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DOI: 10.1177/0733464810386222November 2010

2012 31: 354 originally published online 2Journal of Applied GerontologyAlice Ming Lin Chong

ResidentsCognitive Predictors of Satisfaction in Hong Kong Institutional Care

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JAG 31 3 10.1177/0733464810386222ChongJournal of Applied Gerontology TheAuthor(s) 2012

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Manuscript received: November 4, 2009; fnal revision received: August 21, 2010;accepted: September 11, 2010.

1City University o Hong Kong, Hong Kong, Peoples Republic o China

Corresponding Author:

Alice Ming Lin Chong, Department o Applied Social Studies, College o Humanities and Social

Sciences, City University o Hong Kong, Tat Chee Avenue, Hong Kong, Peoples Republic o China

Email: [email protected]

Cognitive Predictors

o Satisaction

in Hong Kong

Institutional

Care Residents

Alice Ming Lin Chong

1

Abstract

This article reports one o the irst known studies which examine the association

between cognitive factors and older peoples satisfaction with residential care. These

actors are conceptually related to but have seldom been examined in institutional

care. They include perceived service performance, service expectation, expectancy

disconfirmation (operationalized as the difference between service expectation and

perceived performance), perceived care need, and care need fulfillment. Face-to-face

interviews were conducted with Chinese Hong Kong residents from 11 government-

unded long-term care homes randomly and proportionately selected rom two

strata based on acility size. Finally, 405 residents were successully interviewed.

Path analysis revealed that perceived performance, expectancy disconfirmation, and

being emale predicted residents satisaction with care. Perceived care need and

care need fulfillment exerted an indirect effect on residents satisfaction through

perceived perormance. It is suggested that cognitive actors as perceived by the

residents be included as predictors o resident satisaction in long-term care.

Keywords

resident satisaction, perceived perormance, expectancy disconfrmation, care

need, care need ulfllment

Article

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Chong 355

Population aging inevitably leads to an increase in both the absolute number and

the percentage of older people who, because of physical and mental impairments,

require institutional care. Hong Kong is no exception. In 2009, 13% of its popula-

tion were aged 65 and above, and this ratio is projected to rise to 25.9% in 2039

(Census and Statistics Department, 2010), mainly due to improved longevity. Insti-

tutional care has emerged as the major alternate option to home care for older

Chinese who require assistance with their daily living (Wu, Tang, & Yan, 2004)

due to the rise of the nuclear family and the crowded living environment.

Due to the frailty and vulnerability of the residents, there has always been a great

concern about the service quality of the institutions. Increasingly, resident satisfac-

tion with care has been used as an outcome indicator of the quality of long-term

care (Atherly, Kane, & Smith, 2004; Chou, Boldy, & Lee, 2002; Kruzich, Clinton,

& Kelber, 1992; Lee, Lee, & Woo, 2005; Sikorska, 1999; Yeh, Sehy, & Lin, 2002).

Castle, Lowe, Lucas, Robinson, and Crystal (2004), for example, found that 86%

of nursing homes in New Jersey monitored quality of care with resident satisfaction

surveys. This reflects a delightful change from past reservation about the ability of

the long-term care residents to give reliable and valid feedbacks (Chou et al., 2002;

Ejaz & Castle, 2007; Straker, Ejaz, McCarthy, & Jones, 2007).

Satisfaction with care is an experience or a response that is associated with the

consumption of certain services. According to Oliver (1997), satisfaction is theconsumers fulfilment response. It is a judgement that a product or service feature,

or the product or service itself, provided (or is providing) a pleasurable level

of consumption-related fulfilment, including levels of under- or over-fulfilment

(p. 13). An important issue in resident satisfaction study is to identify factors that

would affect residents satisfaction with care to provide crucial information to

long-term care providers and professionals. Yet a review of the literature reveals

that, although personal factors (such as health and age), as well as organizational

factors (such as staffing), have been examined frequently, there is a lack of studyon cognitive-based perceptual factors (such as service expectation, perceived

performance of the facility) that are conceptually related to residents satisfaction

with care. Although cognitive variables are quite commonly used in the marketing

and service industries, to our knowledge, they have seldom been applied to the

context of residential care. Akamigbo and Wolinsky (2006) did examine resident

expectation, but they measured the service expectation of obtaining a nursing home

placement, rather than expectations of service quality. Cognitive factors are impor-

tant because they reflect residents subjective reality and their personal assessment,

which are directly related to their sense of well-being. Moreover, these factors are

more within the control of service providers than the residents personal factors

such as gender and age, which are completely beyond control, and organizational

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356 Journal of Applied Gerontology31(3)

factors such as institutional size, which may involve resources that are not readily

available.

