Perceived Access to Health Care Questionnaire

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Abstract

The perceived access to Health Care Questionnaire is a multidimensional psychometric instrument designed to evaluate how individuals subjectively experience and navigate barriers to medical services. While traditional public health metrics often rely on objective indicators—such as the geographic distance to a clinic or the ratio of hospital beds to citizens—this tool pivots toward the psychological reality of the patient. It operates on the premise that objective availability does not guarantee actual utilization; rather, a patient's personal perception of accessibility, affordability, and cultural acceptability ultimately dictates their healthcare-seeking behavior.

Developed by synthesizing Penchansky and Thomas's foundational five-dimension model of access with Saurman's later addition of 'awareness', the instrument captures a holistic picture of healthcare barriers. It bridges the gap between spatial limitations, economic constraints, organizational hurdles, and health literacy. By quantifying these subjective experiences, the questionnaire provides researchers and policymakers with actionable data to identify hidden inequities in healthcare systems, particularly those that persist despite adequate physical infrastructure.

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Keywords
healthcare access
perceived access
health equity
psychometrics
instrument development
health psychology

📊 Psychometric Scorecard

Items Count
30
Structure
Multidimensional
Cronbach's α
0.86
Validation Country
📍 Iran

Authors

👤 Sara-Sadat Hoseini-Esfidarjani
✉ [email protected]

👤 Reza Negarandeh
✉ [email protected]

👤 Farzaneh Delavar
✉ [email protected]

👤 Leila Janani
✉ [email protected]

Purpose

In the realm of health services research, there is a historical overreliance on objective, market-driven metrics to define healthcare access. However, these metrics frequently fail to explain why certain populations—despite living near well-funded facilities—continue to underutilize medical care. The perceived access to Health Care Questionnaire was developed to address this critical measurement gap. It shifts the analytical focus from the structural capacity of the health system to the lived experience of the consumer.

For clinicians and public health researchers, this scale is invaluable because it operationalizes the psychological and cultural dimensions of access. Existing tools tend to be fragmented, focusing on single dimensions like cost or geographic distance. By offering a unified, standardized measure of perceived access across six distinct domains, this instrument allows researchers to pinpoint exactly where the breakdown in healthcare delivery occurs, facilitating highly targeted interventions to improve health equity.

Construct

The psychological construct of 'perceived access' measured by this scale is grounded in a comprehensive, six-factor theoretical framework. The first two dimensions are spatial: 'Availability' evaluates the perceived adequacy of healthcare resources and personnel, while 'Accessibility' captures the subjective burden of travel time and geographic distance. The subsequent three dimensions are non-spatial, focusing on the socio-economic and cultural interface between patient and provider. 'Affordability' assesses the individual's perceived financial capacity to bear healthcare costs, 'Accommodation' measures how well the organization of services aligns with patient needs and schedules, and 'Acceptability' gauges the cultural and interpersonal comfort between patients and medical staff.

The final dimension, 'Awareness', represents a vital cognitive component added to modern access models. It encompasses health literacy and the patient's ability to identify their own medical needs, understand what services exist, and navigate the system to utilize them. Together, these six dimensions form a cohesive construct reflecting the complex, multifaceted nature of healthcare access as a subjective human experience rather than a mere logistical reality.

Validity

The development of the questionnaire involved rigorous validation protocols to ensure psychometric soundness. Content validity was established through both qualitative expert review and quantitative metrics. A panel of specialists evaluated the initial 31 items, resulting in excellent Content Validity Ratio (CVR) scores exceeding 0.78 for 30 items, leading to the elimination of one underperforming item. The Content Validity Index (CVI) further supported the item pool, with 29 items scoring above the strict 0.79 threshold and one requiring minor revisions.

Face validity was confirmed quantitatively, with all retained items achieving an impact score greater than 1.5, indicating high relevance and clarity as judged by both experts and the target demographic. Construct validity was subsequently evaluated using Confirmatory Factor Analysis (CFA) on a sample of 300 Adults. The CFA successfully validated the theoretical six-factor structure, demonstrating that the empirical data aligned well with the a priori dimensions of availability, accessibility, affordability, accommodation, acceptability, and awareness.

