Psychometric Evaluation of the Chinese Version of the Mental Health System Responsiveness Questionnaire for Psychiatric Outpatients: Classical Test Theory and Item Response Theory Approaches.

Background: The Health System Responsiveness Questionnaire has been an important tool for evaluating the quality of health services from non-clinical perspectives. However, there is a lack of reliable and valid tools to assess the responsiveness of the mental health system in China, despite the increasing attention to the quality of mental health services.

Purpose: This study aimed to adapt a Chinese version of the Mental Health System Responsiveness Questionnaire based on the WHO Health System Responsiveness Questionnaire and assess its psychometric properties among psychiatric outpatients.

Patients and methods: We adapted the Health System Responsiveness Questionnaire into Chinese and used it on psychiatric outpatients through face-to-face interviews, resulting in 1067 valid responses. We conducted a reliability and validity analysis based on classical test theory (CTT) and applied the graded response model based on item response theory (IRT) to examine the performance of each item.

Results: From the CTT analysis, values of Cronbach's alpha, test-retest reliability, and split-half reliability of the questionnaire were all greater than 0.8. Confirmatory factor analysis exhibited a good fit; convergent and discriminant validity were achieved with average variance extracted > 0.5 and heterotrait-monotrait ratio < 0.9. Results from the IRT analysis showed that all items demonstrated acceptable discrimination (discrimination parameters ≥ 0.65) and appropriate difficulty parameters (ranging from -4 to 4). Additionally, all items provided sufficient information, except for two items in the prompt attention domain.

Conclusion: Our adapted Mental Health System Responsiveness Questionnaire possessed strong psychometric properties and could serve as an effective tool for assessing the responsiveness of mental health systems in China. However, improving two items in the domain of prompt attention may contribute to more optimal psychometric properties of the questionnaire.