Email updates

Keep up to date with the latest news and content from BMC Health Services Research and BioMed Central.

Open Access Open Badges Research article

REFERQUAL: a pilot study of a new service quality assessment instrument in the GP exercise referral scheme setting

Don Cock1*, Iain C Adams2, Adrian B Ibbetson2 and Phil Baugh3

Author Affiliations

1 Centre for Sport and Dance Studies, Liverpool John Moores University, Liverpool, UK

2 Department of Tourism and Leisure Management, University of Central Lancashire, Preston, UK

3 Department of Information and Finance, University of Central Lancashire, Preston, UK

For all author emails, please log on.

BMC Health Services Research 2006, 6:61  doi:10.1186/1472-6963-6-61

Published: 25 May 2006



The development of an instrument accurately assessing service quality in the GP Exercise Referral Scheme (ERS) industry could potentially inform scheme organisers of the factors that affect adherence rates leading to the implementation of strategic interventions aimed at reducing client drop-out.


A modified version of the SERVQUAL instrument was designed for use in the ERS setting and subsequently piloted amongst 27 ERS clients.


Test re-test correlations were calculated via Pearson's 'r' or Spearman's 'rho', depending on whether the variables were Normally Distributed, to show a significant (mean r = 0.957, SD = 0.02, p < 0.05; mean rho = 0.934, SD = 0.03, p < 0.05) relationship between all items within the questionnaire. In addition, satisfactory internal consistency was demonstrated via Cronbach's 'α'. Furthermore, clients responded favourably towards the usability, wording and applicability of the instrument's items.


REFERQUAL is considered to represent promise as a suitable tool for future evaluation of service quality within the ERS community. Future research should further assess the validity and reliability of this instrument through the use of a confirmatory factor analysis to scrutinise the proposed dimensional structure.