ADAPTED SERVQUAL: A Health Service Quality Scale Incorporating Indicators of Sanitation and Hygiene

Background and Objectives: Many scales have been developed to measure health care quality over the years, but no scale available today incorporates all important indicators of sanitation and hygiene in health care. This study therefore assessed the psychometric properties of an adapted scale, hereby called ADAPTED SERVQUAL, in an attempt to provide a scale that includes relevant indicators of hospital hygiene and sanitation. Methods: The setting of the study was low- and medium-capacity hospitals in the Greater Accra Region of Ghana. Patients in wards and outpatient departments in the hospitals participated in the study. We used relevant statistical tools to estimate the psychometric properties of ADAPTED SERVQUAL. To understand the relative importance of the new scale, we compared and related it to a recent scale, HEALTHQUAL. Results: Principal component analysis yielded 6 factors: “tangibles,” “reliability,” “responsiveness,” “assurance,” “empathy,” and “sanitation and hygiene,” which explained 84% of the total variance. ADAPTED SERVQUAL has a good internal consistency (Cronbach α = 0.96). Confirmatory factor analysis confirmed the 6-factor solution and produced satisfactory discriminant validity and convergent validity indicators. The adapted scale was highly correlated with all dimensions of HEALTHQUAL, including continuous quality improvement (r ≥0.75, P < .001). In multiple linear regression, the 5 domains of HEALTHQUAL explained 59% of the variance in ADAPTED SERVQUAL (P < .001). Conclusions: The study concluded that 8 items that make up a single factor (ie, sanitation and hygiene) and contribute most of the total variance satisfactorily fit into the SERVQUAL scale as additional indicators of health care quality.