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Open Access Highly Accessed Research article

Chronic kidney-disease screening service quality: questionnaire survey research evidence from Taichung city

Deng-Juin Lin1, Ya-Hsin Li2, Jar-Yuan Pai3*, Ing-Cheau Sheu4, Robert Glen5, Ming-Jen Chou3 and Ching-Yi Lee1

Author Affiliations

1 Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan

2 Department of Health Policy and Management, Chung Shan Medical University, Taichung, Taiwan

3 Department of Health Policy and Management, Chung Shan Medical University, Taichung, Taiwan; Also Chung Shan Medical University Hospital, Taichung, Taiwan

4 Center of General Education, Chung Shan Medical University, Taichung, Taiwan

5 Department of Applied Foreign Languages, Chung Shan Medical University, Taichung, Taiwan

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BMC Health Services Research 2009, 9:239  doi:10.1186/1472-6963-9-239

Published: 19 December 2009



Chronic kidney disease (CKD) is a serious public health problem in Taiwan and the world. The most effective, affordable treatments involve early prevention/detection/intervention, requiring screening. Successfully implementing CKD programs requires good patient participation, affected by patient perceptions of screening service quality. Service quality improvements can help make such programs more successful. Thus, good tools for assessing service quality perceptions are important. Aim: to investigate using a modified SERVQUAL questionnaire in assessing patient expectations, perceptions, and loyalty towards kidney disease screening service quality.


1595 kidney disease screening program patients in Taichung City were requested to complete and return a modified kidney disease screening SERVQUAL questionnaire. 1187 returned them. Incomplete ones (102) were culled and 1085 were chosen as effective for use. Paired t-tests, correlation tests, ANOVA, LSD test, and factor analysis identified the characteristics and factors of service quality. The paired t-test tested expectation score and perception score gaps. A structural equation modeling system examined satisfaction-based components' relationships.


The effective response rate was 91.4%. Several methods verified validity. Cronbach's alpha on internal reliability was above 0.902. On patient satisfaction, expectation scores are high: 6.50 (0.82), but perception scores are significantly lower 6.14 (1.02). Older patients' perception scores are lower than younger patients'. Expectation and perception scores for patients with different types of jobs are significantly different. Patients higher on education have lower scores for expectation (r = -0.09) and perception (r = -0.26). Factor analysis identified three factors in the 22 item SERVQUAL form, which account for 80.8% of the total variance for the expectation scores and 86.9% of the total variance for the satisfaction scores. Expectation and perception score gaps in all 22 items are significant. The goodness-of-fit summary of the SEM results indicates that expectations and perceptions are positively correlated, perceptions and loyalty are positively correlated, but expectations and loyalty are not positively correlated.


The results of this research suggest that the SERVQUAL instrument is a useful measurement tool in assessing and monitoring service quality in kidney disease screening services, enabling the staff to identify where service improvements are needed from the patients' perspectives.