Assessing the Generalizability of Client Experience Measurement Tools in Low- and Middle-Income Countries: A Narrative Review

Andrew Corley; Susannah Gibbs; Nirali Chakraborty; Lara Fields; Giannina Chávez Ackermann; Jasmine Coulson; Yixin Zhang; Paul Bouanchaud

doi:10.9745/GHSP-D-23-00364

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FIGURE 1
Conceptual Framework for Person-Centered Measures of Health System Quality and Responsiveness^a
^a Source: Larson et al., 2019¹²

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TABLE 1.

Number of Client Experience Measures and Citations in Included Articles, by Health Area

Health Area	No. of Measures	No. of Citations
Sexual and Reproductive Health	12	14
HIV	3	4
Primary Care	2	6
Noncommunicable Diseases	21	26
LMICs	2	4
HICs	19	22
Health Services Marketing and Management	23	23
LMICs	6	6
HICs	17	17
Total	61	73

Abbreviations: HICs, high-income countries; LMICs, low- and middle-income countries.

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TABLE 2.

Client Experience Domains of the Measurement Tools in the Included Articles and Their Overlap With Larson and Colleagues’ Domains^a

Client Experience of Care Domains
Effective Communication	Respect and Dignity	Emotional Support
Access to Information Care Teams Across Settings Clarity of Information Communication Communication and Autonomy Communication with Nurses and Doctors Continuity of Care Coordinated and Comprehensive Care Coordination Coordination of Care Decision Support Diagnosis Education and Shared Knowledge Effective Use of Method Eliciting Client’s Preferences Financial Advice Follow-up/Coordination Free Flow and Accessibility of Information General Practitioner Involvement Goal Setting/Tailoring Health Information and Decision-Making Support Information and Questions Information Exchange Information for Treatment Decision-Making Information of Care Pathway Information on Changes Related to Illness Information Services Managing Appointments Method Selection Patient Activation Person-Focused Care Over Time Problem Solving Providing General Information Providing Specific Information Provision of Information Rapport Receiving Adequate Information Suspicion of Diagnosis Symptom Non-reporting	Abuse Abuse-Free Care Accessibility of Care Accessing Support Attitude and Commitment of Service Providers Autonomy Care Goals for Patients Conduct of Healthcare Professionals Confidentiality Cultural Competence Decision-Making About Treatment Dignity Discrimination Discriminatory Behavior Friendliness Interpersonal Connection Interpersonal Relationship Making Treatment Decisions Non-Discrimination Patient-Centered Approach by Doctors Patient-Centeredness Physical Abuse Privacy Quality of Life Respect Respectful and Engaging Interaction Respectful and Supportive Care Respectful Care Respectful Coordinated Care Stigma Stigma and Discrimination Verbal Abuse	Activities to Address Biopsychosocial Needs Comfort Disclosure Support Family-Centeredness Feelings of Abandonment Provide Social Support Psychosocial Care and Aftercare Psychosocial Needs Sharing Feelings with Others Social Support Supportive Care Sustaining Normality Trustful Relationship with Health Care Staff Value for Non-Provider Social Support Worries and Anxieties

↵a Larson and colleagues¹² proposed that client experience of care is broadly composed of 3 domains: effective communication, respect and dignity, and emotional support.

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TABLE 3.

Client Experience Measures in Included Articles, by Health Area and Measure Domains

