Defense Date


Document Type


Degree Name

Master of Public Health


Epidemiology & Community Health

First Advisor

R Leonard Vance


BACKGROUND In recent years, there has been a push to measure and monitor the quality of health care and the delivery of effective services. Substance use disorders are debilitating and in order to better understand this facet of substance abuse, it is important for organizations and providers to assess the quality of services, client satisfaction, and the relationships that exist between clients and treatment providers. PURPOSE The purpose of the study was to (1) assess the extent of the relationship between measures of client perceptions of satisfaction and treatment outcomes and (2) to assess the relationship between measures of therapeutic alliance and treatment outcomes. METHODS Data was obtained from a larger study assessing organizational factors affecting the implementation of evidence-based practices in the treatment of substance use disorders. This study was focused on the client satisfaction survey data obtained during the months of August and December of 2008, consisting of several five-day periods, during which clients were asked to complete the survey. The study population consisted of 371 clients aged 18 to 64 years. Logistic regression was used to evaluate demographic and other substance use-disorder factors for each of the scales pertaining to client satisfaction (general satisfaction, access, and quality/appropriateness) and therapeutic alliance (bond, goal, and task) in order to obtain odds ratios and 95% confidence intervals. Pearson correlation coefficients were used to assess the strength of the relationship of each of the measures of client satisfaction and therapeutic alliance with client perceived outcomes. Due to the nature of the survey questions being adapted from validated measures, Cronbach's coefficient alphas were used to determine internal consistency and reliability within each of the scales. To further assess client measures of satisfaction, multivariate linear regression was used to examine whether a specific client satisfaction measure or therapeutic alliance measure was a significant predictor of better client perceived outcomes. RESULTS Client perceptions of satisfaction - general satisfaction, access, and quality/appropriateness (worse vs. better) were significantly associated with better client perceived outcomes. Therapeutic alliance measures were also significantly associated with better client perceived outcomes. The strongest predictors from logistic regression analysis were quality/appropriateness (OR = 14.45, 95% CI 1.16-19.01) and general satisfaction (OR = 11.96, 95% CI 7.04-20.33) followed by WAI Goal (OR = 5.56, 95% 3.29-9.39), access (OR = 5.81, 95% CI 3.55-9.50), WAI Task (OR = 4.42, 95% CI 3.29-9.39), and WAI Bond (OR =3.61, 95% CI 2.06-5.22). Cronbach's coefficient alphas were all above the .70 threshold indicating strong internal consistency among the measures of client satisfaction, therapeutic alliance and client perceived outcomes. Pearson correlation coefficients indicated moderate relationships between access, general satisfaction, WAI Bond, Goal and Task with client perceived outcomes. The strongest correlation was that of quality/appropriateness of treatment services and client-perceived outcomes (r = 0.61, p<0.0007) CONCLUSIONS Client perceptions of satisfaction and therapeutic alliance were found to be significantly associated with better client perceived outcomes. Age, time in treatment, and number of times a client moved in the past 6 months was implicated in the association of general satisfaction and better client perceived outcomes. Age and race were implicated in the association of access and better client perceived outcomes. Further research is needed to measure the effectiveness of treatment services to ensure that clients are receiving appropriate evidence-based services that result in better outcomes.


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VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

December 2009

Included in

Epidemiology Commons