This article reports the findings of a study that examined a group of cognitive

predictors which is very much neglected in nursing home satisfaction. In particular,

the study explored how satisfaction with care might be related to residents service

expectation and perception of their own care needs on one hand and, in their eyes,

the facilities service performance and provision of assistance to meet their care

needs on the other. The study also explored how residents sense of satisfaction

would be related to the discrepancy between their service expectation and perceived

service performance (assessed as expectancy disconfirmation). This study is part

of a larger research on examining the degree of satisfaction and various predictors

of satisfaction among Chinese residents of long-term care homes in Hong Kong

(Chong, 2003; Chong & Chi, 2001).

Resident Satisaction

and Cognitive Determinants

One major issue in satisfaction study is whether the construct of satisfaction is

unidimensional or multidimensional. Levkoff and DeShane (1979) stated that sat-

isfaction appeared to be unidemensional because high satisfaction with service wasfound irrespective of service types. However, many others argue that the construct

of satisfaction is multidimensional (Chou, Boldy, & Lee, 2001; Hayes, 1992; Lee

et al., 2005; Oliver, 1997). Higgs, MacDonald, MadDonald, and Ward (1998)

identified five themes of satisfaction experienced by residents of nursing homes in

United Kingdom, including relation with staff, autonomy, amenities, privacy, and

social environment. Chou et al. (2001) suggests satisfaction consists of six correlated

factors. More recently, Straker et al. (2007), through a survey of 18,560 residents

in Ohio, have identified eight factors (such as activities, choice, administration,meals and dining, laundry), along with an underlying secondary Global Satisfaction

factor. Castles (2007) review of 50 studies on resident satisfaction also found many

tools that ask both overall satisfaction and different care domains, reflecting a

multidimensional approach to satisfaction.

Another challenge in measuring consumer satisfaction is that the notion of

satisfaction has many proxies, such as assessment, good feelings, and service quality.

The last one, namely service quality, is very often used interchangeably with

satisfaction. Bergman and Klefsjo (1994), for example, defined quality as consumer

satisfaction and delight. However, service quality and consumer satisfaction could

be recognized as closely related but distinct constructs. Service quality is defined

as the consumers judgment about a service/products overall excellence or supe-

riority (Oliver, 1997; Parasuraman, Zeithaml, & Berry, 1988), and it is generally



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Chong 357

assumed that higher quality of care would lead to higher level of resident satisfac-

tion (Chou et al., 2002). However, satisfaction is a state felt by a consumer who has

experienced a performance/outcome that has fulfilled his or her expectation (Kotler,

1982), it is primarily a subjective response to a consumption experience and may

involve the interplay of the individuals cognition and emotions or, as suggested by

Oliver (1997, p. 319), a hybrid cognition-emotion. This article argues that long-

term care satisfaction arises from the residents subjective assessment of the quality

of aged care.

A related complexity concerns the way satisfaction and quality of care are opera-

tionalized. Features of care such as food and choice could be taken both as inde-

pendent variables affecting satisfaction and as components of care making up the

satisfaction experience. Some studies (such as those conducted by Chou et al., 2001,

2002; Martin & Kettner, 1996; Straker et al., 2007) used features of care as different

dimensions of satisfaction, whereas other studies (Duffy, Duffy, & Kilbourne, 1997;

Higgs et al., 1998; Kane et al., 1997) used features of care as quality indicators and

not as outcome measures of satisfaction. The present study adopts the second

approach and uses features of care in the measure of perceived performance, service

expectation, and expectancy disconfirmation, to cover major quality indicators

involved in long-term care.