Measure Name or Study Description	Countries Validated	Population(s)	Client Experience of Care Domains			Other Domains Addressed	References
Measure Name or Study Description	Countries Validated	Population(s)	Effective Communication	Respect and Dignity	Emotional Support	Other Domains Addressed	References
Sexual and Reproductive Health
Person-Centered Maternity Care (PCMC)	India Kenya	Women who recently gave birth in a health facility	Communication and Autonomy	Dignity and Respect	Supportive Care		²²^,²³
PCMC short	Kenya Ghana India	Women who recently gave birth in a health facility	Communication and Autonomy	Dignity and Respect	Supportive Care		²⁴
Bohren et al. (2018)	Nigeria Ghana Guinea Myanmar	Women who gave birth in the past 8 weeks	Communication	Physical Abuse; Verbal Abuse; Stigma; Discrimination	Supportive Care	Failure to Meet Professional Standards; Neglect and Abandonment; Pain Relief	²⁵^,²⁶
Gurung et al. (2021)	Nepal	Women giving birth at a public hospital providing comprehensive emergency obstetric and neonatal care	Rapport	Abuse; Stigma and Discrimination		Standard of Care; Care Not Refused Due To Finances	²⁷
QCC (Quality Contraceptive Counselling) Scale	Mexico	Health facility clients interested in learning about contraception during their visit	Information Exchange	Disrespect and Abuse; Interpersonal Relationship			²⁸
Jain et al. (2019)	India	Married women adopting a long-acting reversible contraceptive method	Method Selection	Respectful Care		Continuity of Contraceptive Care Use Effective Use of Method	²⁹
IQFP (Interpersonal Quality of Family Planning) scale	India	Young married couples	Receiving Adequate Information	Interpersonal Connection	Decision Support		³⁰
Net Promoter Score (NPS)	India Kenya Nigeria El Salvador	Family planning clinic clients				General (e.g., likelihood of recommending this clinic to someone)	³¹
Respectful Maternity Care (RMC) Scale	Ethiopia	Women who gave birth in the past 7 weeks		Non-Discrimination; Abuse-Free Care; Friendliness		Timeliness of Care	³²
Person-Centered Family Planning (PCFP) Scale	India Kenya	Women seeking family planning services at public health facilities	Communication	Autonomy; Respectful Care		Health Facility Environment	³³
Person-Centered Abortion Care (PCAC) Scale	Kenya	Women who received an abortion-related service	Communication and Autonomy	Respectful and Supportive Care			³⁴
Quality of Family Planning Counselling (QFPC) Measure	India	Family planning clients	Provision of Information; Eliciting Client’s Preferences	Respectful and Engaging Interaction			³⁵
HIV
Health System Responsiveness Survey	Tanzania	Adults living with HIV currently on antiretroviral therapy	Communication	Respect; Confidentiality	Comfort	Access; Perceived Quality	³⁶
CARE’s Community Score Card (CSC)	Malawi	Pregnant and lactating people living with HIV		Attitude and Commitment of Service Providers; Discriminatory Behavior; Confidentiality	Disclosure Support		³⁷
Quality of Care Through the Patient's Eyes - HIV (QUOTE-HIV)	Brazil The Netherlands	Clients living with HIV receiving outpatient care	Communication; Access to Information	Respect; Dignity; Privacy; Autonomy	Social Support	Facilities; Time	³⁸^,³⁹
Primary Care
Primary Care Assessment Tool (PCAT)	United States Canada Brazil Spain South Korea China Taiwan Tibet Vietnam South Africa Malawi	Primary care clients	Person-Focused Care Over Time; Coordination	Cultural Competence	Family-Centeredness	First Contact Care; Comprehensiveness; Community Orientation	⁴⁰^–⁴⁵
Patient Assessment of Healthcare for Outpatient Care (O-PAHC)	Ethiopia	Adults receiving outpatient care at hospitals or health centers	Communication with Nurses and Doctors			Physical Environment	⁴⁶
Noncommunicable Diseases
Chronic Cancer Experiences Questionnaire (CCEQ)	United Kingdom	Patients with breast, gynecological, colorectal, renal, or prostate cancer	Information and Questions; General Practitioner Involvement; Financial Advice; Managing Appointments; Coordination of Care; Symptom Non-reporting	Making Treatment Decisions; Accessing Support	Sharing Feelings with Others; Worries and Anxieties; Sustaining Normality	Clinical Trials	⁴⁷
Consumer Quality Index Breast Cancer (CQI-BC)	The Netherlands	Patients with breast, lung, colorectal, prostate, hematological, gynecological, or skin cancer	Information Services; Continuity of Care	Conduct of Healthcare Professionals; Accessibility of Care; Autonomy	Psychosocial Care and Aftercare	Expertise of Healthcare Professionals; Hospital Facilities; Time Schedule	⁴⁸
