Background: The onset of the COVID-19 pandemic precipitated a rapid shift to virtual care in health care settings, inclusive of mental health care. Understanding clients' perspectives on virtual mental health care quality will be critical to informing future policies and practices.
Objective: This study aimed to outline the process of redesigning and validating the Virtual Client Experience Survey (VCES), which can be used to evaluate client and family experiences of virtual care, specifically virtual mental health and addiction care.
Methods: The VCES was adapted from a previously validated telepsychiatry survey. All items were reviewed and updated, with particular attention to the need to ensure relevance across mental health care sectors and settings. The survey was then revalidated using the 6 domains of health care quality of the Institute of Medicine (IOM) as a guiding framework. These 6 domains include being safe, effective, patient-centered, efficient, timely, and equitable. The VCES was piloted with a convenience sample of clients and family members accessing outpatient care at the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario, through video or telephone. A confirmatory factor analysis (CFA) was conducted in MPlus and used to test the factorial structures of the VCES, with minor respecification of the model based on modification indices, factor loadings, reliability, and item-total correlation. The respecifications were checked for alignment with the construct definitions and item interpretation. The reliability of the constructs was estimated by the Cronbach α coefficient.
Results: The survey was completed 181 times. The construct reliability was generally high. Timely was the only subscale with an α lower than 0.7; all others were above 0.8. In all cases, the corrected item-total correlation was higher than 0.3. For the CFA, the model was adjusted after multiple imputations with 20 datasets. The mean chi-square value was 437.5, with df=199 (P<.001). The mean root mean square error of approximation (RMSEA) was 0.08 (SD 0.002), the mean confirmatory fit index (CFI) was 0.987 (SD 0.001), the mean Tucker-Lewis Index (TLI) was 0.985 (SD 0.001), and the mean standardized root mean square residual (SRMR) was 0.04 (SD 0.001).
Conclusions: This study describes the validation of the VCES to evaluate client and family experiences of virtual mental health and addictions care. Given the widespread uptake of virtual care, this survey has broad applicability across settings that provide mental health and addiction care. The VCES can be used to guide targeted quality improvement initiatives across health care quality domains. By effectively addressing challenges as they emerge, it is anticipated that we will continue to move toward hybrid modalities of practice that leverage the strengths and benefits of telephone, video, and in-person care to effectively respond to unique client and family needs and circumstances.
Keywords: Virtual Client Experience Survey; client satisfaction; digital health; eHealth; health care quality; mental health; telehealth; telemedicine; virtual care.
©Allison Crawford, Anne Kirvan, Marcos Sanches, Amanda Gambin, Denise Canso, Eva Serhal. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 03.01.2025.