Most of the publications on cognitive determinants of consumer satisfaction arein the field of marketing and service industry which takes consumer satisfaction

as a consumer response to the evaluation of the discrepancy between actual service/

product performance and the consumers different comparison standards (Oliver,

1997). Tse and Wilton (1988) suggest ideal performance, equity, expectation, and

expectancy disconfirmation as possible comparison standards or determinants.

Oliver (1997) argued that satisfaction results from the psychological processing

of service performance, and proposed expectation, expectancy disconfirmation,

needs, need fulfillment, performance, service quality, and fairness as possibly affect-ing the consumers satisfaction or dissatisfaction.

The present study hypothesized that the residents satisfaction with care was

associated with cognitive-based perceptual factors. In particular, resident satisfac-

tion was postulated to be positively related to the perceived performance of the

institution, service expectation, expectancy disconfirmation, and perceived care

need fulfillment and negatively related to perceived care need. In addition to the

direct influence, it was also hypothesized that perceived performance and expecta-

tion exerted an indirect positive effect on satisfaction via expectancy disconfirma-

tion and that perceived care need exerted an indirect and positive effect on

satisfaction through care need fulfillment (Figure 1).

Assessing the perception of service performance has been the traditional approach

in the consumer satisfaction literature (Oliver, 1997). Tse and Wilton (1988) found



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that perceived performance exerts both a direct influence on satisfaction and an

indirect effect on satisfaction through expectancy disconfirmation. Service expecta-tion refers to pretrial beliefs about a product or service (Faranda, 1996) and are

formed on the basis of peoples past experience with similar situations and the

statement made by friends, operators, or organizations (Kotler, 1982). It includes

ideal or desirable expectation, and practical or realistic expectation (Ellmer &

Olbrisch, 1983). Practical expectation was examined in the present study because

in the pilot study, the participants became confused when being asked about their

desirable expectation. Expectancy disconfirmation has been a dominant measure

in consumer satisfaction in the service industry (Gotlieb, Grewal, & Brown, 1994;Oliver, 1997, Oliver & DeSarbo, 1988). It refers to the difference (positive, nega-

tive, or neutral) between the residents expectation of the service provided by their

institutions and the institutions performance on individual features of care as per-

ceived by the resident (Oliver, 1997; Yi, 1990). Kotler (1982) argued that if perfor-

mance matched the expectation, the consumer was satisfied. If the performance fell

short of the expectation, the consumer was dissatisfied.

The notion ofcare needrefers to fundamental requirements for human survival

and basic well-being. Oliver (1997) differentiates between need and want in that

needs are more aligned with deficits whereas wants result from desired enhance-

ment. Need fulfillment assesses the fit between the care needs of the resident and

the resources/assistance provided by the long-term care home. The question is

whether service performance meets, falls short, or exceeds a consumers care needs

Expectation+

Expectancy

Disconfirmation +

+

Perceived

Performance

+ Resident

Satisfaction

Care Need

Fulfilment+

_

+Perceived Care

Need

+

Figure 1. Conceptual model o the cognitive predictors o resident satisaction



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Chong 359

(Oliver, 1997). As is pointed out by Bradshaw (1977), the concept of need is inher-

ent in the idea of social service, yet there are very few empirical studies on both

the concept of need and need fulfillment, possibly because the concept is too intui-

tively obvious (Oliver, 1997).

Method

Research Design

A cross-sectional survey using face-to-face interview was conducted in Hong Kong

with 405 Chinese residents living in 11 government-funded care-and-attention

homes randomly and proportionately selected from two strata based on facility size.

Sample and Setting

There are two main types of long-term care homes for older people in Hong Kong:

government-funded and privately funded homes. The focus of this study was

on government-funded care-and-attention homes, which provide the bulk of pub-

licly funded institutional care. Care-and-attention homes mainly provide personal

care and limited nursing care to their residents and, compared with long-term carehomes in the West such as in the United States, fall somewhere between continuous

care residential centers and long-term care institutions. Although the majority of

long-term care residents in the United States are cognitively impaired, the percent-

age tends to be lower in Hong Kong because some residents have been institutional-

ized due to social instead of nursing needs (Lee et al., 2005). These homes are in

great demand among older people. As of February 28, 2010, 25,879 older people

were on the central waiting list for residential care and 75% of them were waiting

for care-and-attention homes. The average waiting time was as high as 30 months(Social Welfare Department, 2010).

