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Development and Results of the Eye Care Expectations Survey (ECES)

Aerlyn G. Dawn; Gerald McGwin, Jr, MS, PhD; Paul P. Lee, MD, JD

Arch Ophthalmol. 2005;123:534-541.

Objective  To develop an instrument (the Eye Care Expectations Survey [ECES]) that can identify and quantify the expectations of patients visiting eye care providers.

Methods  A total of 202 patients attending 4 ophthalmology practices affiliated with Duke University Eye Center enrolled in the study. All participants completed the pilot version of the ECES, which was developed through a review of the expectations literature and a multicondition focus group process. Factor analysis of patients’ responses was used to identify the performance characteristics of the ECES.

Results  Factor analysis yielded factors that describe 4 distinct types of expectations: patient involvement in eye care, interpersonal manner, information about diagnosis and prognosis, and communication and clinical competence. These 4 factors explained 89% of the total variance. The factor analysis identified a subset of 27 questions (of the original 37) to represent the 4 factors. Estimates of internal consistency and test-retest reproducibility indicate that the ECES is reliable. In addition, tests of association with clinical variables support the construct validity of the survey. The psychometric properties of the ECES were influenced by the severity of the underlying eye condition as well as other demographic and clinical variables, including the patient’s rating of his or her own vision, best corrected visual acuity, sex, education, race, and household income.

Conclusions  Based on this cross-sectional study, the 27-item ECES appears to be a useful tool for better understanding patients’ expectations regarding eye care.

Author Affiliations: Department of Ophthalmology, Duke University School of Medicine (Mr Dawn and Dr Lee), and Fuqua School of Business (Mr Dawn), Durham, NC; Department of Epidemiology, School of Public Health, and Department of Ophthalmology, School of Medicine, University of Alabama, Birmingham (Dr McGwin); and RAND, Santa Monica, Calif (Dr Lee). At the time of this study Mr Dawn was an MD/MBA candidate; he has now received MD and MBA degrees.