Psychometric Properties Assessment and Determinants of the Health Services OutPatient Experience (HSOPE) Among Chinese Outpatients: A Cross-Sectional Study

Wenli Chen,1,* Lan Zhou,2,* Qiuxuan Zeng,1,* Qin Luo,3 Weixia Liao,3 Daniel Yee Tak Fong,4 Junxin Li,5 Zeng Jie Ye,6 Anliu Nie,7 Yaqin Li,8 Zhiting Guo,9 Jiaying Li10 1Guangzhou Institute of Respiratory Health, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China; 2Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China; 3Outpatient Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China; 4School of Nursing, University of Hong Kong, Hong Kong SAR, People’s Republic of China; 5School of Nursing, Johns Hopkins University, Baltimore, MD, USA; 6School of Nursing, Guangzhou Medical University, Guangzhou, People’s Republic of China; 7Emergency Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China; 8School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, People’s Republic of China; 9Nursing Department, The Second Affiliated Hospital Zhejiang University School of Medicine, Zhejiang, People’s Republic of China; 10The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jiaying Li, The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People’s Republic of China, Email [email protected]: Dissatisfaction with outpatient experiences can cause patient disengagement, reduced adherence, and poorer outcomes. Due to the absence of an appropriate outpatient experience assessment tool in China, our study aims to translate the Health Services Outpatient Experience (HSOPE) scale into the Chinese context, evaluate its psychometric properties, and identify factors (eg, patient characteristics, interpersonal dynamics, and clinical specifics) that determine patient satisfaction and healthcare quality among Chinese outpatients.Patients and Methods: Our study consisted of two phases: translation of the HSOPE scale and psychometric validation and analysis. The scale was translated into Chinese using both forward and backward translation methods. A cross-sectional study was then conducted among outpatients from a general hospital in China from October 2023 to April 2024. We collected data from 556 participants, and the total sample was randomly split for validation: one subset for exploratory factor analysis (EFA) and another for confirmatory factor analysis (CFA). We assessed the scale’s reliability and validity through measures of internal consistency, item analysis, EFA, and CFA, and used linear regression to identify determinants of outpatient experiences.Results: The 10-item Chinese HSOPE scale demonstrated high reliability (Cronbach’s alpha: 0.93; Guttman split-half: 0.92) in the full sample (n = 556). EFA (n = 385) extracted one factor, explaining 56.01% of the variance, and CFA (n = 171) confirmed a good model fit (χ²/df = 1.69, RMSEA = 0.06). Older age and being single were associated with positive experiences. Negative experiences were linked to visiting gynecology/obstetrics or pediatrics, poor doctor communication, lack of pre-test information, inadequate medication instructions, perceived privacy violations, insufficient doctor thoroughness, and long wait times (1– 2 hours or > 2 hours) (all P < 0.05).Conclusion: The 10-item Chinese HSOPE scale is a reliable and valid tool for assessing outpatient experiences in China. The identified factors, such as communication, privacy protection, and wait times, can guide targeted improvements to enhance patient satisfaction and healthcare outcomes.Keywords: psychometrics, reproducibility of results, patient satisfaction, ambulatory care, validation study, outpatient experiences, associated factors