Study On The Applicability Of SERVQUAL Scale In Evaluating The Community Health Service Quality In China

Objective This study was aimed to introduce the international scale SERVQUAL,which was designed to measure the basic aspects of service quality,to the community health service institutions(CHSIs)in China and to indigenize it through modification.Further,this study was to explore and verify the dimensionality of the modified scale,and to analysis its applicability and practicability in the Chinese CHSIs backgrounds.Methods The original SERVQUAL scale was revised according to Chinese social-cultural backgrounds and the characteristics of community health service.The items pool was established through literature review,and the scale items for the formal investigation were determined through experts evaluation and patients interviews.Three CHSIs were selected from Fuyong street of Shenzhen by simple random sampling method.During July and August of 2016,patients of the three CHSIs were investigated by convenient sampling.Of the 1120 questionnaires issued,1030 valid ones were returned with a recovery rate of 91.96%.Data entry was performed using EpiData3.1.Data analysis was performed using SPSS17.0 and AMOS21.0.The applicability of the modified scale was evaluated by conducting the exploratory factor analysis(EFA)and confirmatory factor analysis(CFA)based on a cross validation method and the structural equation model(SEM)with the gap scores between the expectations and perceptions of the participants,and by testing its reliability and validity.The practicability of the modified scale was evaluated by statistical graphs,descriptive analysis and covariance analysis.In addition,the psychometric properties of SERVQUAL and SERVPERF were compared from the three aspects of the EFA factor structure,CFA model fitting degree and concurrent validity.Results 1.After scale modification and model validation,this study developed a modified SERVQUAL scale with 5 dimensions of 20 items.the original dimensions "tangible" and "empathy" were preserved.However,a new dimension "effectiveness" was isolated from the designed items of the dimension "reliability".Besides,the dimension "responsiveness" become weakening.And it merged with the dimension "assurance" to form a new dimension called "communication".These changes were consistent with the characteristics of Chinese healthcare system.2.Five common factors were extracted by EFA.All the fitness indexes of the first and second order models of CFA satisfied the criteria.The Cronbach's ? and the construction reliability of four dimensions were all higher than 0.7 and 0.6 separately,except “reliability” which was slightly lower.In the first order CFA model,the factor load of each measurement variable and the average variance extracted(AVE)of each dimension were all higher than 0.5.And the test of the chi-square difference between any two dimensions is statistically significant.3.The score of the modified scale accurately reflected the service quality of the samples institutions from the whole to the details,and the differences between different institutions.Furthermore,it could analyze the resource of the differences in service quality across the institutions.4.SERVPERF obtained three common factors by EFA.Its fitness indices of CFA model were mostly substandard.And its concurrent validity was lower than SERVQUAL.Conclusion The modified SERVQUAL scale is embedded with the specific attributes of the medical and healthcare services and is proved to have good psychometrics properties and practical performance.It could be used as a standardized measuring tool for the community health service quality based on the experience of patients.And it has the potential to be extended and promoted in Shenzhen and China.In addition,this study provides evidence that SERVQUAL is superior to SERVPERF in psychometric performance.