There was an absence of a complete list of institutionalized older people in

Hong Kong; the only available information was the list of long-term care homes,

which indicated that there were 8,519 beds in 78 care-and-attention homes at the

time of the study. All institutions were financed by the government according to

a standard subvention formula based on the capacity of the institutions and thus the

resource input would be very similar among institutions of similar size. Proportion-

ate stratified random sampling was used, taking 150 beds as the cutting point

between large and small institutions according to government practice. Under this

classification, there were 56 small institutions and 22 large ones, providing 47%

and 53% beds, respectively.



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The sample size was calculated by adopting the formula (t2p[1 - p]) / d2, where

t= .05 significance level for making a Type 1 error,p= estimated proportion of

residents who were satisfied and was assumed to be 50%, and d= acceptable error

of 5% that the estimated proportion will lie outside p 5%. The resulted figure of

384.16 was around up to a sample size of 400, which, in proportion should include

189 respondents from small institutions and 211 from large ones. Letters with reply

slips were sent to institutions down the two randomized list of institutions until

the quota was met. A total of 18 care-and-attention homes were approached and

11 consented, giving a response rate of 61%. This rate, though low, is in fact higher

than the rate of 55% of another study on government-funded long-term care homes

(Chong & Kwan, 2001). Moreover, phone contact was made with superintendents

of the seven institutions to detect any possible bias among institutions which refused

to participate. Being busy with preparing for external assessment newly introduced

by the government was given by all the superintendents. Other reasons were as

follows: the decision of the senior management, being preoccupied with preparing

its own opening ceremony, and having just gone through massive renovation and

the whole home had not yet settled down.

The 11 institutions were asked to carry out the initial screening according to the

sampling criteria, which is not an uncommon practice in research on residential care

(Uman & Urman, 1997), because the institution staff should be knowledgeable aboutwhether individual residents met the selection criteria. Each responsible staff was

provided by the research team with a standardized information sheet and briefing

on the selection criteria, namely ageing 60 or older, being capable of communicating

clearly, not suffering from severe cognitive or physical impairments, and having

lived in the facilities for not less than 3 months. In particular, the staff was asked to

screen out only residents who were diagnosed by physicians to be severely impaired

physically or cognitively or both, but to retain residents about whose eligibility they

were not sure. The 10-item Chinese version of Pfeiffers Short Portable Mental StatusQuestionnaire (SPMSQ) was administered as a screening test to ascertain individual

residents level of cognitive competence. Residents with an adjusted SPMSQ summed

score lower than 5 were excluded, as they would not be able to give reliable responses

(Chi & Boey, 1992). These selection measures were intended to reduce selection

bias and to retain as many residents as possible, including those who were having

mild to moderate cognitive impairment.

After the screening test, 474 (54.9%) out of the 864 residents from these

11 institutions were identified as eligible for the study and were interviewed by

trained interviewers. Finally, 405 residents were successfully interviewed, giving

a response rate of 85%. The reasons for the 69 residents who were eligible but did

not participate mainly concerned health issues such as feeling unwell, sleeping at



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Chong 361

the time of interview, attending medical appointment, and hospitalization (13%).

Some were attending activities or having visitors (1.5%), a few found the interview

too long (0.5%). Among the respondents, 193 (47.7%) lived in 6 small institutions

and 212 (52.3%) in 5 large institutions, which was an accurate reflection of the

actual distribution of beds in the two types of institutions. T-tests found no significant

difference in the distribution of age and gender of respondents from large and

small homes.

Measures

Six of the seven measurement tools used in the study were specially constructed

for use with older Chinese and were validated through a systematic validation

process that included a literature review, a focus group discussion with 5 residents

with different health conditions, a review by 8 multidisciplinary experts in long-term

care, a pretest with 20 residents, and a pilot survey of 99 residents (Chong, 2003;

Chong & Chi, 2001).

