Client Satisfaction Questionnaire (CSQ)

Abstract

The Client Satisfaction Questionnaire (CSQ) is a widely utilized, brief, and robust psychometric instrument designed to measure global client satisfaction with human service programs, particularly within the fields of mental health and social services. Developed by Larsen, Attkisson, Hargreaves, and Nguyen in 1979, the CSQ-8 (the most common version) consists of eight items rated on a 4-point Likert scale. Its primary function is to provide a standardized, reliable, and valid metric for evaluating service effectiveness from the consumer’s perspective, making it a critical tool in outcomes assessment and program planning. The scale is valued for its brevity and consistent psychometric properties across diverse populations and settings.

Keywords

Client satisfaction, service evaluation, program planning, outcomes assessment, mental health services, psychometrics, CSQ-8, consumer feedback.

Authors

Larsen, D. L., Attkisson, C. C., Hargreaves, W. A., Nguyen, T. D.

Purpose

The primary purpose of the CSQ is to quantify the degree of satisfaction experienced by individuals receiving professional help or services. This measurement is crucial for quality assurance, program evaluation, and administrative decision-making in various human service delivery settings, ranging from outpatient clinics to inpatient facilities. The instrument was specifically designed to be generalizable, allowing it to be applied consistently across different types of intervention programs, ensuring comparability of satisfaction scores.

The scale provides administrators and clinicians with immediate, actionable feedback regarding the perceived quality and effectiveness of the care provided. By focusing on the client’s subjective experience, the CSQ serves as an essential component of a comprehensive outcomes monitoring system, helping organizations identify areas needing improvement and demonstrate accountability to funding bodies and stakeholders.

Construct

The CSQ measures the construct of Global Client Satisfaction. This construct is defined as the consumer’s overall affective and cognitive judgment regarding the quality, utility, and appropriateness of the services received. It is understood as a single, unidimensional factor that reflects the client’s appraisal of whether the program successfully met their needs and expectations.

Unlike instruments that focus on specific aspects of service delivery (e.g., waiting times, staff friendliness), the CSQ focuses on the overarching evaluation of the therapeutic outcome and utility, including the perceived quality of care, the extent to which the services matched the client’s goals, and the likelihood of future recommendation or return. This focus on global satisfaction makes it a powerful predictor of treatment compliance and overall program success.

Validity

The CSQ demonstrates strong evidence of construct validity and concurrent validity. Studies have consistently shown that CSQ scores correlate positively and significantly with various measures of therapeutic outcome and service utilization. Specifically, higher satisfaction scores are associated with better clinical outcomes, including reduced symptoms and improved functioning, as documented in studies by Attkisson and Zwick (1982).

Furthermore, the instrument exhibits robust face validity, as the items are clearly relevant to the experience of receiving human services. Its generalizability across diverse cultural and demographic groups further supports its validity, confirming that it measures the intended construct of global satisfaction regardless of the specific service context, such as inpatient or outpatient mental health services.

Reliability

The CSQ possesses excellent internal consistency, which is the primary measure of its Reliability. Across numerous studies conducted in various settings, the coefficient alpha (Cronbach’s alpha) for the CSQ-8 typically ranges between 0.90 and 0.95. This high level of internal consistency suggests that all eight items are measuring the same underlying construct—global client satisfaction—with a high degree of precision.

While test-retest reliability is less frequently reported, the scale’s design as a post-service assessment tool implies that it is intended to capture satisfaction at a specific point in time, usually immediately following or shortly after service completion. The consistently high internal consistency is one of the most cited strengths of the CSQ, solidifying its reputation as a dependable measure for program evaluation.

Factor Analysis

Extensive Factor Analysis studies of the CSQ-8 generally support a unidimensional factor structure. This means that the eight items load heavily onto a single factor, confirming the theoretical premise that the scale measures a single, global construct of satisfaction rather than multiple distinct facets of service quality.

Although some research has explored minor sub-factors, the overwhelming consensus is that the CSQ is best utilized as a single, composite score reflecting overall client satisfaction. This unidimensionality simplifies scoring and interpretation, making the CSQ highly practical for clinical and administrative settings where quick, generalized metrics are required.

Instrument

Test Type: Self-report questionnaire / Outcomes assessment tool.

Format: 8 items (CSQ-8) utilizing a 4-point Likert-type scale.

Language Available: English (widely translated into Spanish and various other languages for international use).

Population Group: Consumers of human services (e.g., patients, clients, service recipients).

