Development and Validation of a Service Quality Assessment System for Chronic Disease Management in Primary Healthcare

Summary

This study developed and validated a service quality assessment system for primary chronic disease management using Delphi- analytic hierarchy process (AHP) methods. Psychometric evaluation confirmed high reliability. A comparative analysis showed that the AHP-SERVQUAL framework has higher predictive power for patient adherence than the alternative models.

Abstract

Chronic non-communicable diseases require high-quality primary healthcare management, yet existing evaluation systems often fail to capture the multidimensional nature of patient-perceived service quality in chronic care settings. This study developed and validated a service quality assessment system (SERVQUAL) tailored for primary chronic disease management based on the SERVQUAL framework. A multi-stage methodology integrating the Delphi method and analytic hierarchy process (AHP) was employed to construct and weight the scale. The instrument was empirically validated using cross-sectional data from 433 patients across five primary healthcare institutions. Construct validity and reliability were evaluated through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Furthermore, the predictive performance of the AHP-SERVQUAL model was compared with that of alternative models (KANO, TOPSIS-RSR) for patient compliance, problem resolution rates, and complaint frequencies. Psychometric evaluation demonstrated that the adapted five-dimensional scale (tangibility, reliability, responsiveness, assurance, and empathy) possessed high internal consistency and structural validity. Application across the centers revealed significant variations in service quality, particularly in the assurance and empathy dimensions. Comparative modeling indicated that the AHP-SERVQUAL framework yielded higher predictive power for patient adherence and overall service quality than the alternative models. Additionally, the quality indices generated by this model were significantly correlated with higher problem-resolution rates and lower complaint frequencies. The AHP-SERVQUAL-based system offers a reliable and valid metric for evaluating chronic disease management in primary care. By accurately capturing patient-perceived quality, this instrument provides administrators with an evidence-based tool to target quality improvement initiatives.

Introduction

Chronic non-communicable diseases have become an extraordinarily serious public health issue around the world¹. According to recent data from the world health organization, more than 70% of global deaths are attributable to chronic diseases. With the acceleration of an aging population in China, the number of people with metabolic diseases such as hypertension and diabetes is increasing rapidly, putting greater pressure on society and the medical system^2,3. In response to this, primary healthcare institutions, as the frontlines of chronic disease management, have gradually become more p....

Protocol

This study was conducted in strict accordance with the ethical principles outlined in the Declaration of Helsinki. The study protocol was reviewed and formally approved by the Institutional Review Board (IRB) of Chongqing Medical University (ethical approval no.: 2026127). Prior to enrollment, all participants were provided with a comprehensive explanation of the study’s objectives, procedures, and potential risks, and subsequently provided written informed consent. To safeguard patient privacy and ensure data confidentiality, all collected information was fully anonymized and de-identified before being accessed for statistical analysis. The complete list of sur....

Results

Study design and participant recruitment

A total of 433 cases involving individuals who had visited any of the five primary healthcare institutions in different areas, both urban and rural, were included. The participants' ages ranged from 30 to 85 years, with an average age of 61.2 years (standard deviation: 10.0). The gender distribution was 50.4% male and 49.6% female. Approximately 56.8% of the participants had hypertension, about 50.0% had type 2 diabetes mellitus (T2DM),.......

Discussion

This study proposes a refined methodological framework for evaluating primary chronic disease management by integrating the SERVQUAL model with a Delphi-AHP weighting scheme. Beyond establishing a standard assessment system, our findings demonstrate that the inclusion of context-specific dimensions—such as longitudinal care continuity and digital touchpoints—addresses critical gaps in existing primary care evaluation tools, thereby providing a more granular lens for assessing patient-centered service quality<.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
AHP Pairwise Comparison Matrix Template	This study (Repository / Supplementary Material)	Saaty’s 1-to-9 fundamental scale	Determination of relative indicator weights
Delphi Expert Consultation Forms	This study (Repository / Supplementary Material)	Two-round consensus protocol	Indicator screening and content validity evaluation
IBM SPSS AMOS	IBM Corp., Armonk, NY, USA	Version 24.0	CFA, SEM validation, and predictive modeling
IBM SPSS Statistics	IBM Corp., Armonk, NY, USA	Version 26.0	Data management, MICE imputation, and EFA
Localized AHP-SERVQUAL Questionnaire	This study (Repository / Supplementary Material)	Final 5-dimension, 15-item version	Assessment of patient-perceived service quality