The four-item Residential Care Satisfaction Scale (RCSS; Chong, 2003) measured

the dependent variable of resident satisfaction and explored different behavioral

emotive dimensions of satisfaction. The first two items measured the behavioral

dimension of satisfaction and asked residents whether they would recommend theirinstitution to their friends and choose their institution again should they be able

to start afresh. The last two items measured the affective dimension of satisfaction,

asked them whether they were happy to live in their institution at the time of inter-

view, and their overall satisfaction or dissatisfaction with their institution. A 4-point

Likert-type scale was used in the first three items, with higher scores indicating a

higher degree of satisfaction. For the last item, a 20-point Likert-type scale was

used to obtain a fine differentiation of the degree of satisfaction or dissatisfaction.

RCSS has previously reported to have satisfactory validity and factor analysis foundall four items clustering under one factor, accounting for 44.13% of the variance

(Chong, 2003). In terms of reliability, its Cronbachs alpha was only .58, which

was quite low even after taking into consideration the fact that it has four items only.

The Perceived Performance Scale (PPS), Expectation Scale (ES), and Expectancy

Disconfirmation Scale (EDS) each was composed of the same 28-item battery of

quality indicators (Chong & Chi, 2001). These 28 items were developed from a list

of 72 items identified through residents focus group discussion and literature review,

it was cut down to 55 through a review by eight experts and a pretest with 20 resi-

dents, and was further shortened and validated through a pilot study of 98 residents.

The 35-item scale was used in the present survey, and 7 items were deleted after

the repeated interactive sequence of computing alphas (deleting item if item-total

correlation was below .1 and if removal improved correlation alpha) and factors

analysis (deleting item if factor loading was below .3). The same 28 items were used



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in PPS, ES, and EDS to facilitate matching and comparison among the three scales.

The score of each scale was the means of the summated score of all 28 items.

The PPS asks respondents to assess the performance of their institution for each

of the indicators, with a response format ranging from 1 =never like this, to

4 =always like this. The ES asks respondents about their service expectation,

measured on a 5-point Likert-type scale with 0 being no expectation and 1 being

definitely should not be like this to 4 being definitely should be like this; the higher

the score, the higher the expectation. The EDS was operationalized by multiplying

the perceived performance score by the expectation score to give the interaction

value. The Cronbachs alphas were .81, .86, and .87 for PPS, ES, and EDS, respec-

tively, reflecting high internal consistency.

The construct care need in this study is related to the residents perceived

difficulties in functional and sensory activities, including activities of daily living

(such as bathing and dressing), instrumental activities of daily living (such as

getting outside and handling money), and basic sensory functioning such as hearing

and reading abilities in the past 3 months. Care need fulfillment assesses the degree

of fit, in the eyes of the residents, between their perceived difficulties and the

assistance provided by the long-term care homes. The 4-point Likert-type scale was

used in the 13-item Perceived Care Need Scale (PCNS), ranged from 1 =no difficulty

to 4 =cannot do it, whereas Care Need Fulfilment Scale (CNFS) asks whether thelevel of assistance provided by the institution for each of the 13 activities was 1=too

little, 2 =too much, or 3 =appropriate. The Cronbachs alphas were .83 and .80,

respectively, which suggest high internal consistency.

Cognitive competence of the residents was measured with the 10-item Chinese

version of SPMSQ which asked respondents to give the date, their age, name of

district they were living, and to subtract 3 from 20 all the way down. It has been

translated into Chinese and validated by Chi and Boey (1992) and is commonly

used in Hong Kong. Its scores range from 0 to 11 and are adjusted by the educationlevel of the participants by giving one additional point to participants without any

formal education. Respondents with adjusted SPMSQ scores below 5 were con-

sidered too severely impaired cognitively to give reliable responses. This screening

test is in response to the concern to include residents with cognitive impairment

(Ejaz & Castle, 2007). With population ageing, an increasing number of demented

residents is expected, and their views are important to design services that meet

with their expectation and care needs.

