Influence of patients' age and sex and the mode of administration on results from the NHS Friends and Family Test of patient experience

J Health Serv Res Policy. 2015 Jan;20(1):5-10. doi: 10.1177/1355819614536887. Epub 2014 Jun 27.


Objective: To investigate the impact of demographic factors (patients' age and sex) and of the mode of administration of a national patient experience questionnaire in England: the NHS Friends and Family Test.

Methods: Secondary analysis of April-August 2013 data collected using a mixed mode approach from 38,998 inpatients and 29,610 emergency department attendees at 429 wards or units in 32 hospitals. Multilevel models were applied with responses from wards nested within hospitals and trusts. Age, sex and mode of administration were entered as main effects.

Results: There were consistent differences in response for patients and emergency department attendees related to their age and sex. Women gave less positive ratings than men, whilst the likelihood of positive responses increased with age except among the oldest age group (75 years and above). As regards mode of administration, online responses were significantly less positive than postcard responses: the mean differences in score were 22.0 points for inpatients (95% confidence interval 27.3 to 16.7) and 18.0 points for emergency department attendees (29.0 to 7.0). Telephone responses were significantly more positive than postcard responses, with a mean difference of 9.2 (1.6-16.8) in the emergency department setting.

Conclusions: Data from the Friends and Family Test are vulnerable to bias from demographic factors and from the mode of administration. Comparisons between organisations should be avoided. Scores may be useful at a local level where the test is implemented consistently and patients' demographic characteristics remain stable. Improving the utility of the Friends and Family Test nationally requires a standardised method for administration and adjustment of results for demographic characteristics.

Keywords: Friends and Family Test; patient experience; patient satisfaction.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Emergency Service, Hospital*
  • England
  • Female
  • Humans
  • Inpatients*
  • Internet
  • Male
  • Middle Aged
  • Patient Satisfaction / statistics & numerical data*
  • Postal Service
  • Quality Improvement*
  • Sex Factors
  • State Medicine / statistics & numerical data*
  • Surveys and Questionnaires
  • Young Adult