Document Type : Original Article


Department of Public Health, School of Health, Arak University of Medical Sciences, Arak, Iran


Background: Quality gap is the gap between client’s understanding and expectations. The
first step in removing this gap is to recognize client’s understanding and expectations of the
services. This study aimed to determine women’s viewpoint of quality gap in primary health
care centers of Isfahan. Materials and Methods: This cross-sectional study was conducted
on women who came to primary health care centers in Isfahan city. Sample size was 1280
people. Service Quality was used to collect data including tangible dimensions, confidence,
responsiveness, assurance and sympathy in providing services. Data were analyzed by t test
and chi square test. Results: The results showed that women had controversy over all 5
dimensions. The least mean quality gap was seen in assurance (-11.08) and the highest mean
quality gap was seen in tangible dimension (-14.41). The difference between women’s viewpoint
in all 5 dimensions was significant. (P < 0.05) Conclusion: Negative difference means clients’
expectations are much higher than their understanding of the current situation, so there is a
large space to improve services and satisfy clients.


1. Lewis P, Goodman SH, Fandt PM. Management challenges in the
21st century. U.S.A: West Publishing Co; 1995.
2. Briscoe G, Arthur G. CQI teamwork: Reevaluate, restructure, renew.
Nurs Manage 1998;29:73-80.
3. Morris B, Bell L. “Quality in health care”. Managing Health Care,
challenges for the 90s. London, England: W.B Saunders Co., Ltd.;
1995. p. 119-42.
4. Mirmolaei ST, Khakbazan Z, Kazemnejad A, Azari M. Prenatal
care utilization rate and patients satisfaction. J Faculty of Nursing
Midwifery 2007;13:31-40.
5. Sheikhtaheri A, Farzandipour M, Sadughi F. Consumer’s
satisfaction with admission services in teaching hospitals affiliated
to Kashan University of Medical Sciences; 2006. J Health Manag
2007;10:15- 24.
6. Blonsky J. Organizational Effectiveness; Total Quality Management.
Total Performance Efficiency; What is TQM? QA? QC? QI? CQI? CPI?
[on-line]. Available from: 4263. [Last
cited in 2002].
7. Heizer/ Render. Operations Management. Managing Quality
chapter 6. [on-line]. Available from: http://myphliputil. Pearsonmg.
com/student/bp-heizer-opsmgmt-7/lec-cho6. PPt. [Last accessed on
2004 Nov 29].
8. Larry G. TQM. [on-line]. Available from: enet.
net/~leg/ tqm.htm. [Last accessed on 2004 Nov 05].
9. Review for Exam1. [on-line]. Available from: http://burns.
Isqs5243/ppt/Reviw%20 for 20% Exam%201.ppt. [Last accessed on
2004 Nov 29].
10. Gore G. “The challenges and Potential for Assuring Quality Health
care for the 21st Century” [Report]. [on-line]. Available from: http:// [Last accessed on 2001 Oct 07].
11. Lancaster J. Nursing Issues. Philadelphia: Mosby Company; 1999.
12. Griffin R. Management. 6th ed. Boston: Houghton Mifflin Co.; 1999.
13. Duplessis M, Inkelas M, Halfon N. Assessing the performance of
community systems for children. Health Serv Res 2001;33:1111-42.
14. Koing M, Foo GH, Joshi K. Quality of care within the Indian family
welfare programme. Stud Fam Plann 2001;31:1-8.
15. Brook R, McGlynn EA, Shekelle PG. “Defining and measuring quality
of care: A perspective from U.S researchers”. [Abstract]. Int J Qual
Health Care 2000;12:281-94. [on-line]. Available from: http://www. [Last accessed on 2002 Jan 04].
16. Allender J, Walton B. Community health nursing. 5th ed.,
Philadelphia: Lippincot Co.; 2001.
17. Zairi M. Benchmarking for best practice. Oxford: Butterworth
Heinemann; 1999.
18. Nies M, Ewen M. Maternal and child Nursing. 3rd ed. Philadelphia:
WB Saunders, Co.; 2001.
19. Kahassay M, Taylor M, Berman P., et al. Community health workers.
Geneva: W.H.O; 1998.
20. Lundy S, Janes S. Community health nursing. Massachusetts: Janes
and Barlett; 2001.
21. Sakharkar BM. Principles of hospital administration and planning.
New Delhi, India: Jaypee Brothess Medical Publishers (p) Ltd.; 1998.
22. Ghazizadeh A. Cost-benefit analysis of treatment of depressed
patients in health system of Kurdistan province in 1993. Sci J
Kurdistan Univ Med Sci 2001;5:17-14.
23. Jadid Milani M, Mahfouzpour S, Valaie N, Hosseinzadeh S,
Soheil Arshadi F. Assessing the quality of care services for
0-6 years children in urban health centers of Shahid Beheshti
University of Medical Sciences, 2001-02. Pejouhandeh Quart Res
J 2003;8:297- 291.
24. Pakgohar M, Jamshidi Evanaki F, Mehran A, AkbaritorkestaniN.Parent’s
satisfaction of infant health care. J Faculty Nursing Midwifery
25. Seyedoshohadaii F, Ghanei H. Quality of prenatal care in the PHC
and privative system in Sanandaj. Sci J Kurdistan Univ Med Sci
1999;4:33-28.26. Najafi F, Rakhshani F. Effect of group counseling program for women
on spouse communication regarding family planning in Zahedan
health care centers in 2002. Med J Reprod Infertility 2004;5:345-338.
27. Shahidzadeh A, Mir Moeini ES, Azimian MH, Mani Kashani Kh.
A qualitative assessment of urban family planning facilities in
Hamadan, May-September 2003. J School Public Health Inst Public
Health Res 2003;2:10-1.
28. Jafari F, Johari Z, Zayeri F, Ramezan Khani A, Sayyah-Iran
Z. Satisfaction survey in health center clients daneshvar, scientificresearch. J Shahed Univ 2007;14:15-22.
29. Ehiri JE, Oyo-Ita AE, Anyanwu EC, Meremikwu MM. Quality of child
health services in primary health care facilities in south-east Nigeria.
Child Care Health Dev 2005;31:181-91.
30. Shabrawy A. A study of pattient satisfactory of utilization of primary
health care service. J Roy Soc Health 1992;112:64-7.
31. Wisniewski M, Wisniewski H. Measuring service quality in a hospital
colposcopy clinic. Int J Health Care Qual Assur Inc Leadersh Health
Serv 2005;18:217-28.
32. Karydis A, Komboli M, Pannis V. Expectation and perception of
Greek patients regarding the quality of dental health care. Int J Qual
Health Care 2001;13:409-16.
33. Gagliano KB, Cote JH. Customer expectations and perceptions of
service quality in retail apparel specialty stores. J Serv Marketing
34. Campbell JL, Ramsay J, Green J. Age, gender, socioeconomic and
ethnic differences in patient’s assessments of primary health care.
Qual Health Care 2001;10:90-5.
35. Lim PC, Tang NK. A study of patients’ expectations and satisfaction
in Singapore hospitals. Int J Health Care Qual Assur 2000;13:290-9.
36. Mike D, Mik W, John FD, Adrienne CC. Measuring service quality
in local government: The SERVQUAL approach. Int J Public Sector
Manage 1995;8:15-20.
37. Kebriaei A, Roudbari M. A comparative study on the importance of
dimensions of educational services at Zahedan University of Medical
Sciences: Faculties and Students’ Viewpoints. J Jahrom Univ Med
Sci 2008;6:56-65