Procedure

Participants were interviewed by interviewers who were social work undergradu-

ates selected on their empathetic communication skills and prior practicum experi-

ence with the senior citizens. Two training sessions were organized to strengthen



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Chong 363

their ability to communicate with older people with different levels of physical and

cognitive impairment. Face-to-face interviews would only take place after obtaining

the residents informed consent. If the residents could not be contacted (such as

when they were out for medical consultation or were attending activities), or if they

were unfit for interview due to poor health or being asleep, the interviewer would

make no less than three attempts to contact them before the respondents were

dropped from the list. If the respondents became tired, the interviewers would sug-

gest a break or arrange another appointment. On average, each interview took about

40 to 60 min. The interview took place in a place free from disturbances such as the

conference room, the nursing room, or a quiet corner of the residents bedroom.

Data Analysis

With the use of SPSS, frequency tables were computed to find out the demographic

profile of the participants and their mean scores in the various scales. Pearsons

correlation coefficients were calculated to determine the correlation between the

various independent and dependent variables. Regression analysis was conducted

to control for the effect of confounding variables. Satisfaction was regressed on

all five cognitive variables together with basic demographic variables to identify

which independent variables might predict satisfaction with care. Path analysiswas then conducted to examine the goodness-of-fit between the hypothesized

model (Figure 1) and the extracted model based on data of the survey and to identify

the predictors of resident satisfaction.

Results

Participants Profile

On average, the participants were 82 years old (SD= 7.33). The majority (63.7%)

were aged 80 years or above, and approximately 70% were female. More than half

(56.3%) were widowed, a quarter (24.7%) were married, 14.3% had never been

married, and 3.7% were divorced or separated. The participants had received an

average of 2.42 years (SD=3.57) of formal education, but about half (51.5%) had

no education. The demographic distribution of the participants was very similar to

that found by the Thematic Household Survey conducted by the Census and Statistics

DepartmentHong Kong (2005) to examine the long-term care needs of older

persons residing in institutions, suggesting the representativeness of the sample.

The majority (75%) of the respondents had lived in their facilities for 5 years

or below, 15.3% more than 5 years but less than 10 years, 8.7% more than 10 years

but less than 20 years, and 1% more than 20 years. As mentioned above, only residents



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with adjusted SPMSQ scores of 5 and above would be interviewed. The cognitive

levels of the participants were quite evenly distributed among adjusted SPMSQ

scores from 5 to 11, ranging from 13.3% to 18.3%, and the average score was 7.6

(SD= 1.8). The only exception was with those who had the highest score of 11 mean-

ing good cognitive competence, which was only 3.5%.

Descriptive Analysis

Resident satisfaction. To render the response format of the 20-point general sat-

isfaction item comparable with that of the other three items in the RCSS Scale, it

was recoded into four categories by recoding the original points 1 to 5 as 1 mean-

ing very dissatisfied, 6 to 10 as 2 meaningslightly dissatisfied, 11 to 15 as 3

meaningslightly satisfied, and 16 to 20 as 4 meaning very satisfied. The average

summated scores of the RCSS revealed that nearly half (46.4%) of the participants

were very satisfied with the service performance of their long-term care homes,

44.7% were somewhat satisfied, 8.6% were somewhat dissatisfied, and 0.2% were

very dissatisfied. The means of the scale was 3.37 (SD= .65) out of 4.

Cognitive variables. The means of individual items of the PPS, ES, EDS, PCNS,

and CNFS are given in Tables 1 and 2. The PPS had an average score of 3.13

(SD= .32) on a 4-point scale, which reflected generally good perceived performance,with the means of individual items ranging from 1.44 to 3.91.

The average score for the ES was 2.99 (SD= .52). Participants had the lowest

expectations on choice of main dish (M= 1.89, SD= 1.26) and life is routinized

and boring here (M= 1.90, SD= 1.24; Table 1), and they had the highest expecta-

tion (M= 3.72, SD= .66) on room is clean and tidy. Generally speaking, participants

did not have high expectations on the service quality of their care home. Score of

each item of EDS was calculated by multiplying ES and PPS score of the concerned

item. The means of the EDS was 10.04 (SD= 2.18).Table 2 shows that among the 13 PCNS items, the participants had the greatest

difficulty in writing (M= 2.87), reading (M= 2.74), climbing up and down stairs

(M= 2.27), and getting outside (M= 2.23). Overall, the participants need for

assistance was not very high (M= 1.93, SD= .58). However, residents suffering

from severe frailty would have been screened out by the institutions in accordance

with the selection criteria. The means of the CNFS was 2.75 (SD= .34) on a 3-point

scale, reflecting a high proportion of appropriate assistance.

