Quality gap of primary health care services at Kashan District Health Centers, Iran

ABSTRACT

This study aims to identify quality gap by assessing users' perceptions and expectations of primary health care quality at Kashan district health centers in Iran. This cross sectional study was carried out during the first three months of 2002. A total of 324 regular female users of primary health care services at Kashan district health centers have been approached. Random sampling of the households covered by each health center was undertaken. The survey instrument was designed around the validated SERVQUAL instrument. Service quality gap was measured by computing the difference between the rating respondents assign to expectations and perceptions statements. Internal consistency of different items of expectations and perceptions were 0.80 and 0.85, respectively using Cronbach's alpha coefficient. The Wilcoxon signed rank test to compare the distributions of the expectations and perceptions. Results show that there were mean differences between clients' expectations and perceptions in all dimensions of service. The largest and smallest mean quality gaps were in the responsiveness and tangibility dimensions, respectively. There were significant differences between clients' expectations and perceptions. The clients' choices clearly show that responsiveness, reliability and assurance are the three most critical dimensions of health care services, respectively. Negative quality gap in all dimensions indicate that there is room for service quality improvement in all five dimensions. These findings suggest that primary health care managers should be looking carefully at each of the dimensions where customers perceive that they are receiving a different service than expected and consider the extent to which they should work on influencing expectations or perceptions, or both