Consumer Quality Index Cancer Care (CQI-CC)	The Netherlands	Patients with breast, lung, colorectal, prostate, hematological, gynecological, or skin cancer	Education and Shared Knowledge; Free Flow and Accessibility of Information	Patient-Centered Approach by Doctors		Skills & Cooperation of Healthcare Professionals; Collaboration & Team Management	⁴⁹
LifeCourse Experience Tool	United States	Patients with heart failure, cancer, or dementia	Care Teams Across Settings; Communication	Care Goals for Patients			⁵⁰
Measure of Processes of Care for Adults (MPOC-A)	Canada	Patients with joint or hip replacements	Providing General Information; Providing Specific Information; Coordinated and Comprehensive Care	Respectful and Supportive Care			⁵¹
Opportunity for Treatment In Oncology (OPTION) Questionnaire	Italy	Patients with breast or colorectal cancer	Information of Care Pathway; Information on Changes Related to Illness		Feelings of Abandonment; Trustful Relationship with Health Care Staff	Collaboration Among Health Care Professionals	⁵²
Pulmonary Arterial Hypertension Clinic - Patient Reported Experience Measurement (PAH-PREM)	Sweden	Patients with pulmonary arterial hypertension	Communication	Patient-Centeredness		Effectiveness; Timeliness	⁵³
Patient Assessment of Cancer Communication Experiences (PACE)	Portugal	Oncology patients		Decision-Making About Treatment		Surgery; Chemotherapy; Radiation Therapy; Suspicion of Diagnosis; Diagnosis	⁵⁴
Patient Assessment of Chronic Illness Care (PACIC)	Denmark The Netherlands United States France	Patients with cardiovascular disease or diabetes mellitus	Patient Activation; Goal Setting/Tailoring; Problem Solving; Follow-up/Coordination			Delivery-System/Practice Design	⁵⁵^–⁵⁸
Short version of the Patient Assessment of Chronic Illness Care (PACIC-M11)	Malaysia	People with type 2 diabetes or hypertension in primary care settings	Patient Activation; Goal Getting/Tailoring			Delivery System Design/Practice Design	⁵⁹^–⁶¹
Older Patient Assessment of Chronic Illness Care (O-PACIC) Sale	The Netherlands	Recently discharged hospitalized patients	Patient Activation; Goal Setting/Tailoring; Problem Solving/Contextual; Follow-Up Coordination			Delivery-System/Practice Design	⁶²
Patient Satisfaction with Cancer-Related Care (PSCC)	United States	Patients with breast, cervical, colorectal, or prostate cancer	Communicational/ Informational; Coordination of Care	Interpersonal/ Relational		Access/Logistical	⁶³
Patient-Centered Quality of Cancer Care Questionnaire (PCQCCQ-S)	Mexico	Oncology patients	Clarity of Information; Information for Treatment Decision-Making	Respectful Coordinated Care	Activities to Address Biopsychosocial Needs	Timely Care	⁶⁴
Patients and the Cancer Care Experience (PCCE)	United States	Oncology patients	Health Information and Decision-Making Support	Quality of Life	Provide Social Support; Psychosocial Needs; Value for Non-Provider Social Support		⁶⁵
Quality of Care Through the Patient's Eyes (QUOTE)	The Netherlands	Oncology patients	Treatment-related Information; Prognosis Information; Rehabilitation Information; Interpersonal communication; Tailored Communication; Affective Communication		Coping Information		⁶⁶
Quality of Patient-Centered Cancer Care (QPCCC)	Australia	Hematology cancer patients	Provision of Information, Communication and Education; Coordinated and Integrated Care	Patient Centeredness; Safety; Equity	Emotional Support; Involvement of Family and Friends	Physical Comfort; Effectiveness; Timeliness; Efficiency	⁶⁷
CONTACT-Patient-Centered Care Questionnaire (CONACT-PCCQ)	Belgium	Oncology patients	Information, Communication and Education; Coordination of Care	Respect for the Patient’s Values, Preferences and Expressed Needs	Emotional Support; Involvement of Family and Friends	Physical Comfort	⁶⁸
Patient Experience Survey (PES)	Canada	Radiation therapy patients	Appointment Scheduling	Interprofessional Staff/Patient Encounters		Same Day Waits; Hospital/Waiting Room Environment; Patient Care; Weekly Oncologist Review; Parking	⁶⁹
Patient Centered Communication in Cancer Care (PCCCC)	United States	Patients with colon or rectal cancer	Exchanging Information; Fostering Health Relationships; Making Decisions; Managing Uncertainty	Enabling Patient Self-Management	Responding to Emotions	Cross-Cutting Items	⁷⁰
Patient-Centered Measures of End-of-Life Care Quality for Children with Cancer	United States	Pediatric oncology and palliative care patients	Communication	Meeting Patient Preferences; Symptom Management		Healthcare Use; Interdisciplinary Care	⁷¹
Patient-Centered Primary Care	The Netherlands	Patients with multiple chronic conditions	Information and Education; Continuity and Secure Transition between Healthcare Settings; Coordination of Care	Respect for Patients’ Preferences	Emotional Support; Involvement of Family and Friends	Access to Care; Physical Comfort	⁷²