Correlation Between Variables

Pearson correlation coefficients between the dependent variable of resident satis-

faction and the independent variables of perceived performance, service expectation,



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365

Table1.MeansofthePerceivedPerformanceScale,E

xpectationScale,andExpectancyDisconfirmationScale(N=4

05)

Perceived

Performancea

Expectationb

Expe

ctancy

Disconfirmationc

Qualityindicators

M

SD

M

SD

M

SD

Systematicorientationprogramsareorg

anizedtopromotethe

adjustmentofnewcomers.

2.65

1.17

2.97

1.31

8.59

5.67

Sufficientfam

ilyactivitiesareorganizedforresidentsandtheir

familymemb

ers.

2.61

1.01

2.65

1.40

7.59

5.29

Thepurchase

servicecanhelpyoubuythefoodordaily

necessitiest

hatyouwant.

3.50

0.77

3.46

0.94

12.35

4.40

Manysociala

ndrecreationalprogramsareorganizedforresidents.

3.49

0.58

3.39

0.98

11.90

4.11

Arrangement

saremadetoenableresidentstoengageintheir

ownreligiou

sbeliefs.

2.37

1.25

2.31

1.49

6.20

5.69

Youareregularlyinformedofwhatishappeninginthehome.

2.44

1.17

2.79

1.38

7.64

5.59

Youarewelcometogivesuggestionstothemanagement.

3.05

1.06

2.70

1.38

8.98

5.91

Staffarepolit

eandrespectyou.

3.68

0.63

3.45

1.04

12.82

4.48

Staffshowco

ncern.

3.67

0.65

3.63

0.74

13.38

3.68

Someofyourpersonalbelongingshaved

isappeared.d

3.63

0.73

2.08

1.28

7.52

4.92

Staffarenice

andcarefulintakingcareo

fresidentswholackself-

careability.

3.71

0.66

3.57

0.79

13.37

3.85

Youcanseea

doctorquicklywhenyouaresick.

3.82

0.50

3.62

0.76

13.87

3.49

Yourroomis

tidyandclean.

3.91

0.33

3.72

0.66

14.56

2.86

Thewashroo

misclean,w

ithoutunpleasantodor.

3.75

0.56

3.57

0.71

13.88

3.42

Foodandcutleryareclean.

3.85

0.45

3.69

0.67

14.25

3.14

Thefacilitiesandphysicale

nvironmento

fthehomemeetthe

olderpeoplesneeds.

3.53

0.58

3.40

1.00

12.17

4.30

(continued)



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366

Perceived

Performancea

Expectationb

Expe

ctancy

Disconfirmationc

Qualityindicators

M

SD

M

SD

M

SD

Youhavelimitedspaceinthehomeandstayinyourroom/sitting

roommostofthetime.

d

3.05

0.84

2.04

1.28

6.36

4.63

Thefoodisgood.

3.41

0.68

2.97

1.29

10.23

5.00

Lifeisroutinizedandboringhere.d

3.11

1.06

1.90

1.24

5.90

4.56

Healthtalksandexercisesorganizedbythehomeareeffective

inpromotingyourhealth.

3.23

0.80

3.46

0.95

11.40

4.33

Therearealotofrestrictionshere.d

3.60

0.70

2.09

1.31

7.48

5.01

Relationshipwithroommates.

3.58

0.93

3.02

0.74

13.80

5.18

Relationshipwithotherresidents.

3.45

0.75

2.97

0.74

12.70

4.45

Thereisachoiceofmaindish.

1.44

0.93

1.89

1.26

3.24

4.02

Sufficientassistanceisprovidedforresid

entstoseekconsultation

aboutnon-W

esternmedication.

