Patient preference and adherence · 2026
Prioritizing Nursing Care Improvements in Chronic Disease Outpatients: A Cross-Sectional Study Based on SERVQUAL and Kano Models.
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Liu Na, Wang Wen, Wang Yuanyuan
Аннотация
OBJECTIVE: We aimed to analyze the requirement attributes and service quality gap characteristics in nursing care for patients with chronic diseases based on the Service Quality (SERVQUAL) model and Kano model, and to create a two-dimensional framework for priority analysis.
METHODS: A cross-sectional survey was conducted among chronic disease outpatients in a tertiary hospital. A modified Kano-SERVQUAL questionnaire was used to assess nursing service expectations, perceptions, and requirement attributes. SERVQUAL Gap scores, Kano classifications, Better and Worse coefficients, and the comprehensive improvement index (CII) were calculated. A Kano-SERVQUAL priority matrix and Kano-SERVQUAL Sensitivity Prioritization Model (KSSPM) were constructed, and subgroup analysis by specialty was performed.
RESULTS: A total of 490 patients were included. Perception scores were lower than expectations in all SERVQUAL dimensions. Gap scores for tangibles, responsiveness, and empathy were significantly smaller in special outpatient clinics than in general outpatient clinics (P<0.05). Nursing safety assurance, information communication clarity, and privacy protection were classified as must-be requirements, whereas continuous follow-up, personalized health guidance, and psychological support were attractive requirements. Their Better coefficients were 0.76, 0.72, and 0.68, respectively, and they were identified as key improvement priorities in the Kano-SERVQUAL matrix and KSSPM. Oncology patients showed higher Better coefficients for these priority items (P<0.05).
CONCLUSION: Outpatient nursing care does not fully meet expectations. Continuous follow-up, personalized guidance, and psychological support are key priorities for improvement. The integrated SERVQUAL-Kano model may support resource allocation and refined nursing management.
METHODS: A cross-sectional survey was conducted among chronic disease outpatients in a tertiary hospital. A modified Kano-SERVQUAL questionnaire was used to assess nursing service expectations, perceptions, and requirement attributes. SERVQUAL Gap scores, Kano classifications, Better and Worse coefficients, and the comprehensive improvement index (CII) were calculated. A Kano-SERVQUAL priority matrix and Kano-SERVQUAL Sensitivity Prioritization Model (KSSPM) were constructed, and subgroup analysis by specialty was performed.
RESULTS: A total of 490 patients were included. Perception scores were lower than expectations in all SERVQUAL dimensions. Gap scores for tangibles, responsiveness, and empathy were significantly smaller in special outpatient clinics than in general outpatient clinics (P<0.05). Nursing safety assurance, information communication clarity, and privacy protection were classified as must-be requirements, whereas continuous follow-up, personalized health guidance, and psychological support were attractive requirements. Their Better coefficients were 0.76, 0.72, and 0.68, respectively, and they were identified as key improvement priorities in the Kano-SERVQUAL matrix and KSSPM. Oncology patients showed higher Better coefficients for these priority items (P<0.05).
CONCLUSION: Outpatient nursing care does not fully meet expectations. Continuous follow-up, personalized guidance, and psychological support are key priorities for improvement. The integrated SERVQUAL-Kano model may support resource allocation and refined nursing management.