Dimensional structure of the satisfaction of Family Health users

The study aims to analyze the dimensional structure of the instrument SERVQUAL, used to measure the satisfaction of users of public health services at the basic attention. A quantitative study, conducted through surveys anwered by 353 users of the Family Health Strategy. The participants were: female (71.7%); aged 31 to 40 years (30.9%) and who completed High School education (43.3%). In the model adjustment analysis, the results were unsatisfactory for the established criteria. A new model was suggested given the specific context of the public health presenting inadequate results for all criteria. The results were satisfactory for convergent and discriminatory validity. The study implicates an indication of a new adjusted model, to comprehend the satisfaction of users of the family health, that should tested in future nursing and public health studies with more in-depth analyses, discussing the findings of this study to consolidate a new analytical instrument. Descriptors: Patient Satisfaction; Family Health Strategy; Primary Health Care. 1 Nurse, Ph.D in Biotechnology. Coordinator of the Professional Master’s of Family Health of the University Center UNINOVAFAPI. Teresina, PI, Brazil. E-mail: eliana@uninovafapi.edu.br. 2 Dental Surgeon, Ph.D in Clinical Dentistry. Professor at the University Center UNINOVAFAPI. Teresina, PI, Brazil. E-mail: ftapety@uninovafapi.edu.br. 3 Nurse. Sc.D Professor at the University Center UNINOVAFAPI. Teresina, PI, Brazil. E-mail: camila@uninovafapi.edu.br. 4 Undergraduate Student at Piauí Federal University. Teresina, PI, Brazil. E-mail: matheuscbmatos@gmail.com. 5 Nurse, Master of Nursing. Student of the Graduate Program of Fundamental Nursing, Doctorate level, at Ribeirão Preto College of Nursing at University of São Paulo. Ribeirão Preto, SP, Brazil. E-mail: laelson@usp.br. 6 Dietitian, Ph.D in Biological Sciences. Full Professor at Piauí Federal University. Teresina, PI, Brazil. E-mail: carminhamartins@ufpi.edu.br. 7 Nurse, Ph.D in Public Policies. Coordinator of the Nursing course at the University Center UNINOVAFAPI. Teresina, PI, Brazil. E-mail: oliveiracairo@ig.com.br. 8 Dental Surgeon. Ph.D in Endodontics. Professor at the University Center UNINOVAFAPI. Teresina, PI, Brazil. E-mail: luanamoura@uninovafapi.edu.br. 9 Nurse, Ph.D in Nursing focused on Adult Health. Professor at Faculty Estácio of Teresina. Teresina, PI, Brazil. E-mail: lucianabmneiva@uol.com.br. Received: 01/06/2018. Accepted: 10/17/2018. Published: 12/31/2018. Suggest citation: Lago EC, Tapety FI, Almeida CAPL, Matos MCB, Sousa LRM, Martins MCC, et al. Dimensional structure of the satisfaction of Family Health users. Rev. Eletr. Enf. [Internet]. 2018 [cited ____________];20:v20a55. Available from: https://doi.org/10.5216/ree.v20.51007. Lago EC, Tapety FI, Almeida CAPL, Matos MCB, Sousa LRM, Martins MCC, et al. Rev. Eletr. Enf. 2018;20:v20a55. doi: 10.5216/ree.v20.51007. INTRODUCTION The Unified Health System (SUS) is structured in different levels of health attention that are organized in accordance with the complexity level. The basic attention (BA) is characterized as the main entrance door to the system, and it is responsible by the health of families and hard-to-reach populations through the Family Health Strategy (FHS). The FHS was implemented in Brazil as the main BA reorganization strategy; it is allocated in strategical regions to facilitate the population access to SUS services(1). For the population to have access to FHS services consistently according to their needs, a bond should exist between health professionals and service users. The established relationships increase the user’s rust and satisfaction(1). Satisfaction in the health field can be seen as a complex process related to individual needs and expectations, involving different aspects of attention. Thus, satisfaction consists of an assessment of various elements of health care, as infrastructure, access, and human resources quality, occupying a differentiated position in the assessment processes of services(2). Considering that the user’s satisfaction interferes in the level of therapeutic adherence and behaviors towards the health and disease, its measurement is indispensable to assess public policies and health services concerning the quality of service and response capacity of the system. In international contexts, in countries where health considered merchandise and the user a consumer, satisfaction increments implicates to the rise of health services consumption(3). In the Brazilian context, in public health services linked to SUS, the satisfaction is associated with improvements of health state, actively involving the patient in the decision-making regarding their assistance(1). The Family Health Strategy (FHS) prioritizes actions of protection and health promotion of individuals and family, reaffirming the basic principles of the Unified Health System (SUS) and substituting the traditional biomedical model. However, the level of satisfaction by the user is decisive in the search for services(4). The knowledge of these levels can guide actions and the development of new programs and strategies, a particular way to identify issues and contribute to the improvement of health services. Considering that the assessment of the attention offered subsidizes the improvement of the health system and that the free and critical participation of users favors the empowering within the system, this study aimed to analyze the dimensional structure of the SERVQUAL instrument, used to assess users’ satisfaction with public health services in the basic attention. The SERVQUAL scale or Service Quality is an analytical instrument widely used to measure the quality of services from the perception of their users(5). When analyzing the gaps or disagreements that interfere with the quality level of services offered to users, the scale points the real divergence between perceptions and expectations, investigating how the service is offered to the user and considering the aspects that need to be improved within an institution(6). The assessment of users’ satisfaction with health services still is scarce in the academic literature, especially provided by the SERVQUAL application, could contribute with the innovative potential of management instruments use converted in public health analytical instruments from the perspective of its users. Lago EC, Tapety FI, Almeida CAPL, Matos MCB, Sousa LRM, Martins MCC, et al. Rev. Eletr. Enf. 2018;20:v20a55. doi: 10.5216/ree.v20.51007. METHODS Ethical aspects The Ethics and Research Committee of the UNINOVAFAPI University Center approved the research project with the registration no 893.065 and CAAE no 38532614.0.0000.5210. The study participants signed the Informed Consent, and their confidentiality was guaranteed. Study design and data A quantitative study was conducted through a survey applied to 353 users of the Family Health Strategy who were assisted in the Teresina/PI (Brazil). The data collection was during January and May 2015. The study was conducted with users of two FHS teams in the east area of the city. At the study time, 927 families were benefited by the two investigated FHS teams. Beyond the assessment of the satisfaction level of users which is a general indication of the scale use, the study aimed to analyze its dimensions for the specific public health context, from its application. Population and sample: inclusion and exclusion criteria The following inclusion criteria were followed: to be registered in the FHS; to be 18 years or older; capable of responding a questionnaire and, to have been assisted at least once by one of the FHS teams. The exclusion criterion was to be an FHS employee or of any other service related to the Municipal Health Foundation of Teresina. To estimate the population of attended individuals, the average of people per family in Teresina was used, calculated in accordance with data from the last census conducted by the Brazilian Institute of Geography and Statistics (IBGE) in 2010 and in accordance with the current estimates of 2018 (average of 3.65 people) with an estimation of 3,384 attended people(7). From the estimative of the attended population which was supporting data for the sample calculation, we used the Formula 1 that guided the number of applied questionnaires. Formula 1: Sample calculation