1.63

0.92

2.44

1.40

4.16

4.02

Youcandecid

ewhetherstaffassistanceis

neededwithtakingabath.

3.15

1.24

2.94

1.32

10.02

6.11

Staffwills

eek

yourconsentbeforetidyin

gyourpersonaldrawer.

3.32

1.08

3.20

1.23

10.90

5.65

Thephysicalenvironmentoftheinstitutionresemblesthatofa

domesticho

me.

2.18

1.05

2.33

1.40

5.72

5.04

Meansofscale

3.13

0.32

2.99

0.52

10.00

2.18

a.R

esponseformatofthePerceivedPerform

anceScale:1=n

everto4=alw

ays.

b.R

esponseformatoftheExpectationScale:0=n

oexpectation,1=d

efinitelyshouldnotto4=d

efinitelyshould.

c.S

coreofExp

ectancyDisconfirmationiscalc

ulatedbymultiplyingthescore

ofPerceivedPerformanceand

thescoreofExpectationtogether,g

iving

theinteraction

valueofExpectancyDisconfirmation.

d.R

eversedscore.

Table1.

(co

ntinued)



16/25

Chong 367

expectancy disconfirmation, and care need fulfillment were .47, .29, .44, and .27,

respectively, all significant atp< .001. However, perceived care need was nega-

tively correlated with satisfaction (r=-.13,p< .01). Although the levels of signifi-cance of the correlation between all these variables are high, the magnitude of the

correlations is only moderate or weak, ranging from .13 to .47.

Pearson correlation showed that all the cognitive variables were significantly

(p< .001) related with each other. However, the magnitude of the correlations were

not high; the exception was found between service expectation and expectancy

disconfirmation which was as high as .90 (Table 3), and so in further data analysis,

only expectancy disconfirmation would be used. It is because expectancy discon-

firmation is usually regarded as the most important predictor in consumer satisfaction

studies (Oliver, 1997; Tse, Nicosia, & Wilton, 1990). Moreover, regression analysis

of all five cognitive variables only found perceived performance and expectancy

disconfirmation predicted respondents satisfaction with care. Care need and need

fulfillment were also expected to be related to each other. However, the finding that

Table 2. Means o Perceived Care Need Scale and Care Need Fulilment Scale(N= 405)

PerceivedCare Needa

Care NeedFulilmentb

General unctional abilities M SD M SD

Bathing 1.91 1.17 2.87 0.44

Dressing/personal grooming 1.48 0.89 2.87 0.49

Getting in and out o bed or chair 1.36 0.75 2.85 0.53

Climbing up and down the staircases 2.27 1.14 2.72 0.68

Getting outside 2.23 1.11 2.72 0.69

Handling your own money 1.30 0.76 2.84 0.5

Shopping or grocery or personal items 1.79 1.13 2.87 0.46

Walking indoors 1.98 1.01 2.72 0.68

Laying on your bed 1.76 1.08 2.89 0.44

Listening (hearing ability) 1.51 0.70 2.73 0.68

Seeing (eyesight) 1.87 0.81 2.53 0.85

Reading 2.74 1.19 2.48 0.88

Writing 2.87 1.21 2.66 0.76

Means o scale 1.93 0.58 2.75 0.34

a. Perceived Care Need Scale: 1 =no difficultyto 4 =cannot do it.b. Care Need Fulilment Scale: 1 =too little assistance, 2 = too much assistance, 3 =appropriateassistance.



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368

Table3.PearsonCorrelationAmongth

eCognitiveVariablesandResidentSatisfaction(N=405)

Perceived

Performance

Scale

Expec

tation

Scale

Expectancy

Disconfirmation

Scale

Perceived

Care

Need

Scale

Care

Need

Fulfilment

Scale

ExpectationS

cale

0.46**

ExpectancyD

isconfirmationScale

0.76**

0.9

0**

PerceivedCareNeedScale

-0.29**

-0.1

8**

-0.28**

CareNeedFulfilmentScale

0.45**

0.1

6**

0.33**

-0.16**

ResidentialCareSatisfactionScale

0.47**

0.2

9**

0.44**

-0.13*

0.27**

*p

journal of applied gerontologyp

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