (n=55) MPOC-56 MPOC-56 + MPOC-SP MPOC-SP MPOC-20 MPOC-20 + MPOC-SP MPOC-A MPOC-28 (modified with permission) MPOC-8 (SA) MPOC, Measure of Processes of Care; SP, service provider; A, adult.
18 5 5 20 4 1 1 1
Table II: Countries represented in articles reporting the MPOC Canada United States The Netherlands Australia England Sweden Finland Singapore Iceland Norway South Africa
20 9 7 5 4 3 2 2 1 1 1
MPOC, Measure of Processes of Care.
stable, neurodevelopmental disabilities in Canada. The parents who helped with the development of MPOC-56 were recruited from 13 of 19 ambulatory children’s rehabilitation centres and participation was voluntary. It was therefore not known how MPOC would perform if it were used with children and families outside traditional children’s treatment centres or with children with diagnoses other than stable neurodevelopmental disabilities.1,2,4 Second, testing was done only in English. Non-Englishspeaking Canadians were not sampled, and differences for ethnicity were not examined; the developers did not know how parents from cultures other than the majority English-Canadian group would respond to the measures.1,2,4 Finally, the developers wondered whether the measures would stand up as tools that could be used over time.1,2,4
Use outside traditional children’s treatment centres Overall, MPOC-56 and MPOC-20 have been used to measure parents’ perceptions of the provision of FCS in a variety of settings, including child development and rehabilitation centres, hospitals, children’s hospitals, and a paediatric neurology clinic.1,10–19 These measures worked as expected for their originally intended population (children with stable neurodevelopmental disorders). They were also able to measure FCS in other populations for which they were not initially intended, including children with visual impairment,20 children with diabetes,21 children in complex care clinics,22,23 and children in paediatric oncology wards.24,25 MPOC-20 was used to measure provision of FCS for families in an acquired brain injury treatment clinic;26 however, MPOC-56 was less successful in measuring the provision of FCS for children with acute mild head injury.27 It was thought that, owing to the mild nature of the injury and intervention in that study, the parents of children with acute mild head injury had difficulty completing all items on MPOC-56.27 The authors of that report felt that MPOC would have been more effective had it been used for children with more severe head injuries, who required longer hospital stays and more direct intervention.27 In our examination of the literature, MPOC-SP proved to be a useful measure in the setting of traditional children’s treatment centres.16,17,28–30 It was also used in other settings, including hospitals,10,14,31 children’s hospitals,32 and community development programmes.13 MPOC-SP
was reported to be useful in gathering service providers’ perceptions about their use of family-centred practices;14,28,31 in identifying strengths and gaps in service delivery;13,17,32 and in comparing parents’ perceptions with service providers’ perceptions.10,12,29 There was some evidence to suggest that professionals rated their provision of FCS differently depending on their working environment and their past experiences. For example, Jeglinsky et al.31 found that professionals working in multidisciplinary teams rated provision of general information higher than those who worked independently (p