Reliability

The instrument demonstrates robust reliability, making it a dependable tool for both cross-sectional and longitudinal research. Internal consistency for the overall 30-item scale is strong, yielding a Cronbach's alpha of 0.86. When examining the individual subscales, the alpha coefficients range from 0.60 to 0.80 (specifically: acceptability at 0.80, accessibility and awareness at 0.76, affordability at 0.66, availability at 0.61, and accommodation at 0.60). While some subscale values are modest, they remain within acceptable psychometric boundaries for multidimensional constructs with relatively few items per factor.

Temporal stability was also rigorously tested. A two-week test-retest reliability analysis utilizing the two-way mixed absolute agreement method produced an Intraclass Correlation Coefficient (ICC) of 0.94. This exceptionally high ICC value indicates that the questionnaire is highly stable over time, ensuring that any changes detected in longitudinal studies are likely due to true shifts in perceived access rather than measurement error.

Factor Analysis

To verify the underlying structure of the questionnaire, the researchers employed Confirmatory Factor Analysis (CFA) using the lavaan package in R. Unlike exploratory approaches, CFA requires the researchers to specify the exact factor structure beforehand based on theory—in this case, the six-dimensional model of access.

The analysis evaluated how well the 30 items mapped onto their respective latent variables (availability, accessibility, affordability, accommodation, acceptability, and awareness). The researchers established stringent a priori fit criteria, including a Tucker Lewis Index (TLI) and Goodness of Fit (GFI) of 0.95 or higher, and a Root Mean Square Error of Approximation (RMSEA) below 0.05. The results confirmed that the six-factor model provided an appropriate and statistically sound fit for the empirical data, validating the multidimensional nature of perceived healthcare access.

Subscales

Subscale Items Description
Availability Measures the perceived physical availability and capacity of healthcare resources.
Accessibility Measures the perceived burden of geographic distance and commuting time to healthcare facilities.
Affordability Measures the perceived economic capacity to pay for healthcare services and insurance.
Accommodation Measures perceptions of how well healthcare services are organized to meet patient needs and schedules.
Acceptability Measures the perceived cultural and interpersonal comfort between patients and healthcare providers.
Awareness Measures health literacy and the ability to identify needs and navigate the healthcare system.

Instrument

Test Type Self-report questionnaire
Format 30 items, 5-point Likert scale (strongly agree to strongly disagree)
Language Persian
Population Adults, Medical patients
Age Group 20-60 years
Administration Interview-administered

Perceived Access to Health Care Questionnaire Items

📋 Items are currently not available

The individual items of this scale are not publicly available. Researchers interested in using this instrument should contact the original authors directly to request the scale materials.

Sample

300 adult patients (aged 20 to 60 years) who were citizens and residents of Iran, referred to healthcare centers in south Tehran. Participants were selected using a multi-stage sampling method, excluding those with severe cognitive impairments or specific chronic diseases.

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Cite This Paper

Sara-Sadat Hoseini-Esfidarjani, Reza Negarandeh, Farzaneh Delavar, Leila Janani (2021). perceived access to Health Care Questionnaire. BMC Health Services Research. https://doi.org/10.1186/s12913-021-06655-2

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References
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Cite this article

Mohammed looti (2026). Perceived Access to Health Care Questionnaire. PSYCHOLOGICAL SCALES. Retrieved from https://scales.arabpsychology.com/s/perceived-access-to-health-care-questionnaire/

Mohammed looti. "Perceived Access to Health Care Questionnaire." PSYCHOLOGICAL SCALES, 12 Aug. 2026, https://scales.arabpsychology.com/s/perceived-access-to-health-care-questionnaire/.

Mohammed looti. "Perceived Access to Health Care Questionnaire." PSYCHOLOGICAL SCALES, 2026. https://scales.arabpsychology.com/s/perceived-access-to-health-care-questionnaire/.

Mohammed looti (2026) 'Perceived Access to Health Care Questionnaire', PSYCHOLOGICAL SCALES. Available at: https://scales.arabpsychology.com/s/perceived-access-to-health-care-questionnaire/.

[1] Mohammed looti, "Perceived Access to Health Care Questionnaire," PSYCHOLOGICAL SCALES, vol. X, no. Y, ص Z-Z, August, 2026.

Mohammed looti. Perceived Access to Health Care Questionnaire. PSYCHOLOGICAL SCALES. 2026;vol(issue):pages.

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