Age Group: Adolescents and Adults (typically 13 years and older, depending on cognitive ability).

Population Details: Applicable across diverse settings, including mental health, substance abuse treatment, medical rehabilitation, and social welfare programs.

Test Methodology: The client responds to each item by selecting one of four response options, typically ranging from a negative evaluation (e.g., Poor, Definitely Not) to a positive evaluation (e.g., Excellent, Definitely Yes). Items are summed to produce a total satisfaction score, with higher scores indicating greater satisfaction.

The instrument is often cited in academic literature. The original instrument and related documentation can be found via several public sources, including academic dissertations and program reports. The original PDF documentation can be downloaded here: http://eenet.ca/wp-content/uploads/2013/08/OPOC-Final-Report-2013.pdf and here: http://www.primarycarecore.org/PDF/303.pdf.

Keywords

Larsen, Attkisson, Hargreaves, Nguyen, global satisfaction, psychotherapy outcome, evaluation, psychometric scale, service quality.

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: [email protected] (C. Clifford Attkisson).

Correspondence Address: Not provided in source content (original affiliation was often linked to the University of California, San Francisco).

Permissions & Fee and Test Year

The CSQ was developed in 1979 (Larsen, Attkisson, Hargreaves, & Nguyen). The scale is often considered public domain for clinical use and academic research, though formal permission for commercial or large-scale adaptations should be sought from the primary authors or their affiliated institutions. Specific fee structures are not detailed, but the scale is widely available and frequently utilized without cost in non-profit and academic settings.

Reference’s

• Attkisson, C. C., & Greenfield, T. K. (1996). The Client Satisfaction Questionnaire (CSQ) Scales and the Service Satisfaction Scale-30 (SSS-30). In L. I. Sederer & B. Dickey (Eds.), Outcomes assessment in clinical practice (pp. 120-127). Baltimore, MD: Williams & Wilkins.
• Attkisson, C. Clifford., & Zwick, Rebecca. (1982). The client satisfaction questionnaire: Psychometric properties and correlations with service utilization and psychotherapy outcome. Evaluation and Program Planning; 5(3), 233-237.
• Attkisson, C. C., Roberts, R. E., & Pascoe, G. C. (1983). The Evaluation Ranking Scale: Clarification of methodological and procedural issues. Evaluation and Program Planning, 6(3 and 4), 349-358.
• Larsen, D. L., Attkisson, C. C., Hargreaves, W. A., & Nguyen, T. D. (1979). Assessment of client/patient satisfaction: Development of a general scale. Evaluation and Program Planning, 2, 197-207.

Items of the Client Satisfaction Questionnaire (CSQ)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. How would you rate the quality of the services you have received?

2. Did you get the kind of service you wanted?

3. To what extent has our program met your needs?

4. If a friend were in need of similar help, would you recommend our program to him or her?

5. How satisfied are you with the amount of help you have received?

6. Have the services you received helped you to deal more effectively with problems/difficulties?

7. In an overall general sense, how satisfied are you with the services you have received?

8. If you were to seek help again, would you come back to our program?

1=Poor, 2=Fair, 3=Good, 4=Excellent

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1. How would you rate the quality of services you received?

1=Excellent, 2=Good, 3=Fair, 4=Poor

2. Did you get the kind of services you wanted?

1= No, definitely not, 2= No, not really, 3=Yes, generally, 4=Yes, definitely

3. To what extent has our program met your needs?

1= Almost all of my needs have been met, 2= Most of my needs have been met, 3=Only a few of my needs have been met, 4= None of my needs have been met

4. If a friend were in need of similar help, would you recommend our program to him or her?

1=No, definitely not, 2= No, not really, 3=Yes, generally, 4=Yes, definitely

5. How satisfied are you with the amount of help you have received?

1= Quite dissatisfied, 2= Indifferent or mildly dissatisfied, 3= Mostly satisfied, 4=Very Satisfied

6. Have the services you received helped you deal more effectively with your problems?

1=Yes, they helped a great deal, 2= Yes, they helped somewhat, 3= No, they really did not help, 4= No, they seemed to make things worse

7. In an overall, general sense, how satisfied are you with the service you have received?

1=Very satisfied, 2= Mostly satisfied, 3=Indifferent or mildly dissatisfied, 4= Quite dissatisfied

8. If you were to seek help again, would you come back to our program?

1= No, definitely not, 2= No, I don’t think so, 3= Yes, I think so, 4=Yes, definitely