Journal of health research in community

Introduction
Patient satisfaction serves as a crucial indicator for evaluating the quality of healthcare services and reflects the extent to which services meet the expectations and needs of participants. In low- and middle-income countries, a considerable proportion of preventable mortality is attributed to poor-quality healthcare services. Rural and border areas face additional challenges, such as limited human resources, inadequate infrastructure, and geographical barriers, all of which can adversely impact the accessibility and quality of healthcare services. 
In Iran, rural comprehensive health centers play a crucial role in delivering primary healthcare. Although efforts have been made to strengthen these services, evaluating their effectiveness requires not only objective performance indicators but also an assessment of clients’ experiences and satisfaction. Previous studies using the SERVQUAL model have often reported gaps in service quality, particularly in underserved areas. 
Given the specific socio-demographic and structural conditions of border regions, the present study aimed to assess the level of client satisfaction with services provided in rural comprehensive health centers in Abadan and Khorramshahr counties and to identify associated demographic factors. 

Methods
This cross-sectional descriptive–analytical study was conducted in 2024 among 120 participants attending rural comprehensive health centers in Abadan and Khorramshahr counties. Participants aged 15 years and older were included using convenience sampling. 
Data were collected using the standardized SERVQUAL questionnaire, which evaluates service quality across five dimensions: tangibles, reliability, responsiveness, assurance, and empathy, using a 5-point Likert scale. Higher scores indicate better perceived service quality. 
Satisfaction was categorized as a binary variable, where mean scores of 4 or above were considered “satisfied” and scores below 4 were deemed “not satisfied.” Descriptive statistics were used to summarize participants’ characteristics and satisfaction levels. Cochran’s Q test was applied to compare satisfaction across the SERVQUAL dimensions. 
To identify factors associated with overall satisfaction, multiple logistic regression analysis was performed, and the results were reported as odds ratios (OR) with 95% confidence intervals. Data analysis was conducted using SPSS version 27, R software, and Microsoft Excel at a significance level of 0.05. 

Results
A total of 120 participants were included in the study, with the majority being female (55%) and under 30 years of age (64.2%). Overall, 79.2% of participants were classified as satisfied, achieving a mean satisfaction score of 4.3 out of 5, indicating an acceptable level of satisfaction.
Among the SERVQUAL dimensions, the highest satisfaction was observed in the reliability domain, while the lowest score was related to the tangibles dimension. However, no statistically significant differences were found between the five dimensions (P=0.34), indicating relatively consistent perceptions of service quality across all dimensions.
Logistic regression analysis showed that several demographic factors were significantly associated with satisfaction. Residents of Khorramshahr exhibited higher odds of satisfaction compared to those residing in Abadan (OR=3.92; 95% CI: 1.36–11.30). Participants under 30 years of age were more likely to be satisfied than individuals over 50 years old (OR=6.70; 95% CI: 1.64–27.35). 
In addition, individuals with education levels ranging from guidance school to diploma had higher satisfaction compared to those with university education (OR = 6.19; 95% CI: 2.04–18.77). Participants with lower income levels also expressed greater satisfaction in comparison to those in higher income brackets. 

Conclusion
This study demonstrated that the overall level of client satisfaction with rural comprehensive health services in southwest border areas of Iran is acceptable. However, notable disparities were observed among different demographic groups. 
The higher satisfaction levels found among younger, less-educated, and lower-income participants might stem from variations in their expectations and perceptions of service quality. The comparatively lower score in the “tangibles” dimension underscores the necessity for enhancing the physical infrastructure and facilities within rural health centers.
To improve service quality and client satisfaction, policymakers should adopt equity-oriented approaches, paying particular attention to groups with lower satisfaction levels, such as older adults and individuals with higher education. Strengthening healthcare infrastructure and improving communication skills of healthcare providers are essential strategies for boosting patient satisfaction and the overall quality of services.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Abadan University of Medical Sciences (IR.ABADANUMS.REC.1402.083).  

Funding
This research was supported by Abadan University of Medical Sciences.

Authors contributions
Study design, supervision, and data analysis: Bagher Pahlavanzadeh; Data collection and manuscript preparation: Zahra Khasraji Asl, Zahra Shojaei, Anahita Norouz Hoveidi; Review and editing: Bagher Pahlavanzadeh.

Conflicts of interest
The authors declared no conflicts of interest.

Acknowledgments
The authors extend their sincere gratitude to all participants who contributed their time and cooperation to this study. 
 

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