Health Services Marketing & Management
Health Service Quality Scale	Australia	Outpatient oncology clinic and primary care clinic clients	Interpersonal Quality			Technical Quality; Environment Quality; Administrative Quality	⁷³
Emergency Room Service Quality	Israel	Individuals accompanying emergency department patients			Staff Caring	Staff Professionalism; Tangibles	⁷⁴
Health Service Quality Scale	Colombia	Outpatient health clinic clients	Patient-Centered Communication			Process Quality	⁷⁵
Continuity Quality of Care Indicator	Poland	Outpatient health clinic clients	Informational Continuity; Cross-Boundary and Team Continuity	Patient Empowerment	Relational Continuity	Managerial Continuity; Flexible Continuity; Longitudinal Continuity	⁷⁶
Alberta Continuity of Services Scale-Mental Health (ACSS-MH)	Canada	In- and outpatient mental health service clients		Individualized Care		Responsive Caregiver Responsive System	⁷⁷
The Humanistic Relationship Importance Scale	Canada	Chronic care facility patients		Recognizing and Supporting Choice; Supporting Human Uniqueness	Relational Availability; Forming Connections	Promoting Quality of Daily Life	⁷⁸
Parent Satisfaction Scale (PSS)	United States	Pediatric mental health treatment clients		Met Expectations		Met Desires; Met Needs	⁷⁹
Responsiveness of Physician (ROP) Scale	Bangladesh	Rural health service clients	Informing and Guiding	Respecting	Friendliness	Financial Sensitivity; Gaining Trust	⁸⁰
mHealth Service Quality Scale	Bangladesh	mHealth consumers	Information Quality		Interaction Quality	System Quality	⁸¹
Multidimensional Scale for Healthcare Service Quality (HCSQ)	India	Medicine, surgery, pediatric, and gynecology inpatients	Interaction Quality			Physical Environment Quality; Outcome Quality	⁸²
Evaluation of Client Services (ECS)	United States	Outpatient mental health treatment services clients	Communication and Information Exchange		Treatment Relationship	Treatment Management and Outcome; Reachability of Treatment Facilities	⁸³
The Health Service Quality (HEALTHQUAL) Measure	South Korea	Hospital in- and outpatients			Empathy	Tangible; Safety; Efficiency; Care Service Improvements	⁸⁴
Medical Tourism Experience (MTEX) Scale	India	Medical tourism clients		Medical Service Quality		Treatment Quality; Medical Tourism Expenses; Medical Tourism Infrastructure; Destination Appeal; Destination Culture; Ease of Access	⁸⁵
Cultural Differences in Healthcare	South Korea	Medical tourism clients	Communication	Cultural Values; Religion		Hospital Care and Services; Food; Healthcare System; Facility	⁸⁶
Scale for e-Health Service Quality	Switzerland	mHealth consumers	Information		Empathy; Individualization; Ethical Conduct	Accessibility; Competence; Usability; Security; System Integration; Trust; Performance; Reliability; Ability to Respond	⁸⁷
Navigation Satisfaction Tool (NAVSAT)	Canada	Parent and guardians of youth receiving mental health and addiction services	Ability to Listen; Communication Frequency; Frequency of Contact	Confidentiality		Likelihood of Recommending Service; Overall Satisfaction; Navigator Helpfulness; Ability to Understand Mental Health System; Intake Procedures; Treatment Options Information; Appropriate Treatment Found; Impact on Family	⁸⁸
The Acute Care Hospital Foodservice Patient Satisfaction Questionnaire (ACHFPSQ)	Australia	Acute care inpatients				Food Quality; Meal Service Quality; Staff Service Issues; Physical Environment	⁸⁹
The Birth Satisfaction Scale (BSS)	United Kingdom	Postpartum women		Quality of Care Provision	Quality of Care Provision	Personal Attributes; Stress Experienced During Labor	⁹⁰
The Cataract Service Satisfaction Tool	United Kingdom	Outpatient cataract surgery clients	Collaboration With Doctors and Nurses; Quantity and Quality of Information	Autonomy; Empathy		Knowledge; Facilities; Waiting Times; Overall Satisfaction; Ability to Manage at Home; Access to Postoperative Support	⁹¹
Clinical Decision-making Involvement and Satisfaction (CDIS) Scale	Germany; England; Italy; Hungary; Switzerland	Community-based mental health service clients		Involvement		Satisfaction	⁹²
Key Quality Characteristics Assessment for Hospital (KQCAH) Scale	United States	Recently discharged hospitalized patients	Information	Respect & Caring		Effectiveness & Continuity; Appropriateness; Efficiency; Effectiveness-Meals; First Impression; Staff Diversity	⁹³
Chinese Patients' Satisfaction Scale (C-PSS)	Taiwan	Hospital outpatient clients		Respect	Warm Interactions	Efficiency; Fairness; Professionalism; Responsibility	⁹⁴
Responsiveness of Physicians Scale (ROP-Scale)	Bangladesh	COVID hospitalized patients	Informativeness	Courteousness		Trustworthiness	⁹⁵