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

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.