The w-HEALTHQUAL: A Measurement Scale for Analyzing Patients' Satisfaction With Primary Healthcare

Introduction

Primary health care is the first contact point with the health care system for patients. Therefore, it is essential to offer a high quality service, a quality that needs to be recognised as high quality by both, clinicians and patients. Service quality has been recognised as one of the values of central importance in organisations, in both manufacturing and service sectors (Berry et al., 1985; Bitner et al., 1990; LeBlanc and Nguyen, 1988).

Particularly for the health care field, quality can be understood as an objective measure related to how the health system provides its services. Indicators for this dimension of quality include referrals from primary to secondary care, number of consultations per doctor and per day, number of complementary tests, mortality rates, etc. Despite this, it is impossible to fully describe quality if the user’s point of view is not taken into account (Donabedian, 1984). Considering patients’ perceptions is important as patients provide reliable data and valid diagnosis about their health and about how they feel after seeing their doctor (Dawson et al., 1998). Furthermore, as indicated by Cronin and Taylor (1992), “service quality is an antecedent of consumer satisfaction”. Considering this, efforts need to be focused on offering a high quality service as perceived by the patient, which will ultimately be translated into a greater patient’s satisfaction. Martilla and James (1977) establish that the importance that users of a particular service give to the elements of that service will influence how satisfied they are with it. However, when measuring importance together with perception there are discrepancies in the literature, with authors rejecting the idea of including this indicator (Adil et al., 2013) and others supporting it as importance may increase the diagnosis power of the scale being used (Jain and Gupta, 2004)

With these ideas in mind, the aim of the present study is to develop a scale that allows for adequately measuring patients’ satisfaction with primary care as perceived by the user, i.e. to obtain a measurement instrument that considers all the relevant aspects of primary health care and that precisely reflects patients’ priorities.

In doing so, the authors, firstly, present a weighted scale specially designed to measure patients’ satisfaction with primary health care that comprises not only patients’ preferences, but also a weighting factor to incorporate the importance of the elements being assessed. Secondly, it is analysed how patients’ satisfaction varies within settings.

To the best of the researchers’ knowledge there is not a scale in the literature specifically created for the study of satisfaction in primary health care that includes patient’ preferences with the health care together with the importance patients attribute to those preferences. Furthermore, there is not any piece of research aiming to identify differences in satisfaction within settings, in spite of the fact that users’ preferences with certain services have previously been measured across countries and systems (Schäfer et al., 2015).

In order to achieve the previously mentioned objective, the rest of the research is structured as follows. First, it is analysed the different measures of service quality proposed in the literature and that have been the basis for the construction of the measurement instrument, the weighted HEALTHQUAL scale (w-HEALTHQUAL). Next, it is described the methods applied to build the scale, using information provided by primary health care users in the Spanish region of Extremadura. This new scale allows for adequately measuring patients’ satisfaction with primary health care. Following the methods section, it is presented the results of the analysis, firstly, looking at the characteristics of the w-HEALTQUAL; secondly, performing a cluster analysis that allows for the identification of groups of patients that differ among them based on their levels of satisfaction with the health care, and thirdly, representing the levels of satisfaction across the health map of the region of Extremadura. Finally, it is presented a discussion of the main findings and conclusions of the research.